Obese people to be refused surgery

[ReallyReallyNearly]

Isn't this just another form of discrimination, www.bbc.co.uk/news/uk-england-york-north-yorkshire-37265752
Argument seems to be on financial reason rather than health, do we stop nhs services for people who smoke, or those who drink too much etc. Where does one draw a line?!

[HelenaDove]

"" Resent my taxes going to surgery for someone who was obese when it could go elsewhere""




So you even resent them after they have lost the weight Preying. Should i have been left to suffer the excrutiating pain of gallstones after i had gone to the herculean effort that i did to lose 10 stone?

[Preyingmantis]

I guess that should say 'was' Helena. good on you losing that weight.

[Preyingmantis]

'is' even!?

[HelenaDove]

Ah so it was a typo.

[whattheseithakasmean]

If you were told that you need an operation and your risk of serious complications was 50%, but there was a drug that could halve that risk, you would expect to be given that drug, wouldn't you?

This is the crux, for me. Doctors prescribe the one thing that could make the biggest difference to health and well being - lose weight. But is takes an effort and no one can do it for you, so people bitterly resent being told the truth. Any treatment will be more effective if you lose weight, so lose weight first. It is a clinical judgement as much as a financial one. Prioritise resource where it will have the the greatest long term benefit - which is for those who are prepared to make some personal effort for the sake of their health.

[Xenophile]

This is interesting to me, because my weight gain was caused by medical negligence. It was physically impossible for me to lose weight until really recently, I was eating fewer calories per day than I needed and even so, I was putting weight on. I have not changed anything and am now slowly losing weight.

I would be refused an elective operation until I lost a lot of weight. By the same medics who caused the problem with me gaining weight in the first place.

And yes, I am very aware that, thank the goddess, I am an extreme rarity, the kind of mistakes that were made with my care are very very rare indeed, the fact that I was nearly killed through a doctor's negligence however, shouldn't be taken into account, unless this really is about separating virtuous fatties from "self-inflicted" fatties.

[lougle]

Xenophile, I'm really sorry you got poor care and I hope you are now receiving good care. I agree with you, though, that the reason for your weight gain shouldn't be a deciding factor of whether you get surgery with or without weightloss. It should be as simple as a risk/benefit assessment of surgery now vs. surgery after X kg weightloss, with considerations of what the risk/benefit is if that weightloss is achieved in X months, y months or z months (ie. Factoring in disease progression, age, etc).

[HeyOverHere]

then how would you suggest the NHS decides how to allocate treatment given that it is not possible to treat everyone who needs treatment
what criteria do you think should be used?

I admit I don't have an answer for that, but dehumanizing people is not the way to do it.

[0pti0na1]

given that it is not possible to treat everyone who needs treatment
what criteria do you think should be used?

Well for a start, don't pick on obese people just because their food addiction is easy to see and less socially acceptable than other ways in which people are unhealthy (not exercising, not having a balanced diet, drinking alcohol, smoking, being under too much stress etc).

Also 1 in 4 people will have a mental health problem which you can't see, and in some cases where people aren't diagnosed or fully well from their NHS treatment, food may become a problem in anyone susceptible.

I don't have an answer for that, but dehumanizing people is not the way to do it.

I completely agree Hey. The person who "deserves" to receive treatment is any human being. Perhaps the judgier the person, the further to the back of the queue they should go...!

[captainproton]

I got to say having spent a fair amount of time in various hospitals I find such a scheme very sadistic.

A lot of HCP are obese, the hospital food is crap. The canteen food is barely nutritious, there are Costas and LOF shops peddling sugary drinks and chocolate etc at most main entrances.

Sugar addiction causes obesity, lecturing patients about eating healthy and then actually promoting the opposite lifestyle at the same time is twisted.

You wouldn't expect smoking rooms in hospitals so why the easy access to the junk?

[HicDraconis]

I agree in principle with some elective procedures being postponed to ensure the best outcome for the patient.

Certainly obesity is one area where there are worse outcomes (depending on the type of surgery) but my understanding is that this relates to patients with a BMI in the morbidly obese category. From discussing with the orthopaedic surgeons here, there is no evidence to show worse outcomes following joint replacement surgery in those patients who have a BMI of 25-35 compared with those patients who have a BMI under 25.

There is, however, pretty good evidence to suggest that obesity has no effect on outcomes following major cancer surgery, but that those who were underweight had 5 times the mortality. Article here

This is quite a nice meta-analysis demonstrating no effect on ICU outcomes for obese patients but possibly a lower hospital mortality.

And this one shows no association between higher BMI and outcomes.

Orthopaedic study showing that obesity is linked to longer operation times, but has no significant influence on perioperative morbidity.

Patients with a BMI of 25-30 are no more challenging, anaesthetically, than those with a BMI of 20-25. 30-35 can be more interesting but generally aren't. Once you get over 35 then things can be technically more difficult in terms of siting lines and breathing tubes, or putting in regional blocks. There's a higher failure rate for regional blocks if you're obese, making it more likely that you'll have to have a general anaesthetic.

Why I don't like this particular decision is that it's dressed up as outcome-driven when in reality it's probably cost driven. I don't see why waiting a year for elective surgery if your BMI is 32 is going to make any difference to your outcome, except for the fact that your pain is going to be the same or worse for the year, your mobility is going to be less for the year and your ability to work is going to be severely impacted. I don't think it's going to act as the carrot to make people lose weight because if it were that simple we wouldn't have an obesity problem.

I am also concerned about which operations are being delayed. Elective joint replacement is one thing, but there are other elective procedures which can present as emergencies if left untreated (hernias being a case in point) - and if it's too risky to operate electively, the risk isn't going to go down when they pitch up in ED needing an emergency repair.

