You’re too fat to have surgery

This isn’t an emailed submission, but it’s definitely relevant to the scope of this site. An article, “Where Fat Rules Out Surgery,” reported today in the Monterey Herald reveals a growing trend in the numbers of patients being denied nonessential surgeries by British health authorities because of their weight.

For two years, Frances Kinley-Manton says she lived with arthritis pain in her hips, a condition that kept her in a wheelchair. She wanted hip replacement surgery. But doctors at Britain’s National Health Service said she was too fat for the operation

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“They wouldn’t even put me on a waiting list,” Kinley-Manton recalled.

Her doctor told the 210-pound woman to lose about 30 pounds before he would consider her for surgery.

Unable to drop the weight through dieting, the 68-year-old Scotland resident took out a mortgage on her house to pay for a private operation on the Mediterranean island of Malta. She had her first hip operation in July. Now she’s awaiting surgery on the other hip.

“I had no alternative,” she said. “NHS said they wouldn’t operate on me because I’m overweight, but I think they were just trying to keep their costs down…”

Kinley-Manton’s doctors in Malta said they were puzzled that her weight posed a problem. Hip replacements cost about $14,600 at the hospital where she had her surgery.

“It’s evident that there are a number of (hospitals) with a large deficit who are making decisions that have no medical bearing,” said Michael Summers, a spokesman for Britain’s Patients’ Association, an advocacy group. “This is a very disturbing trend.”

Kinley-Manton considers her own treatment discriminatory.

“It goes against my principles to have come to Malta, but I didn’t think the surgery was ever going to happen in the U.K.,” she said.

The Patients’ Association said it got dozens of complaints every month about the National Health Service, including the refusal of surgeries to overweight patients. Obesity advocates said the issue has been raised at national medical meetings.

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  1. Limor

     /  November 17, 2007

    I have a friend who is a transplant coordinator in MI. She told me that for people who have a BMI of 35 or up, they WILL NOT do a transplant. They make you diet first. These are people who need kidney transplants, so they are on dialysis 3 times a week. I asked her if they look at lifetyle/diet/family history etc. She said that the BMI is the most important factor other than alcohol and illicit drug use.

  2. nuckingfutz

     /  November 17, 2007

    I hate to say this, but this article doesn’t surprise me in the least.

    In the 4 and a half years that I’ve been living here, the NHS has slowly been gravitating towards refusing care to patients who “bring it upon themselves.” I.e. smokers and overweight people. The ironic thing is, though, that they wouldn’t for a minute consider refusing care to, say, a runner who fucked up their knees. Or a rugby player who shattered a limb. Those people brought it upon themselves, too, by choosing to play/compete in high-impact sports that have a high incidence of injury. But no, it’s just the smokers and the fatties that are draining the NHS of funds.

    Never mind paying for doctors that literally do nothing. (For example, my husband went to a physiotherapist after hitting a concrete pylon head-on at 30 mph — that doctor SPOKE to my hub for FIVE minutes and announced that there was nothing wrong with him. Never mind the fact that he could barely stand sometimes with his back pain. Naw… talking to him about what television shows he watched was good enough for the doctor to know that there was nothing wrong with his back. Yeah. And taxpayers’ money pays this doctor’s salary.) Or the hundreds of thousands of pounds they pay on ART for the hospitals’ walls. Or the myriad other things that they could be dealing with.

    Nope. It’s all down to the smokers and the fatties.

    (For the record, I smoke and I’m fat, and I can count on one hand all the times I’ve been to a doctor since I’ve been here. But yeah – I’m one of the ones “DRAINING” the NHS. My ass.)

    The more I hear about this, it seems to me that it’s not only state-approved fat discrimination, but simply an excuse to allow doctors and nurses and whatnot to NOT do their jobs. Federally funded laziness.

  3. Yellowhammer

     /  November 17, 2007

    Do fat people not pay into the fucking system too?

