No Surgery For The Obese

[Drusilla]

Three Suffolk Primary Care Trusts are refusing to perform hip and knee replacement surgery on patients with a Body Mass Index (BMI) of over 30. (The average is between 18.5 and 24.9).
Do you see this as discrimination against the obese, or a prudent use of limited financial resources in our health care system?

[sandbach99]

I am fairly certain that if any person refused an operation on grounds of obesity said to the health authority "I am unable to stand the pain any more here is K�x when can you operate?" the health authority would find a bed very quickly!

It is odd that only obesity seems to be a reason to stop these operations yet someone who smokes or an alcoholic will be operated on.

These operations for an obese person would be life changing, they could exercise, maybe return to work, lose weight just by removing a need for steroids, this would also save the health authority money. Whereas the alcoholic would be unlikely to find work and along with a smoker or drug user would continue to require treatment

[mimififi]

Hey woofgang, I'm sorry I made you feel like stomping off, I didn't mean to offend you at all. :-(

I didn't answer the question about other treatments or 'self inflicted' conditions because the question only spoke about knee/hip replacements. I guess this is another one of those times when there are no easy answers. Maybe the Health Authroity are just trying to find a way to be able to prioritise patients so that they can treat the elderly and children and people who require joint replacements through no fault of their own (if obesity is a cause of the joint failure in the first place, I'm not an actual medical doctor, so I don't know all the medical facts here.) first.

But I do agree with Ward Minter (for once) that my BUPA covers me for nearly everything, and costs relatively little per month. I am also covered for well woman checks annually, I think, this includes not only mammograms, but also ovarian ultrascans. I'd rather have that for a couple of chineses a month, than the chineses. Especially if it helps my BMI.

But seriously, I do apologise for causing any offence, it wasn't my intention.

[woofgang]

mimififi I wasn't offended, and definitely not by you.I was just cross that yet again, NHS bean counters are not being honest about the fact that there are too many people needing a procedure and not enough budget.

As I said, there is no problem spending money on repairing (and re repairing) sports injuries or providing (multiple) joint replacements for "sporting" people, no problem with people having children when they know that they will eb born with disabilities, no problem with multiple childbirths for women who have problems every time, and in many areas, no problem with funding fertility treatment for healthy women who are unable to conceive or who are married to healthy men with low sperm counts.

I too have bupa and both my husband and I have used it (thankfully only for diagnostics) when the NHS would have made us wait. We pay for that out of money that it taxed, we pay tax on the payment, AND we continue to pay into the NHS and then some jumped up little bean counter decides that because someone like me doesn't fit his profile, that person will be denied a treatment.

There are good clinical reasons for refusing provide joint replacements. These are the same for all treatments viz, either the patient is put at too much risk by it, or it is unlikely to improve matters. One of these factors in joint replacement is around the density of the bone ie is the patient osteoporotic, now people with osteoporosis tend to be those who are underweight...no mention of low BMI as being a reason for refusal though.

I am me. I would rather look like Elle Macpherson but I don't. I live an active healthy life, have normal blood pressure, acceptable cholesterol, a strong healthy heart, yet because my BMI is over 30. I would be automatically excluded from surgery.

Sorry, I know that I am taking this personally but it stinks

[stevie21]

YES!!!!!!!!!!!!!!!!!!!!

Remember folks, discriminate, it's good for the economy.

woofgang, your taxing 3rd paragraph just above is very compelling and I have every sympathy for your argument but, in a nutshell, I think that people who make no effort to help themselves should not automatically get treatment if their lifestyle is going to render it useless, Mr Best.

BMI alone is (apparently) a rubbish measure but I'm sure this is just media spin and that docs would take everything possible into account.
It's a bit of a change of subject, but for a tranny to get an op on the NHS he/she has to live effectively as a member of the opposite sex for some time and demonstrate considerable distress at being the wrong gender before an op is offered.
Although not as extreme, I think seriously overweight people should show some commitment to improving their own health before they burden the NHS, as should all other people whose health is seriously bad and self inflicted.

