I think it’s ridiculous. Being obese might increase risk but it also increases the need for assistance. What next - no operations for people who smoke or drink or eat too much red meat because those activities also will make for more complications?
[ Anecdote Alert! ]
I actually knew a guy who went in for surgery that was “helpful” but not required for his survival who was morbidly obese. My wife, the nurse, commented before he went in that she hoped he had no complications because of his weight. She was unfortunately prophetic: because of his weight, the anesthesiologist had a lot of trouble keeping the correct levels during the surgery, following which (perhaps or pehaps not triggered by the anesthesia issues) he suffered a number of respiratory problems following the surgery that led to cardiac problems that led to circulatory problems that led to a general deterioration ending in death.
At each stage of his treatment, his wife reported that the doctors had commented that “this is usually a controllable problem, but not among very obese people.”
[ /Anecdote ]
I do not think that people should be denied medical care because of their weight, but I think it is in everyone’s interest, including that of the patient, to consider the odds when looking a surgery in conjunction with obesity.
Personal point of reference
I am obese (temporarily - the weight is coming off steadily) and have sever arthritis in my knees and back. I did have it in my hips as well, but they are titanium now. My surgeon informed me of all the risks, but understood it’s a quality of life thing. To lose the weight I must exercise. But the pain in my hips (and other joints) was keeping me from doing so. Had I been denied the surgery, I would be well over 500 lbs and in a wheelchair (or perhaps dead), unable to work or be independant.
Now I am able to walk, altho with limits due to my knees still being no good. But they too will be replaced soon.
Peterborough must be under the jurisdiction of an HMO
I thought the whole “fat people as second class citizens” was a US thing only
I’m guessing “certain operations” means elective ones. And I can understand the policy, to a point. In any surgery, the benefit must outweight the risk. If an elective surgery is very risky for the obese patient, is surgery such a great idea? A lot of times, the answer is no.
Gastric by-pass surgery is considered elective and yet it treats a deadly health problem – morbid obesity. People who are obese are more likely to face other health problems such as hypertension and diabetes.
What if teachers decided not to teach slower students?
Makes you love that nationalized health care, don’t it?
In a system where limited medical resources must be apportioned by some means, it makes all the sense in the world for the docs to decide that since Group A has a much worse risk/reward ratio, Group A doesn’t get the operation.
“He’s more machine now than man.”
All systems require medical resources to be apportioned by some means.
Actually, according to an article in the Yorkshire Post, they “are banning obese people from having hip and knee replacement surgery.” While I can see those kinds of surgery as “electives,” it seems more like the choice is whether to be in potentially debilitating pain or not.
The other article also drives home the point that while administrators are defending the move from a medical standpoint, they concede that the policy was put into affect because of financial concerns.
Since we alreday had someone who had a hip replaced and someone else who commented on how it was budgetary issue, it seems that everyone has a dog in this fight, so to speak.
(Also, I didn’t link the article I cited in the OP correctly; it’s actually here. Sorry!)
In a system where limited medical resources must be apportioned by some means, it makes all the sense in the world for the docs to decide that since Group A has a much worse profit/cost ratio, Group A doesn’t get the operation
It sucks to not have unlimited medical resources at our command but until that day, medical professionals have to apply the triage rule and decide which patients are most likely to benefit from treatment. I don’t see the slippery slope the OP is claiming.
It isn’t necessarily (or even likely to be) a case of punishing the patient’s obesity by witholding treatment; hip replacement is about as invasive as surgery gets; there’s a heck of a lot of healing to do afterwards and if you’re not in good health, you don’t stand a good chance of surviving the operation.
Furthermore, in some cases, joint replacements are pointless in overweight cases, because the artificial joints (or the bone into which they are inserted) may fail under those kinds of loads.
Let’s see … you can identify a population that is at greater risk of complications from a procedure and at greater risk of having the procedure not work well even if without complications. More risk and less probability of benefit. Moreover there is a high likelihood that compliance with a noninvasive intervention (diet changes and a low to non-impact exercise plan) could at least partially obviate the need for the procedure and make the risk/benefit profile more favorable if it is still needed.