    I am SICK and TIRED of people saying blah blah blah, fat people cost too much money. Its not like we sit around all day not working. Fat people work, fat people pay taxes. I know this is about the UK, but here in the US, people love to say, we are having to pay beelions of dollars for fat health care. Well if it is like you say, and 2/3s of Ameicans are overweight and obese, well it sounds like thats MOST Americans.

    So eff your prejudice in the aye!!

  4. apricotmuffins

     /  November 17, 2007

    Its like one big playground squabble over here. Its a classic case of ‘HEY! he’s got more than me!’ – everyone pays into the system but because some people are slightly more likely to need healthcare (for a supposedly self inflicted reason) people are screaming about the injustice. Its pretty damn disgusting, and i think the ‘fat people need more healthcare and drain the system’ is being used to take attention away from the fact the NHS drastically needs to make some improvements. Its falling apart at the seams, and somehow the focus is being turned outwards towards the public and not the people who are meant to be providing basic healthcare and arent even doing that, for a lot of people who need it.

  5. This is happening in Australia too. Hospitals are refusing to carry out “elective” surgery (that is anything that isnt going to cause you to drop dead RIGHT NOW) because of patients being overweight. One such example was this,21985,22620061-2862,00.html
    where a bishop was denied a knee replacement because of his weight. It amazes me that they tell people to go home and lose weight but if someone can hardly walk how are they meant to exercise anyway? Not that this is the point, if a fat person wants the surgery, pays their taxes or health insurance (depending what country you are in) then they are as entitled to have their operation as any extreme sportsperson or car accident victim.

  6. jaed

     /  November 18, 2007

    Telling a 68-year-old to lose weight strikes me as prima facie malpractice in any case, considering that the protective effect of weight becomes greater as age progresses. Nobody that age has any business going on a reducing diet – even with the goal of temporary weight loss to meet a bureaucratic checkpoint.

    If the woman had gone on the sort of extreme calorie restriction necessary to get below natural weight while physically unable to exercise, sequelae might be expected to include osteoporosis, electrolyte imbalance, and God knows what nutrient deficiencies, not to mention the well-known metabolic effects of crash dieting.

    What on earth could any doctor, no matter how fat-hating, be thinking, advising something like this for a patient this age in this situation?

  7. I spent 4 years on a waiting list and was then kicked off for being too fat – after the rules changed. My doctor told me I should be happy that they would still consider taking me on if I lost weight, because after all, in Glasgow you couldn’t get treatment if you weighed over 175lbs.

    It was great incentive to move back to the US. And yes, I got treatment, and yes, it worked the very first time.

  8. Limor> I have a genetic kidney disease and it’s highly likely I’d need a transplant somewhere down the line (hopefully many years away). I dread exactly that situation. Telling someone who’s on frikkin’ dialysis to diet is a sad, sick joke. When you’re on dialysis that’s already a diet, you’re nutritionally compromised! It’s called kidney disease wasting. (Which is why fat people on dialysis live longer, as Sandy Szwarc reported.) You’re supposed to eat as much as you can within certain guidelines otherwise you just get WORSE. And kidney failure and dialysis can also make you really bloated and thus seem even fatter yet your muscles and organs are wasting away inside. (My father and uncle were on dialysis for this same disease.) I’m probably going to wind up mortgaging my house to get a transplant done somewhere they’re less afraid of TEH FAT.

    Funny how they claim that “it’s too risky” to operate one someone with a BMI over whatever arbitrary limit has been set, unless that person wants WLS, in which case it’s “Great! Let’s get you into the operating theatre!”.

    Last year I had seven teeth removed prior to orthodontic work, done under general anaesthetic. My anaesthetist met with me beforehand to explain the procedure and all that, and he said weight was really only a confounding factor if someone was already quite ill, simply because of the amount of anaesthetic medication needed per kg (not because fat somehow magically makes you risky), and if a fat person was otherwise healthy there shouldn’t be any more risk than with a slimmer person.

    I agree a lot of this denying surgery is using fat hate as cost-cutting exercise. Instead of oh, fixing up all the stupid and wasteful layers of administration, or actually having enough funding in the first place, they just deny certain people surgery because they know the general public will not care if it’s “only” fat people or smokers, etc.