I should be prime minister - I take back all my "Vic for PM" posts.

[ronniemonda8]

BMI has direct relevance. You're not talking about heart disease here. It's hip and knee. The chances of succesful recovery are far higher for the non-obese. They should be offered preferential access to such a limited resource.

[sandbach99]

What will happen if a patient refused an operation for being slightly over the desired weight goes to court under the human rights act, article 14 prohibition, of discrimination ?

[netibiza]

Well for what it is worth - this is what happens over here in Spain. If you need a replacement operation, then you have to loose weight (if you are obese of course). They won't touch you if nnot and we are talking Insalud here which is the Nat. Health,

[Oneeyedvic]

Oh stevie - you've upset me know!

But seriously, where does discrimination stop?

Should over 80s not get a hip/knee op - after all their chances of getting over major durgery is very small - as are the over 70s and over 60s.

Maybe we should only allow Blue eyed, blonde haired people in their mid 30s with an IQ of over 130 and the perfect weight, have no heridery compalints, who drink no more that 21 units a week, don't smoke and who are capable of having children to have free treatment.

After all, they would have the best chance of recovering - any other person would not have such a good chance and therefore treatment should be withheld.

Stevie21 for deputy PM (I will stand down after 2 terms - promise)

[woofgang]

sorry folks, but an important point is being missed here.

As I said earlier, people are already screened to ensure that they can stand the op and that it actually will do them good ie that the hip will be patent and durable after the op. keep in mind that even the best hip replacement will only last 8 to 15 years and very active people wear them out faster. Screening is done on a patient by patient basis and considers all factors that have an effect including low bmi, poor muscle tone and osteoporosis status.

By what I have read, this is a blanket ban based on only 1 criterion, there is no clinical justification for doing this.

Actually it won't affect people who can afford the approx 5k that a joint replacement costs and I think that sandbach99's point on offering the PCT the cash is very telling.

believe me this is a thin end of a long and divisive wedge. Where will you draw the line in future and who will land on the wrong side of it. Will it be you who damaged yourself playing sport? you who damaged yourself bearing children? You who damaged yourself gardening?

If find it a bit sad that there appears to be some tacit agreement on here that it might be okay, not on good clinical grounds but just because the person is fat. Or maybe I am misunderstanding some of the posters?

[devilbliss]

Reading some threads. Maybe we should nominate Harold Shipman for the Noble Prize. After all, look at the money he saved this country and the NHS. Was it not also stated they would not be operating on overweight children with glue ear. I really do hope that none of your family are ever turned away from an operation for what ever reason. Before anyone asks I'm 19.7 BMI

[woofgang]

cross post vic!

[woofgang]

and good morning to you devilbliss (great name btw)

[ronniemonda8]

It's not about saving money. These individual health outfits have a limited budget. When they use it all it is gone. You have enough money for say, 500 operations. That is it. Once you have done 500, you turn the next person away, fat or thin, man or woman.

3000 people come to you for this op. Some of them will be at risk of the operation as such (ie they could DIE) and even if they get the operation, the chances of the outcome still being negative is quite high.

The rest of the people (1000) are not obese, so do not present such a risk, and are far more likely to have a positive outcome (ie be up and walking in 4 years).

So is it better to turn down a slim, 26 year old man, and never let him walk again, so that you can fit a hip replacement to a very fat 80 year old who may die during the operation because of his weight and who is still 50/50 on being able to use the hip anyway?

So which would you do?

-No discrimination?

-Give it to the young one.

Remember........obesity is largely a choice. The weight don't get on there by itself. 'You are what you eat'......in this case a truckload of nachos.

[stevie21]

Vic, my argument hinged on "their health is bad and self inflicted" and thus with a change in lifestyle, their health could be improved even without the NHS.
NHS treatment could then improve it further once an op would be of more benefit to them but the argument I presented above wouldn't prevent an 80 year old getting an operation.
Another argument I'd present elsewhere would prevent this but not the one above ;-)

You imply that only the healthiest 90% of the population should get treatment when I'd say only the unhealthiest shouldn't : these 2 measures are miles apart. I was addressing the fact that the question said
"no surgery for the OBESE", not slightly out of shape

[Oneeyedvic]

So who should get treatment

1) An obese person who has been obese for the last 20 years.

