Obese people to be refused Surgery

ddraver

Just seen on the BBC London News that Hertfordshire ?PCT is going to refuse obese people routine surgery unless they start losing weight. (exact details not supplied obviously)

Now as a technically, BMI obese person (but who cycles, runs, swims regularly, is built like a Prop forward, and was one until recently) and who is struggling with a relatively major eating disorder this concerns me a little

But what i REALLY want to know is why people who Smoke, take Drugs, drink too much or otherwise are not being threatened with the same "punishment"???

Discuss...

t.m.h.n.e.t

Because of the vat and taxes they pay for their indulgences.

Although I don't think many cocaine dealers are vat registered

slowlanejane

It was smokers and obese people. I think a difficult and delicate one to implement but a move in the right direction - we can't continue eating / smoking ourselves to death, knowing it'll bring poor health and not in the 20, 30, 40 years preceeding ever actually get on top of it despite all the opportunities to do so that must have presented over the period, and then come to the NHS wanting a pill or proceedure to cure, without committing to the substantial lifestyle changes needed to improve health. All part of the live today & let someone ele pay tomorrow culture - it has to end.

I am also high BMI but I'm calm about this - I can demonstrate my healthy & active lifestyle.

ddraver

I swear the BBC did nt mention smokers....

But that is fairer....

OffTheBackAdam

Obesity is a consideration when surgery is being planned.
http://www.ncbi.nlm.nih.gov/pubmed/22224504
Risk factors for postoperative complications after fast-track abdominal hysterectomy
Substantial risk factors for postoperative complications were obesity (OR 8.83), prior laparotomy (OR 2.92) and relative increase in body weight on the first postoperative day (OR 1.52).

MattC59

I'm sure it's not quite as black and white as the thread title suggests. I haven't seen the news item mentioned, but I'd be amazed if the said refusals would include obesity if the toute cause is due to an eating disorder.

If someone has a medical condition which is the result of obesity, then perhaps they need something like this to make them realise that shoveling food down their gullet has consequences. It's not acceptable to do whatever you like and assume that everyone else will pay to sort you out.

If someone has a medical condition which is due to obesity, but that obesity is due to a recognised eating disorder, then that's a totally different situation.

Otherwise, good, there's only one reason for obesity.

ddraver

Well the BBC is a news outlet and therefore always vague on details, but that was the thrust of the idea. There was no discussion of who counts as obese (BMI? skin fold? body fat?), mitigating factors (ED's, psychological issues or whatever) or anything....

The surgeries were (I think) "minor routine" surgeries, and I'm not sure what they are either really....

MattC59

I guess it could also have something to do with potential risks or complications. Something that may only be a minor complication, carring small risks, could become a major complication carrying significant risks during the same surgery on an obese person. These increased complications and risks may outweigh (no pun intended) the benefits of the surgery.

McBain_v1

No doubt that there will be an element of this before long. If you've spent the last ten years trying to stretch your skin to is maximum extent and then suddenly wake up to the fact that having a reinforced bog isn't normal and being unable to wipe your own arse isn't either then there has to be an element of accountability. Certainly surgeons don't want to have to clamp back an acre of flab in order to do a minor procedure.

Mind you, what about those lasses who needlessly inflated their breasts with dodgy French imports? I guess they are now in a bit of a quandary.

ddraver

MattC59 wrote:

I guess it could also have something to do with potential risks or complications. Something that may only be a minor complication, carring small risks, could become a major complication carrying significant risks during the same surgery on an obese person. These increased complications and risks may outweigh (no pun intended) the benefits of the surgery.

That was part of it but they presented it as a weight loss scheme incentive scheme primarily....

MattC59

ddraver wrote:

MattC59 wrote:

I guess it could also have something to do with potential risks or complications. Something that may only be a minor complication, carring small risks, could become a major complication carrying significant risks during the same surgery on an obese person. These increased complications and risks may outweigh (no pun intended) the benefits of the surgery.

That was part of it but they presented it as a weight loss scheme incentive scheme primarily....

Well, again excluding eating disorders, then maybe it will be an incentive, nothing else seems to get through.

Crapaud

ddraver wrote:

... But what i REALLY want to know is why people who Smoke, take Drugs, drink too much or otherwise are not being threatened with the same "punishment"???

Discuss...