[IceBeing]

mistressCeeDee WTAF are you ranting about?

I am not seeing all black people as fat because I am racist - which has to be the most ridiculous thing I have ever been accused of on MN and that is saying something.

I live in the whitest area of the country and see exactly 3 black people on a regular basis all of which appear to be solidly in the normal BMI range.

I was talking about the actual scientific grounds for not using blanket BMI based rules across ethnic populations for whom different BMI values represent different likelihood of adverse clinical outcomes.

My point was that not only is a blanket BMI rule discriminatory in general, it is also racist - and therefore should not be done.

Some of these points as summarized from an NHS policy paper on the topic:

Key points
• Obesity prevalence varies substantially between ethnic groups for both
adults and children in the UK
o Estimates of adult obesity prevalence by ethnic group seem to differ
according to the measurement used (for example, BMI, waist-to-hip
ratio and waist circumference):
Black African women have the highest obesity prevalence when using waist circumference as a measure, and Bangladeshi women when using waist-to-hip ratio; and Chinese men and women appear to have the lowest
obesity prevalence whichever measure is used
• There is continuing debate about the applicability of definitions of obesity across ethnic groups for adults and children
• Different ethnic groups have different physiological responses to fat
storage
• Data from the National Child Measurement Programme (NCMP) show that obesity appears to be increasing for Bangladeshi boys
• Revised BMI thresholds have been recommended for the South Asian
population who are at risk of chronic diseases and mortality at lower BMI
levels than the European population

[TaraCarter]

Tara i think there is something very sinister behind it. As i mentioned upthread someone in RL who felt the need to criticize my loose skin on my tummy is actually 5 stone heavier than me.

I cant help noticing the correlation here. A lot of the criticism is coming from people who are overweight themselves.

Speaking for myself, I only noticed other women's bodyshapes once I became engaged with changing my own. I think sustaining interest in spotting other people's flaws is the consequence of having a certain level of dissatisfaction with one's own and turning it outwards.

[Highlandfling80]

*hic My hernia surgery was delayed due to a BMI of 35. During the period of waiting I spent a morning in A and E with excruciating pain with suspected strangulation. My BMi was 33 at that point. Fortunately it was fine as emergency surgery would have been riskier. Finally had op with BMI 31 with no complications. Consultant blamed my weight for hernia completely despite me having plenty of other risk factors.
Yet despite asking for help with weight loss z was told I didn't qualify.

[Highlandfling80]

Good luck preying

[HelenaDove]

YY Tara. Youve put it better than i did.

[Doggity]

Hic Interesting that you say overweight and even slightly obese people do not pose a risk. A poster in my GP surgery says that if your BMI is 30+, then your risk of getting ill during and post-op is higher and therefore, they may decline elective surgery.

[Sunshineonacloudyday]

My BMI is over 30 I am trying to lose weight. I have never been this heavy for so long before. After my first 3 kids I was consistently 12 stone after having my 4th I'm 14 something stone. I broke my scales. Before kids I was a size 8 and 8 stone I was underweight back then. My ideal weight is 10 stone and I am going to accomplish that.

[Sunshineonacloudyday]

I will be getting myself sterilised will my weight get in the way.

[HelenaDove]

Sunshine do it slowly DONT rush it. Try to avoid getting gallstones because its very VERY painful and you will end up on a waiting list for God knows how long.

[CauliflowerBalti]

I think it's fair enough as long as all 'self-inflicted' injuries are also excluded.

If a car spooks your horse and you're thrown and smash your hip, an investigation will be launched to see who was at fault. If you were wearing the correct hi-vis vest and the horse was wearing a tailband, then yes, we will pay for your surgery, for it was not your fault, assuming of course that the journey you were making on said horse was essential and couldn't have been carried out cross-country. If it is found that an alternative route avoiding traffic would have avoided the accident, or that you were travelling on the road because it was more convenient, then I'm afraid the incident is your fault. A poor life choice. The taxpayer shouldn't have to fund your faulty decision-making and laziness, and you will pay the bill.

I believe the biggest burden on the NHS is old age. That is clearly self-inflicted. If you haven't had the decency to top yourself by age 85/the day you can't walk up stairs on your own any more, whichever comes first, no further treatment will be available to you on the NHS.

Ooh. I just googled. The biggest NHS drain is actually mental health. Now then. It is clearly your own fault if you can't stay on top of your own mind. Anyone not engaged in mindfulness, meditation, weekly visits to a counsellor - no funding for you! Anyone taking mind-altering drugs, including but not limited to coffee, caffeinated soft drinks, alcohol, cannabis - nope, you're out. Those undertaking stressful jobs - you had a choice! No-one made you be a paramedic! No funding for you. If there is a family history of mental illness and you knowingly have children in spite of this, those children will not qualify for mental health services. First sign of dementia and your Living Will doesn't have a Dignitas clause? Shame...

I'd make a bloody AWESOME Tory.

[SoupDragon]

If a car spooks your horse and you're thrown and smash your hip, an investigation will be launched to see who was at fault. If you were wearing the correct hi-vis vest and the horse was wearing a tailband, then yes, we will pay for your surgery...

You do realise that it is only elective surgery and not like the scenario you have described don't you?

[MylaMimi]

Cauliflower you are getting mixed up with emergency and elective surgery. There is no suggestion obese people would be refused emergency and/or life saving surgery (such as in the scenario you describe).

[0pti0na1]

Very good points Cauliflower, elective surgery or not.

[Janetizzy30]

My mother has glandular problems, eats Healthily exercises daily (aerobics, biking, walking swimming) and is not quite 60 yet is obese in bmi terms. She is not obese by her own doing. It is the glandular issues and medication she is on that has risen her weight. Is it fair she would have to suffer through this ridiculous rule?