2) Someone who has smoked for 20 years

3) Someone who has had more than 20 units a week for the last 20 years (which I believe a lot of ABers would fall into)

4) Someone who requires treatment from being in a car crash travelling at 45 mph in a 40mph limit

5) Someone who went played football on a saturday afternoon and got tackled badly.

In all the above cases, it is the individuals fault that they are in situation where they require hospital facilities.

Personally I think that if this is enforced, the hospital will be sued costing it several million more.

[stevie21]

Vic, you're intentionally misunderstanding me here! Anyone (including you) who has read my posts here will be clear that I would withold treatment from people who
1. Are not going to benefit most from the treatment due to their self inflicted ill health
AND
2. Are able to (and need to) improve their health by their own efforts before NHS treatment.

Now, with that in mind, please explain how this applies to a car crash or a sports injury.
Also, you've not made it clear what treatment they're seeking. If the smoker is after a lung transplant and plans to continue smoking then I'd refuse it. If he's in for a hernia operation then fine as that's unaffected by his smoking or not (as far as I can think, at least).

[woofgang]

but stevie, these people are going to benefit. Assuming that they can stand the op and are not an osteoporisis risk, they will be more mobile and they will be pain free. Their replacements are likely to last as long or longer than someone who is originally much fitter and then goes off and skis or plays rugby on it.

Now if their weight means that they have circulatory or pulmonary complications then obviously these need addressing before any op. BUT if the heart and lungs are fine and they are moderately active then they stand an excellent chance of benefitting from the op AND as I have said will probably get more years out of it than someone who is going to indulge in sports such as rugby, football, sking (is that spelt right?) where the risk of hitting the ground at speed is quite high. They are certainly a better risk both for the op and the post op healing than a skinny chain smoker, even if this person runs marathons(yes they do exist, I know one, he gives up when he goes into training, then starts up again harder than ever).

My point is that it is not clinically good sense to take one criterion for treatment and apply it blanket fashion over everyone.What that is is a rather nasty form of rationing and as I have pointed out, the thin end of the wedge

[stevie21]

I didn't say that no fatty would benefit - just that if they were so fat that they wouldn't see the full benefit of treatment without losing weight I'd withold treatment until they lost the weight.

Failing that, withold treatment just to punish them for being fat and encourage the population to be fit and lithe. Especially the women.

Discriminate! It's good for the economy.

(p.s. my first paragraph here was actually serious)

[Oneeyedvic]

Okay - hip replacements are often needed because a atient suffers from Osteoarthritis.

The causes of Osteoarthritis are as follows:

1. age


2. obesity


3. joint injury (or over use) - sports people are susceptible


4. family history

(source Bupa website: http://hcd2.bupa.co.uk/fact_sheets/html/osteoarthritis.html

So if you want to punish obese people, you should also punish people who play a lot of sports as this to is self inflicted. (As pointed out earlier, a sportsperson will actually get less benefit out of a hip replacement than an obese person.)

Also, what do you do if an obese person is old and has a family history - which is the defining reason for it?

[stevie21]

Let me get this straight - to counter my argument that :
"if they were so fat that they wouldn't see the full benefit of treatment without losing weight"

you seem to list people who would benefit from treatment without needing to lose weight?

We're having the same debate here?

To the sporty person, I'd make them agree to tone down the active (damaging) lifestyle. You feel better now? It's not just fatty-bashing : it's "you're not getting treatment if you're going to subsequently abuse it and render it useless"
Or "you're not getting treatment as you're in no fit condition to benefit from it - change your lifestyle first".

To others who would clearly benefit from treatment (including the smoker I mentioned earlier, the sportsperson and any other figments of your imagination you want me to address directly) - they can have treatment.