They have been in the past. It's one of these things that comes round regularly like not changing the clocks twice a year.

slowlanejane wrote:

It was smokers and obese people. I think a difficult and delicate one to implement but a move in the right direction - we can't continue eating / smoking ourselves to death, knowing it'll bring poor health and not in the 20, 30, 40 years preceeding ever actually get on top of it despite all the opportunities to do so that must have presented over the period, and then come to the NHS wanting a pill or proceedure to cure, without committing to the substantial lifestyle changes needed to improve health. All part of the live today & let someone ele pay tomorrow culture - it has to end.

I am also high BMI but I'm calm about this - I can demonstrate my healthy & active lifestyle.

Would it be fair to summerise this as "I'm all right, feck'em!"?

Remember that when you're mandated to wear a helmet, hi-viz and are forced to cycle on cyclepaths. After all, it's for your own good; cycling on the road's dangerous and reckless, everyone knows that.

ddraver wrote:

...
That was part of it but they presented it as a weight loss scheme incentive scheme primarily....

Whatever else it is, it's not an incentive, it's coercion; do what we say, or else...

capt_slog

This isn't a new idea. I recall a someone where I used to work (30 years ago) being told that they wouldn't be operated on until they had lost weight. There was no 'punishment' factor involved, it was just a medical necessity for the operation. The same has been said to transplant patients, basically "we won't give you the transplant if you won't demonstrate a lifestyle change" (livers for alcoholics springs to mind).

@ddraver I don't think you have anything to be concerned about. As you say you are 'technically BMI obese', so are a lot of fit people, and surely this would be recognised by your GP and whoever you are referred to at the hospital.

tarquin_foxglove

Going back through my team's return to work interviews (fascist hr) the reasons for missing work (except for "stomach ache & 'flu") that occur most frequently are some form of sports injury; broken bones, ruptured ligaments & tendons, concussion etc.

If we are losing all these 'man hours' just think of the cost to the NHS looking after these selfish buggers who, with no thought for anyone else, keep writing cheques their body can't cash.

Bought time the NHS withdrew treatment from active sports people until they take the safe option & just drive to Zumba classes...

verylonglegs

Obese people to be refused food would be a far more interesting headline ^^

rolf_f

McBain_v1 wrote:

Mind you, what about those lasses who needlessly inflated their breasts with dodgy French imports? I guess they are now in a bit of a quandary.

Simple - replace the French implants with the fat from the obese people; there'll be enough to supersize all the under-endowed with enough lard left over for a full set of J-Lo arses for all.

Tri-ing

Why shouldn't people be held responsible for their actions? Assuming the obesity is not due to a clinical condition (thyroid dysfunction for example), then it's a case of people shovelled food into their face and didn't do any exercise and watched themselves get fatter over a period of months...and months....and months.

In America, obesity has grown to be such a problem that, on current trends, by 2080 100% of GDP will be taken up by health care. Obviously that's impossible, but it shows the extent of the problem.

Everyone's happy to demand theirs when it comes to things like healthcare, but there's no acceptance that relatively simple (though I accept sometimes challenging) things like losing some weight, not smoking, cutting down booze could do SO much for your own health. People just expect someone else to sort out their problems.

Incidence of obesity in the UK = 25%. Cost to the NHS £4.2 BILLION. £4.2 billion not spent on everything other aspect of healthcare. Smoking is estimated to kill 1 billion in the 21st century. 1 billion people who will need treatment.

DIESELDOG

Well, I guess that means I ought to knock the popcorn, vodka and fags on the head then...

Just in case I need some kind of repairs at a later date.

Love n hugs

DD

gasman_dave

These patients are now called bariatric. They have to have special beds, there are specially designed wedges which they lie on to get anaesthetised, they have special ambulances and they are much higher risk.

There is a difference between lots of hospitals and trusts. If people have a BMI of 35 or more in the place I work, they don't go for day surgery (or get anaesthetised in one of our hospitals which has no anaesthetic cover overnight). They will get assessed by an anaesthetist as to their risk status, so all you fit folk would easily pass.

The folk with central obesity have a higher risk. They suffer more from sleep apnoea, undiagnosed heart failure, dodgy heart rhythms etc. Actually putting these patients off to sleep is a nightmare as they rapidly lose all there blood oxygen levels as soon as they lose consciousness (which then is very difficult to replace quickly). They often have high blood pressure, diabetes and have very high rates of wound infections and wound breakdown.

