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

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

Goodness , how very judgmental people are !!

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.

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

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.

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

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.

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"

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

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.

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 !!!!

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.

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.

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.

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.

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.

I meant 'weight' of course!

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.

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.

HildaW I did have to have L5/S1 disc surgery and had terrible sciatic nerve pain in the run up for several months. I gained a good stone and a half almost. Spent all my time reclined on the sofa on a memory foam pad with an over-bed table with my computer so I could work! Just walking for a few mins to the bedroom would bring on horrible pain in legs or upper back.

Thankfully the surgery worked, but not 100%, the nerve was stuck like chewing gum to my spine and had to be scraped off. This had been going downhill for a long time without knowing it except for twinges that I thought were not serious.

Walking actually helps and keeps me flexible, so we walk at least for a half hour or more each day, just to the shops if nothing else. I walk my stepson's dog, too, which is very uplifting!

Am back to within a couple of pounds of pre-problem/surgery weight and am terrified if I see the scale creeping up as I worry about any load on my spine creating more discomfort. I do not have a happy relationship with food anymore, but just try to get on with it and allow myself at least a treat now and then without going down the slippery slope of comfort eating. I have had to ban certain foods from my home.

Oh, this was just on the telly. I'm in the southwest, but for some reason the link is for N. Yorks.

www.bbc.co.uk/news/uk-england-york-north-yorkshire-37265752

I have Epilepsy & Type 2 Diabetes, I am overweight, gave up alcohol almost a year ago & smoke 5 cigarettes a day. I have knee problems, not bad enough to need an op. yet, Medication for Epilepsy makes it hard to lose weight & I struggle to exercise as I enjoy walking but am unable to walk far. I am an active gardener as far as I am able (good & bad days). My diet is perfect for a Diabetic, plenty of veg, restrict portions of fruit as I should (full of natural sugars) & control portion size but still cannot lose weight.

I do dislike very overweight nurses telling me I need to lose weight - I feel like saying "have you looked in the mirror?"

I appreciate the difficulties the NHS is facing - prescriptions are rationed now for items which are regarded as "personal care"

I am fuming at this suggestion. Wouldn't it be a better idea to start charging all the Health Tourists and those who have not paid a penny into the system but get preferential treatment for free. There was a report recently where many of these people fail to pay for the received treatment - make them pay upfront then.

Yes Im68Now, "in our working lives we had an expectation from cradle to grave", but that was at the inception of the NHS in the 1940s when financially it was possible . There have been so many advances in medical research and treatments that many conditions from which we now expect to survive were unthinkable/ unavailable in the early days of the NHS. e.g. premature baby care, cancer treatments, heart operations, misuse of A&E for minor and alcohol related conditions ,and life-enhancing drug treatments for chronic conditions.
All of these are very costly and the irony of this is , of course, that we are living longer which again puts a strain on resources.
I agree with spyder08, changes will have to be made whatever the political scene. I am no "number cruncher" but throwing vast amounts of money at the present system (even if the money was available) would not support the system in its present form and tinkering here and there will not effect a radical improvement. realistically there may have to be a merger between private and NHS care for everyone.
There have been many comments about personal responsibility for one's health and I consider that a long-term health education plan is a start with free assistance for the aforementioned addictions and perhaps a need for a top-up mutual healthcare policies as in France and Switzerland which was discussed in a forum last week.
Emergency and life-threatening cases are teated 100% by the state but one can choose the level of top-up care on a personal need basis for other treatment. Existing conditions are not excluded and anyone on basic pension / social benefits receive 100% state cover.
I realise that this is anathema to many of you who have always expected NI contributions to cover all health costs, but times are a-changing.
Here in France , at the ages of 73, we pay a top-up of € 75 each a month which covers all our medical needs at the same level as private care in the UK. (Our existing conditions include heart, High BP, asthma and arthritis)
Waiting times to see a consultant are minimal: days or a couple of weeks and x-rays/scans often the next day.
Enough said and I guess I will get some flack mentioning "private and paying"!
Final word - see no problem in refusing deferring treatment if an existing health fact would negate or lesson the effectiveness of the operation : but not as a budget cutting exercise.

Mumsyface there's some evidence to suggest that the multi-billion dollar slimming/diet industry makes its money from the fact that dieting doesn't work or is, at best, a temporary fix. Calorie restriction is what works and it's very cheap to do. Eat less! It's a simple equation:

Energy input (food) = energy output (life processes and activity) maintains the status quo.
Energy input exceeds output leads to weight gain.
Energy input less than output leads to weight loss.

Research has proved the most effective of those has been shown to be the last one but that increasing exercise without cutting calories is nowhere near as effective.