Ban on surgery for patients who are overweight or who smoke?

Nina as the UK is still part of the EU could your friends daughter perhaps make enquiries about having the op here, The Netherlands or France.
I would be happy to find out the details for Belguim.
PM if you think it might help.

Clapping hands works. Good.

I think we have to face the fact that more money is not going to be given to the NHS.

Losing weight is as simple as eating less. If everyone ate 50% less, we would all shrink. An extreme example but you get my drift.

I meant 'weight' of course!

Hilda I think the word you are looking for is hyperbole

To me the fundamental question is how far we want the clinical judgement of doctors and consultants to be superseded by diktats from individual Clinical Commissioning Groups.

If a doctor who is treating a patient advises against surgery for clinical reasons I have no problem with that.
If a Clinical Commissioning Group denies a patient a procedure for financial reasons and the doctor thinks they would benefit from it, then that is quite wrong.

Surely if the problem is lack of cash to run the NHS with then that is the real problem that needs attention. Discussion over who to treat and who not to treat is nonsense - it's a classic case of treating the symptoms rather than the cause!

Let's be clear, addictions and obesity are health problems like any other heather problem, and those who have these need compassion, care and treatment just like any other patient.

Let's also be clear that, unfortunately, losing weight is not as simple as just eating less. If it were then the multi billion dollar slimming/diet industry wouldn't exist. There is a great deal of evidence, both anecdotal and medical, suggesting that as we age a lot of people, especially women, find it harder and harder to lose weight. Interestingly, since I stopped trying to lose weight I have stopped gaining weight - I have no idea why, but am happy to be a little overweight rather than speeding towards obesity.

nina it's so short sighted to deny young people medical treatment for conditions that limit their mobility. Your friend's daughter could have 40 years in a wheelchair ahead of her, with the employment restrictions that must bring or 40 years of good health/mobility during which she has more chances to contribute to society by paying tax and NI. Apologies to anyone who lives with a disability and is lucky enough to be employed but it must make it much harder to find employment. That's another great scandal that's in its infancy of being addressed.

It can be difficult to operate on a joint when a person is very overweight, and the healing process takes longer. Very often the joint has been virtually destroyed by the strain of obesity, and therefore a new joint will likely be seriously damaged in a short time. A no win all round. Suggesting a patient loses weight is for their sake more than for anyone else - after all, it doesn't matter too much to a surgeon whether he operates on the same person ten times or on ten different people - it's the media who make all these situations so personal and vindictive, when probably what has happened is a suggestion to have a drive to get people to lose wait so that surgery is more effective for them.

Re losing weight when unable to walk very far. My Slimming World leader told us this morning that a gentleman who was confined to a wheelchair lost weight by clapping his hands and following the SW plan. Exercise doesn't have to be on the feet.

No political correctness here, my GP at my last blood test with DGS in attendance, loudly prounounced that Grandmere had to get rid of all this fat whilst happily, lightly slapping my tummy.
DGS though it was hilarious, and and now nags me something rotten.
Cardiologist is also quite blunt if you are fat you are fat !!!!

It shame when people take an argument to ridiculous levels to try to score points....there is a term for it but cannot remember it.

I see no harm in encouraging patients to take responsibility for their own bodies and life choices if it can be done.

I'll give one example - my lower back is not healthy, next time I get a slipped disc I could need surgery - so on advice of Dr I sought fitness advice and entered on a set of supervised exercises to very gently improve muscle tone, core strength and general fitness (I also have an underlying Gynae issue that makes some exercises difficult). 12 months later am much more confident about my back and its been totally symptom free - we started very gently doing non- load bearing exercises and have slowly got better and better.
Its had the knock on effect of making me think twice before I eat that next slice of cake or open another bottle of wine. Nothing drastic but I've lost a good stone without really thinking about it. I've also noticed that feeling more positive about myself has helped with my anxiety issues.

Yes, I know this is just me, and we are all different but its our bodies and our lifestyles, we should be expected to take some responsibility and not expect others to step in and 'fix' us.

And, goodness knows, we've had the information on smoking and health for decades.

Gastric bands are only available to those above a certain BMI unless you go private. They are certainly not a quick fix and can have major complications as my friend can testify.
If you need a joint replacement and are over weight then your in a catch 22. You can't exercise to help the weight loss as it's too bloody painful. I do agree with the principal though.
I've mentioned my friends daughter before who is 28 and needs a knee replacement (she's not over weight) but they won't do it as it will need replacing again in 10-20 yrs and so on through out her life. She is at the point where she's told her consultant to "just take it off"

I'm setting out my thoughts on points raised within this thread:

I'm not sure the financial crisis in the NHS is entirely due to government restrictions. When there was a discussion about renationalising the railways, I pointed out that nationalised industries waste millions, possibly billions these days, in inefficiency, jobs for life, inflated salaries at the top, golden handshakes, poor resourcing choices, bad management etc. etc. (e.g. Network Rail, HMRC, the Civil Service). This applies within the NHS right now. It probably applies to a lesser extent in the private sector because profit is the guiding principle. Profit and waste don't go together.

