Need a knee or hip replacement? Fat chance of getting it, NHS tells the obese

Need a knee or hip replacement? Fat chance of getting it, NHS tells the obese
In a one-of-its-kind decision (so far), the NHS in East Suffolk has said it will not undertake hip or knee replacement surgeries for obese patients whose body mass index (BMI) touches 30 or higher.

However, the development does not stem from medical reasons, but from financial ones. The NHS, which is battling a deficit of £47.9 million, ends up paying much more for the surgery of an obese patient than that of a normal weight one, said Dr Brian Keeble, director of public health in Ipswich. “We cannot pretend that this work wasn't stimulated by the pressing financial problems of the NHS in East Suffolk,” he had said.

While obese people are usually accustomed to being the butt of cruel jokes and everyday discrimination, such classification by healthcare services is a new one, even if not surprising. A survey by British United Provident Association (BUPA), a global health organization, found that as many as four in 10 Britons feel that obese patients should be made to pay for not looking after their health. Almost a third of the 2000 participants of the survey said that penalty charges should be imposed on medical treatment for those are obese or are smokers or drinkers.

Around one in 10 felt they should be denied treatment altogether. “We were particularly surprised that people have taken such a hard-line view on self-inflicted illnesses, with so many saying they should not be treated at all. Perhaps this shows a change in public mood and that compassionate Brits are a thing of the past?” said Dr Andrew Vallance-Owen of BUPA.

With the general public feeling this way, it comes as no surprise that medical workers, who have to bear the brunt of obesity, fight shy of extending treatment to obese patients. According to various studies, doctors and nurses tend to blame health problems ailing obese patients on their weight and lack of control over food habits. Kelly Brownell, a psychologist from Yale, said that she has come across many anti-obese comments with one of the most worrying one being, “Obesity is caused by character flaws and a failure to lose weight is due only to non-compliance.”

The fact that most suffering from obesity avoid going for regular checkups because they are ashamed of their weight being checked compounds their health problems further. Interestingly, a new research has found that many who are classified as overweight by the BMI method don't necessarily face increased chances of health problems.

The study, led by Katherine Flegal of the US Centers for Disease Control and Prevention (CDC), said that those whose BMI was high might be at a lower risk of premature death as compared to those with normal body weight. “Although people think there's all this evidence out there showing a high mortality risk associated with being overweight, in fact the literature doesn't show it,” said Flegal. Many from the medical fraternity are now looking at the waist-to-hip ratio as the measure of overweight or obesity instead of the BMI method, which takes into account the height and weight of a person.

Whatever the measure of obesity, the fact that one in two Brits is overweight, with one in five being obese, is worrisome. But instead of complete refusal, what might be more effective is taking on the issue on a case-to-case basis. This is what other health trusts of the Suffolk area have decided to do.

“Patients will be assessed according to their clinical needs, as is the norm, and if necessary advised to lose weight before treatment, which will reduce the risks and improve outcomes for surgery. The message is that patients who need clinical treatment will get it,” said a Norfolk, Suffolk and Cambridgeshire Strategic Health Authority spokesperson. Agreeing with her was King's Lynn's Queen Elizabeth Hospital medical director Dr Colin Bone.

“The risks of treating obese patients are considerably higher, so where it is possible to achieve weight loss in advance of treatment it does reduce the risk significantly and increases the likely success rate of treatment. But each case would be judged on an individual basis,” he said.