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?!

[Lasaraleen]

Also, of course, this would disproportionately affect people from poor, deprived areas, which seems intrinsically unfair. Surely these are the very people that a free at the point of use healthcare system should be helping the most.

[HermioneWeasley]

I can't see the problem with it - obesity brings greater surgery risks and makes some operations (like hip and knee replacements) fairly pointless.

The vast majority of obesity is preventable. If needing surgery and not being able to have it because of the clinical implications isn't enough of a wake up call to change your habits, then the operation isn't money well spent when funds are limited.

I'm fairly chunky, BTW, so this isn't a smug post. But it's nobody's fault but my own that when I bend over, my arse could block out the sun.

[HyacinthFuckit]

Yes however you slice this, clearly some potentially self inflicted risky behaviours are more blameworthy than others. Smoking and obesity bad, alcohol, drugs and contact sports good. You can't have an elective procedure if you've a BMI of 30.3, but you can take a shedload of pills every weekend or get smacked about in a boxing ring on a daily basis and that's fine and dandy.

I'm also wondering about the racial implications here. We know that some ethnic groups are more prone to obesity than others, and while that can be partially due to dietary and lifestyle factors, it's also true that BMI doesn't apply in the same way to eg the average Samoan and the average Japanese. I would have something to say about this if I came from an ethnic group tending to be larger set.

[maddiemookins16mum]

Do we then draw the line at maternity care for say, Mrs Radford, as she chooses to have huge (ridiculous) numbers of children. Everyone, regardless of weight, lifestyle etc deserves to be treated equally in my view. What next, refusing to treat a 17 year old lad injured in a car because he was showing off?

[AnotherOneBitesTheDust9]

Almost half of England has these type of restrictions in place. Local to me if you smoke or have a BMI over 40 you don't get surgery. They do, however, help you quit smoking and put you on a weight loss programme to help you become fit for surgery.

Bottom line is the NHS cannot pay for everything and if you are obese or smoke you have much worse health outcomes post surgery than those who do not, it is effectively better to spend cash on people when they've lost weight and or quit smoking because their health will improve in other ways and you are much less likely to pay for repeat procedures.

I work in finance in the NHS, none of this is new stuff. There have been many public consultations about it.

[BabyGanoush]

But it is not to punish fat people.

It is because often these type of operations (hips, knees) are pointless if you are obese.

[EstellaHavisham]

I had a friend who was having lung surgery and chain smoked. He was told to stop smoking (obviously) as his lung was collapsing. He didn't. He had the surgery after lying about stopping. He was one of those you see outside the hospital doors in pyjamas on a drip with a fag in his mouth...
I was livid with him because if the NHS has a duty of care to operate on him, why the fuck doesn't he have a duty of care to himself to do what he can to look after his health too?
My MIL had lung cancer (doesn't smoke, never has) and the woman in the bed opposite also had it and regularly popped outside with her daughter and husband for a fag.
If you want all the stretched resources that the NHS has to make you better and patch you up, doesn't it make sense to do whatever is within your fighting power to make yourself better too?

[BabyGanoush]

Maddie, where would themoney come from? Would you be happy to fund these people by paying twice the tax you are paying now?

People don't treat the nhs with respect because it is free.

Masses of people don't even bother to show up for their GP appointments, wasting nhs money with no consequence to themselves.

The nhs needs radical reform, partly because us, the public, are taking the piss.

[TikTakTok]

I'm so glad I don't have to make these kinds of decisions. I'd want to look at everyone on a case by case basis and I bet I'd want to give everyone the OP they need.
The BBC article doesn't give all the facts - I imagine that there is a LOT more to it than 'fat people banned from having operations'
My FIL died of obesity so I think I've some understanding of how impossible it is to get someone to loose weight if they don't want to. We literally tried everything but nothing worked. We watched him eat himself into a very early grave.
I don't know the answer but I think everyone has a responsibility to look after their own health and that means loosing weight if they are obese. No one is saying it's easy.
I remember the effect of being overweight from pregnancy and the effect it had on my joints and general energy levels. I felt awful.

[HermioneWeasley]

Agree with baby - it's about the clinical implications (risk of the surgery and likelihood of beneficial outcome). If someone obese needed emergency surgery, they would get it, the same at your hypothetical Mrs Radford would be given NHS services during her pregnancy and birth. But she would not be given IVF on the NHS - that's the difference.

[Lelloteddy]

I think that's one of the key points that people don't want to acknowledge.
The clinical outcomes and evidence are there. This data is the sort of stuff that managers spend their time collecting and analysing. Elective knee and hip replacement surgery in obese patients have 'poor' outcomes in terms of success, complications and long term benefit to the patient.
An emergency operation to save the life of an otherwise fit and healthy 20 year old who crashed his car has a much greater chance of success.
Resources HAVE to be allocated depending on potential outcomes surely?

[PitchFork]

For many many, it's due to medication (myself included, as I am on 3 different medications, all listing weight gain as a side effect).

but then you surely adjust diet and exercise to combat weight gain? it's too easy to say 'I'm fat because of medication'

[Witchend]

When I saw the headline I thought initially how terrible.