  9. Not to mention, this geriatric woman was confined to a wheelchair as a result of the condition she wanted surgery to correct. Just how the hell is she supposed to diet and exercise when she’s stuck in a wheelchair? Maybe if she had just stopped eating she might have lost enough weight to qualify for the surgery. That is, if she didn’t die first.

  10. Kristin

     /  November 19, 2007

    Things like this are what took me so long to finally get moving about the problems I have had with my low back for years. I just figured that I was fat and that was the problem, and I poured money into treatments (mostly massage therapy, which sometimes helped) and painkiller prescriptions (which made me woozy and dumbed me down).

    When I confided in my chiropractor, who’s seen me over the last eight years slowly degenerating into a sure disability, that I wanted to undergo gastric bypass surgery because I felt like I would never be able to lose enough weight on my own to get myself out of the daily excruciating pain that I was now experiencing, he suggested very vehemently that I have an MRI to find out exactly what was going on. His guess was that something very serious was going on that could be fixed through surgery, and before I made the drastic choice of one surgery with lifetime effects, I might be able to help myself with another surgery that could help me achieve health the way he knew I really wanted to.

    The MRI showed that my L4-5 disc was so far herniated that it was completely into the spinal canal and seriously impinging on the nerves there. Within a day I had an appointment to see a neurosurgeon, and within a week I was on the operating table to have the disc taken care of. I was so afraid that she was going to ask me to put off my surgery until I lost weight, because I have been so defeated about it because the pain I’ve been in does not allow me to exercise, but she didn’t. Not one word about it. Her plan: Have the discectomy, take a few weeks to recover and then return to work on a half-time basis, start physical therapy, and then continue with an exercise plan to strengthen my core muscles in order to lessen the chance of my returning to the same predicament.

    My neurosurgeon has done more for me than any other doctor (other than my chiro) has in the entire time I’ve been dealing with this. I realize now that other doctors have been keeping me at arm’s length while my brilliant surgeon didn’t talk down to me, didn’t hustle me out of her office with yet another prescription for pain pills and a diet, and most importantly, didn’t confirm my fear that I would have to live with the pain until I reached a weight she deemed “safe” for surgery. (I currently weight about 295 lbs. and before the surgery couldn’t walk upright and was getting almost no sleep because of the pain.)

    I’m glad I found the right doctors, but I’m pissed it took so long to do it.

  11. Cathy

     /  November 20, 2007

    I think my mom was fortunate. She’s overweight. She had a heart attack, which inspired her to quit smoking (which caused weight gain, natch) – but she also has arthritis in her knee, which interfered with exercising. When she went to the doctor (same one she’s seen for 30 years, which probably helped), he concluded, “Your knee is going to kill you. Here’s a referral to an orthopedic surgeon; get in to see him as soon as you can manage.”

    This should be the obvious conclusion for any patient complaining about pain that makes it difficult to walk. Any doctor who can’t see that maybe needs to go back to med school..

    Mom is now recovering from her knee replacement. If either her PCP or the surgeon had told her to diet before the surgery, she would have laughed – she already eats so little I worry about her sometimes, not because she’s trying to lose weight but because she’s screwed up her metabolism so badly she doesn’t get hungry.

  12. Kathryn

     /  January 9, 2008

    My grandfather was told he was obese when he first started discussing hip replacements, and that (with his congenital heart defect) this greatly increased the risks from the anasthetic. They put him on the waiting list anyway and (since he suggested it) referred him to the nutritionist and a physio for an exercise programme he could actually follow (both hips due for replacement is a real problem for exercise), and by the time he came up for surgery six months later, his BMI was in the high twenties (for our very stocky build, this is ideal). This was in Leeds – I guess the amount of support you get varies from trust to trust. I wish that sort of doctor (and funding) could be available to everyone.

  13. Barbara

     /  February 1, 2011

    What this article fails to mention is that the NHS will pay for Lap Band surgery… better dead than fat in the UK, huh?

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