Life is getting tough in parts of England. The officials who oversee medical care for the county of Hertfordshire have ruled that unless obese patients lose a specified amount of weight and smokers quit smoking for at least eight weeks, they will not be allowed to undergo elective surgery, according to a writer for MedPage Today.
Life Is Getting Tough in Parts of England
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Patients with a body mass index (BMI) greater than 40 must lose 15% of their weight within nine months, and patients with a BMI over 30 must lose at least 10%. Free counseling is offered to all.
This ruling is not unusual in Great Britain. Variations of it have been in effect in about one-third of the country for a time. But these regulations are considered extraordinary because they, presumably, will remain in effect indefinitely.
Opponents doubt that withholding surgery will work. They argue that delaying surgery will cause more suffering and will cost more because in the end patients will need more care after they eventually have their operations. Proponents believe the measure will make patients take more responsibility for their own health.
Hertfordshire, a county of over 1.1 million people, has an obesity rate of 60%. About 16% of the residents are smokers.
According to the Hertfordshire Mercury a local nurse got in trouble for calling an obese patient “Jabba the Hutt.” She told him he was too fat and she would not let him eat the British staple of fish and chips for dinner.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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