But actually reading the article it made much more sense.
Other than the greater risk in an anaesthetic for obese people, it also looked like the operations mentioned are the ones that being obese reduces down the chance of success considerably. (hip/knee operations etc)
It also said that cases would be considered depending on each person. It wasn't a blanket ban. So the muscular sporty man who bmi is over 30 because he's muscular wouldn't be discounted, and nor would the person who's overweight because of medication.

[gingerboy1912]

I think it's unfair. I'm overweight I'm on two lots of medication have been for ten years and they are dreadful for gaining weight. However I do my best to keep on top of it but I'm still classed as obese, but I work four days a week in an active busy job, run a home, raise a family as a lone parent, I don't smoke, don't drink. So yes I would be fucked right off if I couldn't get a knee replacement etc. Also I would most likely loose my job if I couldn't get surgery so how is that helpful to me or the rest of society.

[witsender]

Where do you draw the line? Someone injured doing an extreme sport? Driving too fast? Injured while breaking the law?

[Wolpertinger]

I agree that blaming fat people for being fat as if it was all to do with a lack of willpower and idleness on their part is completely counterproductive.

Most fat people (including me) are fat for a number of complex reasons which include several of childhood diet and upbringing, parental relationships with food, poor knowledge of nutrition, lifestyle that isn't conducive to regular cooking/meal planning, society changing what it accepts as fat, mental health, poor self esteem leading to binge eating or secret eating - and then once you are overweight the changes in metabolism kick in and you are stuck. And that's without including illnesses like PCOS making it harder to lose weight in the first place. In the very very obese the incidence of childhood sexual abuse is high.

And that's without including the role of food manufacturers selling us high fat, high sugar products at eveery opportunity. The vast quantity of stuff I can't eat for the rest of my life is staggering. It's all around us. No wonder diets don't work. So it largely isn't the fault of fat people eating too much and sitting on their arses that they are fat.

So very far from just a lack of willpower and unlikely to be solved by just 'eat less, do more'. Took me a fuckload of counselling and a healthscare to be prepared to even try which most of the population will never get - I'm bloody lucky.

[gingerboy1912]

Pitch the trouble with some the medication is that it slows your metabolism but increases your appetite and makes you feel so hungry and you crave carbs. So Yes people do try to adjust their calorie intake but after ten years (for me) the weight creeps on pound by pound. It is very hard.

[Lelloteddy]

Pitchfork that's also a valid argument.
Medications in themselves do not cause fat cells to multiply in your body. They may cause your appetite to soar, or your energy levels to drop but if you want to take responsibility for your health you then have to adjust your diet and exercise levels to manage the change.

[AnotherOneBitesTheDust9]

castlepointandrochfordccg.nhs.uk/about-us/key-documents/patient-engagement/2209-orthopaedics-consultation-document-2016/file

Example for you all. It is heavily driven by health outcomes. Not to penalise lifestyle choices.

[HyacinthFuckit]

Again, for those of you arguing this is about clinical outcomes, that's not the case if obese people are able to have those same surgeries but have to wait 12 months. Or have them after reducing body weight by 10% even if that still leaves them obese. Which is what the articles I've read are saying, although one wouldn't necessarily trust them to be accurate. It would be heartening if it is in fact to be a case by case decision, although one would hope that's what's happening now?

I also find it rather hard to believe a hip replacement is pointless for someone with a BMI of eg 30.4. I realise once you get to a certain weight that argument can be made, which may be why the trust mentioned upthread get their 40 restriction from, but if we're to believe that hip and knee replacements are pointless per se for everyone who's obese, that's going to need some serious receipts.

[SantasLittleMonkeyButler]

I also thought that this has been happening for ages already .

I clearly remember my DM needing to lose weight for an operation years ago (20+ years).

Personally, and as an "overweight" person myself (previously morbidly obese), I think if it's a non-urgent procedure where the increased risks of surgery on an obese patient actually outweigh the reduced probable benefit, then it's fair enough to say that it's really not worth operating until the patient has lost some weight.

It does require some common sense from HCPs too though & shouldn't be a strict "BMI 30 = no surgery". As others have said, a BMI of 30 on some people is a perfectly healthy weight.

[lazyarse123]

Where does it end? Do we stop mountain rescue or the RNLI from helping people who put themselves in harms way. Obese people need help not vilifying. If fat people (and I am allowed to say that as I am one) are going to be exempt from some operations will they get a refund from their taxes.

[2kids2dogsnosense]

Ratley et al Where then do you draw th line? Does someone who breaks their back conquering Mt Snowden have to pay for their treatment? Or someone who is injured when their speeding car crashes into a wall? Or a passenger in that car who did not try to get the driver to slow down, or got in knowing the driver had had over the limit?

Having worked in a hospital I know that one of the primary reasons formatting obese people lose weight prior to surgery is that being obese hugely increases the risks of heart attack, stroke or organ failure under anaesthetic, surgery takes much longer (and the longer ANYONE is under anaesthetic, the higher the risk of stroke etc) and that recovery is often slower,

[Lelloteddy]

What about fat people who don't pay taxes Lazyarse? Do they get a gift card from the NHS? The 'what ifs' and all the possible related scenarios are endless but as a society we have to take responsibility for our NHS. It's not just Jeremy Hunt who is bringing it to it's knees. These types of restrictions are already in place in many parts of the UK.

[2kids2dogsnosense]

*for making, not formatting.

This bliddy auto-offing-correct!