This is quite a good link - http://www.anaesthesiauk.com/article.as ... eid=100620

If you can demonstrate fitness, you will be fine. The guy with the biggest BMI in our department can beat allcomers at tennis (including the coach at his club) so he would easily get an operation with us. If you tell your anaesthetist you are a keen cyclist, he will understand as a pretty high proportion of anaesthetists are cyclists for some reason.

It has been reported as health fascism, but there is a pretty good reasoning behind this. I think the reporting of this has been sensationalised. The BBC seems to love to slag off the NHS.

Dave

capt_slog

verylonglegs wrote:

Obese people to be refused food would be a far more interesting headline ^^

Yeh, have chip shop owners with the powers as pub landlords........

"Bag of chips please"

"Sorry sir, I can't serve you, I think you've already had enough"

rick_chasey

Hope you don't get refused surgery when you fall off at high-speed on your bike in a sportive or race.

It's your own fault anyway. Shouldn't have been going so fast on a bike.

:roll:

Tri-ing

Rick Chasey wrote:

Hope you don't get refused surgery when you fall off at high-speed on your bike in a sportive or race.

It's your own fault anyway. Shouldn't have been going so fast on a bike.

:roll:

But riding a bike has any number of health benefits. What are the benefits of smoking loads, drinking too much and being obese?

rick_chasey

Tri-ing wrote:

Rick Chasey wrote:

Hope you don't get refused surgery when you fall off at high-speed on your bike in a sportive or race.

It's your own fault anyway. Shouldn't have been going so fast on a bike.

:roll:

But riding a bike has any number of health benefits. What are the benefits of smoking loads, drinking too much and being obese?

Going downhill fast doesn't...

How many of you drink too much according to guidelines?

I bet a good proportion.

How many of you have been injured because you've been drunk?

How many of you have smoked at least once?

Stupid.

Crapaud

gasman_dave wrote:

... It has been reported as health fascism, but there is a pretty good reasoning behind this. I think the reporting of this has been sensationalised. The BBC seems to love to slag off the NHS.

Dave

Do you have any good links?

Try as I might, I can't find the prog that the OP refers to on iPlayer, You Tube or Goolge to see what the details are. The OP reports that it's an 'incentive' to fatties to slim down, ie not the morbidly obese that you seem to be refering to.

gasman_dave

http://www.pulsetoday.co.uk/newsarticle ... e-patients

That's outrageous. I dont know of any justification for that.

This is a great way to justify long waiting lists. The patients will be taken out of the stats and the trust can say they will hit their waiting time targets. In Scotland, patients have to have their treatments / operations within 18 weeks from GP referral. I think this is coming very soon in England and Wales.

BMI of 30 seems a ridiculously low BMI to take as your cut-off. By the way, when I googled this, it seems loads of trusts won't treat smokers either. These rules would decimate surgery in the West of Scotland. If they had set the bar at a BMI of 35, then I could see that that would definitely increase risk. 35 is the cut-off for day surgery in my hospital.

I suspect this is creative management and it seems it is becoming incredibly common in England and Wales.

To those who are fit but BMI >30, come up north. I would have no problem anaesthetising you. I think 30 is way too low. If they used 35, then the complications rocket.

Dave

Tri-ing

Rick Chasey wrote:

Tri-ing wrote:

Rick Chasey wrote:

Hope you don't get refused surgery when you fall off at high-speed on your bike in a sportive or race.

It's your own fault anyway. Shouldn't have been going so fast on a bike.

:roll:

But riding a bike has any number of health benefits. What are the benefits of smoking loads, drinking too much and being obese?

Going downhill fast doesn't...

How many of you drink too much according to guidelines?

I bet a good proportion.

How many of you have been injured because you've been drunk?

How many of you have smoked at least once?

Stupid.

But going downhill, is an unavoidable byproduct of going uphill.

If like gasman_dave says, and they've set the limit at 30, then that is a bit silly, 30 isn't really that uncommon at all and could even be healthy for some people. But, if you increase it to >35....well......unless you are an extreme body type, it's very unlikely you can be fit and have a BMI >35.

This isn't saying, "oh no, you had a puff of a fag round the back of the bike shed when you were 15, no surgery for youuuuu". More along the lines of "your over-eating, under-activity has resulted in you being a much greater risk for surgery and complications, any chance you could make some form of effort to reduce those risks?". It's essentially asking a patient to take some responsibility for their own health.