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?

[Loosehead]

It's also complete Boll(*^cks to use the BMI. It's body composition that's important. Using the BMI most of the England Rugby team are clinically obese, clearly cobblers. I can see their argument but please base it on something meaningful.

[Drusilla]

Another ABer gave me the following info to help you work out your own BMI.

BMI Calculation:
Your weight in pounds x 703
Divide ans. by your height in inches
Divide ans. by height in inches again

Ans =BMI

BMI:
Below 18.5 = underweight
18.5 - 24.9 = healthy
25.0 - 29.9 = overweight
30.0 - 39.9 = obese
Over 40 = morbidly obese

Hope this helps!

[Drusilla]

I can see your point Loosehead. The administrators encircling the medical profession are notorious for picking up on something like this and then basing health care policy around it, but I think many people accept there has to be a cut off line somewhere, but where is that line and on what should it be based?

[youngmafbog]

Simple, ask tubbies to loose it if they refuse and keep eating all the pies then no more treatment.
Same goes for smokers,heavy boozers and drug abusers

[Loosehead]

Just base it on Fat % not weight which is irrelevant. There is a recommended range for men and women, it's possible to be overweight with little fat and underweight with lot's of fat. BMI has no relevance.

[andy hughes]

Assuming that the decision is based on sound medical reasons - is the body weight able to be supported by the new joint - or similar, then this is not 'discrimination' in the accepted sense.

As a 'fatist' society, this will strike a chord with the media who will always nudge opinion towards the equation of excess body weight with excessive eating combined with general lack of slef respect.

Without knowing the actual reasoning behind the PCT's decisions, it's not really possible to give a balanced view.

[Drusilla]

The PCT have admitted to 'pressing financial concerns', andy, so I'm guessing they chose BMI as a measure because it's flavour of the month when dealing with weight issues.

[Hermia]

The problem with excluding people is where do you draw the line? I mean, how many people do you know who don't have any vices at all and are 100% fit/healthy and totally responsible people? I've got a slim friend who has just been diagnosed with nutritional deficiencies because she doesn't eat enough. Should she be excluded if she develops an illness because of this? As a vegetarian, should I be excluded if I develop anaemia?

The problem with excluding people is that the NHS do not give much help to people dealing with their 'vices'. A lot of people do need lots of help to conquer overeating or to give up smoking. It seems a bit mean to deny them help and then punish them! I had a weight problem in my early twenties which was a result of an undiagnosed thyroid disorder and a food allergy. I asked if I could see a nutritionist because (i) I has never been overweight before and therefore didn't know much about diets and (ii) the food allergy meant foods had to be excluded and I needed advice on where else I could get my nutritients from. The doctor basically laughed at me and said there was no chance of getting an appointment.

[Oneeyedvic]

Tricky one - especially since I live in the next county and am obese (used to play rugby - does that count in my favour? ;-))

Does seem a bit paradoxical though:

Doctor - sorry you are too fat - you can't have a new hip until you lose weight.

Patient - Okay, how do I lose weight?

Doctor - I recommend exercise ;-)

Would be facinated to know if someone stops exercising as they have hurt their hip/knee and then pile on the poiunds, will they then get refused?

What about if you crash diet for two months, get an appointment, but then put the weight back on before the operation?

Does seem a shame that the NHS can't cope - this really shouldn't be an either/or question.

[Drusilla]

Good points Hermia, so would you suggest far more emphasis be placed upon prevention, rather than on cures. I agree with that, but I can almost hear the tapping of 'nanny state' on some keyboards and 'is this what my taxes go to?' on others.

[mimififi]

There are other factors also to bear in mind. Clinically obese people are far more at risk when under general Anasthetic from heart failure etc and other complications. It would perhaps not be safe for them to have surgury until they have lost weight.

I know someone who went to have some teeth out under GA, but when she got there, during her pre-op, they said that she was far to overweight to be able to have a GA (she is very overweight). It would be too risky for her. If she still wanted the teeth out, they would have to do it under local, one at a time, or she could lose weight and come back in 6-8 months time. She decided not to bother, rather than trying to lose weight. What can you say???

[andy hughes]

I have heard more information since my original post - it seems that the decision was 'stimulated' (what a fabulous bureaucratic use of language!) by financial constraints, so, to ammend my previous conclusion - this is discrimination, and it's not bloomin' well on!