In surgery, anaesthesia is a risky business. The heavier you are, the more anaesthetic is needed, probably for a longer time. When there's visceral fat, it can make surgery more difficult, although slim people may well have visceral fat surrounding their organs.

I've read that exercise plays a very small part in weight loss. Exercise helps but calorie restriction is what works. If a person's mobility is restricted, sadly, they need to reduce what they eat.

GPs are being encouraged (probably financially) to raise the issue of weight with their patients. In the past, many have been embarrassed to approach the subject. Patients are offered help to lose weight. GP training should perhaps focus more on prevention. Our medical system works largely on shutting the stable door after the horse has bolted! GPs don't usually see patients until there's something wrong. It's bound to be easier to stay slim than to lose weight.

Education plays a part too. There again, it's difficult for teachers to approach the issue of healthy weight when there are overweight children in the class. Parents need guidance on what is an appropriate diet and portion size for a child. I read once about a woman who weaned her baby on chip shop chips. Not surprisingly, the child was obese.

I agree, Barmyoldbat, and it would only apply to surgery for non-life-threatening conditions.

First there is plenty of help around for people to lose weight and stop smoking, gastric bands, prescriptions to use the gym or water gym and patches to give up smoking. Secondly a sports person is doing something about their life style and trying to be healthy, you don't often see a fat runner smoking. and as for paying taxes, well what about all those childless people who pay taxes for schools, children services etc. It's all about taking responsibility for yourself and they are only going to delay operations for a year while the patient tries to lose weight or give up smoking. Just for the record I battle to stay a reasonable weight so that I don't build up any more health problems. Don't like doing it but I do.

People who are over weight do not see themselves as over weight. Perhaps doctors etc should tell these people about their weight, instead of being political correct

It seems to work the other way here sometimes, when I needed my knees done. I asked if they wanted me to lose weight first, sort of tongue-in-cheek, the consultant replied that it would be much easier for me to get fitter and therefore lose weight if I had the ops and was more mobile. One new knee is great the other not so good, but I can certainly walk a bit better.
Unfortunately they had not really taken into consideration my other health problems.

Goodness , how very judgmental people are !!

I think it's justified but also think there should be free support to help them lose weight I have been slightly overweight all my life and if I had no self control would be enormous surely it's possible to start from an early age to educate people!

We are all responsible for ourselves I had a very overweight aunt who ended up paying for a hip replacement cos the NHSwouldnt do it ,it was a complete waste of time and money she remained wheelchair bound just because of the weight

I think these decisions should be evidence based rather than simplistic decisions based on worrying about budgets.
If there was clear evidence to back decisions e.g. if there was research to demonstrate that knee operations had very low success rate if patients are obese.
or if death rates after such surgery were high in overweight smokers, there would be a justification for saying that surgery will be delayed until weight lower/ smoking stopped.
But if they are talking about cost-effectiveness wouldn't it save the NHS money if more resources were put into helping patients lose weight or stop smoking.

Well that's me well and truly out then! I would be classed as overweight and I smoke.
I think before long the decision will be made for us since I do not see how the NHS can continue in it's present form. I do feel that some sort of charging will have to be introduced. Online consultations with a GP was something I was reading about the other day. Charging to see a GP in person perhaps? An age limit on some procedures? Some procedures withdrawn from the NHS completely?
I do feel something will have to give before long. What do others think?

I have mixed feelings about this. I'm a teetotal, underweight ex smoker and I never forget that the tax on cigarettes adds up to around 9 billion a year. Don't know what the tax on alcohol is but people who have these addictions have paid for their treatment many times over, except that these taxes probably never reach the NHS.
Having said that, if giving up cigarettes and alcohol and losing weight helps your chance of recovery you'd be stupid not to at least try.

I meant to say that I do not approve of rationing surgery bu weight. Imagine being in unbearable pain which could be alleviated by removal of kidney stones or gallstones, and being told to go away and lose weight. No doubt a bonus for the private sector for those who can afford their care.

I find myself conflicted: my heart is in the "it should be for all" camp, but my head is very aware that no national health service is ever going to have an infinite budget, and when medical procedures (plus post-op outcomes) have financial ramifications, hard and unpalatable choices have to be - and are - made every day in our hospitals. It is horrible to think of it this way, but a 'pecking order of worthiness' is established, and my use of the loaded term 'worthiness' was deliberate: those making the decisions will of course bring their own personal opinions on worthiness to the table. Even if someone designed an algorithm to make the decisions in every case, so that there were no local variations, the bias of the designer/programmer would automatically be built into the algorithm. It isn't fair, it isnt giving everyone an equal chance, but until we live in some utopia where budget is no longer an issue, it will be increasingly the case that certain groups will have less access to certain surgeries and treatments, and this will be based on the decision-makers' opinions, however biased they may (or may not) be. I wish I could think that there was a way to resolve it so that none are penalised, but i cannot.

....if the obese are to be denied health treatment should they not be given treatment to help them overcome their addiction to food ?

That strikes me as a reasonable idea, ab. It fits with supporting people overcome other addictions in addition to the necessary self-help/determination that's also required.