Nope not discriminatory. Good individualized decision making.
BTW, yup, many surgical procedures are risky choices for smokers so long as they continue to smoke. Healing is poorer. The risk/benefit profile changes. Many elective procedures should be deferred until a patient has quit smoking for a period of time.
How is this any different from denying an active alcoholic a liver transplant, or denying an active smoker a lung transplant? Obese people can’t heal the replaced joints as well as the non-obese, and there are more likely to be problems in surgery. I don’t see a problem with denying it as long as taxpayers are footing the bill. People paying for NHS (which I support, BTW) are entitled to see a net benefit from their investment, namely that the procedures they pay for lead to a healthier population, and not just for surgeries that will fail consistently and be a waste of money.
So I can’t smoke tobacco or be significantly overweight, but I can smoke all the crack and have all the hookers I want? Is that the way it works? The way many people talk about obesity as if it were simply some disgusting moral failure that can easily be corrected with a little will power really, really bugs me.
It occurs to me that most people probably fall into one high risk category or another and could “fairly” be denied medical treatment by this standard.
But you see, exercise is an important part of weight control, and if you deny obese people these surgeries you may be denying them the most effective way of getting their weight under control in the first place. Trying to control weight by diet alone is pretty much a hopeless cause.
True, and if the risks were large enough it would make sense to deny the treatment. For instance, someone who smokes crack should be denied most types of health coverage since any treatment they have is going to be undone by their dangerous addiction.
As for these surgeries making obese people more able to exercise, what guarantee do we have that they will indeed do that once their knees/hips are okay? We’ve all heard the stories of people who get bariatric surgery reverting to junk food and no exercise and gaining all the weight back. If it could somehow be proven that the person used to be a good exerciser and that they almost certainly would be again after surgery, that’s a different story, but I’m not going to take it on someone’s word that they’ll make a major life change such as a commitment to healthy eating and exercise when they’ve made no move to do this at any other time in their life. And healthy eating is generally considered more important for weight loss than exercise is; exercise keeps you toned but if eating habits don’t change then there is a ceiling on weight loss.
Lonesome, moral judgements have nothing to do with this. Risk/benefit analysis does. Alternative options do.
Crack? Nope, that would be a bigger risk for the procedure than smoking. You’d have to be provably crack-free for a period before and after. Hookers? No consequence to the risk/benefit analysis opf surgical procedures. But at least use condoms, man. The morality of it is not my business.
There are low to non-impact exercises that even the morbidly obese with osteoarthritis can engage in. Water-walking and water aerobics for example.
We’d all be high-risk? By definition, no. High risk is relative to average risk. That’s saying everybody is above average. Can’t be. Some people are indeed at greater risk of complications than others. Some of those factors are outside of their control, some not. And more importantly, some people have more of a risk of harm by intervention than they have of benefit by intervention. And some people have substantially more probability of benefit than harm. Only the latter should be considered for interventions. Then you analyze cost to society vs degree of likely net benfit over possible harm gained.
Yes ma’am, I quite agree (poker face…must not laugh…not even a grin…snerk…urgggh…).
Taking this quite literally, what about places where there isn’t rationed health care - do we adopt airline-type policies and charge patients according to a sliding scale of obesity? That special equipment doesn’t come cheaply.
What are these places “without rationed healthcare” of which you speak? 
In the US, if more expensive equipment or procedures are being used to treat you, someone is getting billed for that. If it is your insurance company, some of the cost may or may not get passed along to you directly, depending on the terms of your insurance (80/20 coverage vs. copay). If it’s not passed on to you directly, we’re all covering it in our premiums. And maybe if it’s a situation that comes up often enough, the insurer will negotiate w/ either the doctor or the patient that the extra cost is or is not covered by insurance.
And if you are one of the lucky Americans who pay for healthcare with cash, you are of course paying whatever it costs.