[Oneeyedvic]

Another thought - what about poeple who have been prescribed steroids. These people often balloon in weight. Shudl tehy be excluded to?

[sandbach99]

My Doctors practice recommends that yuou do not diet to what the BMI says you should be as they believe it is too thin!
I wonder, as this is a financial matter, if their waiting lists are too long and they are having to send patients to private hospials etc for treatment, by jumping on the obesity bandwagon it is giving them the excuse not to run up the bill for private treatment, and keep within government targets thus gaining brownie points,
As said previously, the unfortunate cause of the obesity lies not at the patient overeating but in the treatment they have received ie steroids, and in the fact that these painful conditions have curtailed the lifestyle of the patients by preventing them being as mobile as they were. I beleive that these operations can if necessary be done by epidural type anesthetic therefore reducing the risk.
This decision has been taken by mis-informed, overpaid beaurocrats the sort of penpushers that the hospitals can do without and their salaries being put to better use ie equipment, drugs, nurses,cleaners and doctors etc.

[woofgang]

so...no nhs treatment for sports injuries? No fertility treatment? No complications of childbirth treatment? No caesarean sections of course..No treatment for children where the parents were aware of the disability condition before birth/conception? (spina bifida, down's syndrome)...certainly no treatment for those nasty people who fall off motorbikes. No transplants for alcoholics shall I go on??

[woofgang]

PS if I am going to be refused treatment for certain conditions on no good clinical basis then I want a refund of my national insurance and I will use it to purchase private medical insurance where I can get a joint replacement should I need one.

I actually can't see their argument!!

[mimififi]

I'm sure that each case will be looked at carefully on it's own merits, and the reason and the amount of obesity will be taken into account. I'm not sure that it is saying that it would refer to all treatment for all things if you are overweight, but surely, if a patient is clinically obese, and they are wanting hip/knee replacements, then the weight loss has to be a requiste to the treatment, not least of all because of the G/A issues, but also because of the physio and the activity required for recovery after the ops. Also, the chances of the replacement failing because of the excess weight it will have to endure is quite high. Maybe its become a financial consideration because in these patients, the replacement has to be re-replaced again and again because of the wear and tear caused by the weight. maybe they are trying to encourage patients to tackle the cause of the problem so they can avoid further damage to the joints and clog up the waiting list for people who need the same thing who haven't just wrecked a joint because they didn't want to change their eating habbits. It sounds harsh, but I can see both sides.

I'm sure if someone was obese for medical reasons, then their situation would betaken into account. I don't think it would mean that you would get turned down before the consultant's even seen you, based purely on you BMI report.

I do however, agree that BMI is not always a reliable indicator, but then again, we are not all rugby players either.

[woofgang]

mimififi you haven't answered my point about other forms of choice induced damage??

Each person must be assessed individually for their ability to withstand anaesthetic, heal afterwards and for the predicted patency (durability) of the replacement. Actually someone who is less active is likely to get better wear out of a joint because they won't wear it out and if they could walk beforehand, they will certainly be able to walk afterwards, dealing with the rehab of people with replacement hips and knees has been part of my job for the last 15 plus years.

this, if true is prejudice and prejudice against people who are unable to afford to purchase a new joint privately, if its being used to hightlight a financial problem then why not say people with a low BMI who have poor muscle tone and bulk and thus more likely to dislocate (clincal fact)

(stomps off muttering)

[johnlambert]

The simple answer Druslla is that when you undergo major surgery your heart is put under enormous pressure. When you are already obese, your heart is working much harder than it should, therfor, under anaesthetic your poor old ticker is very very prone to stopping, full stop.

It's a question of keeping you alive as opposed to discrimination

I spent 22 years as an Army Medic so I know a wee bit about the subject

Regards

[Ward-Minter]

i suppose maybe its the kick up the back side they need. Apart from some conditions there is no need to be overweight.

Harsh but true. Simple fact if you eat to much and/or don't do enough excersise you will be fat.

I imagine there is a model or care in the agenda which I have to say I am in favour of.

Further my BUPA costs me the price of about two decent takeaways a month. A point worth considering. BUPA treat fatties no problems.