The National Health Service in parts of Hertfordshire, north of London, England, will no longer pay for non-urgent surgeries for obese patients and smokers.
The new guidelines, issued by the Herts Valleys and East and North Hertfordshire Clinical Commissioning Groups on Oct. 13, require obese patients to lose weight before getting publicly funded surgery. Smokers would be required to quit.
The weight requirements are specific: patients with a BMI over 40 will have to reduce their weight by 15 per cent, and people with a BMI over 30 will have to reduce their weight by 10 per cent before they can receive surgery.
BMI has been widely criticized as a measure of obesity because it can incorrectly classify people as unhealthy.
These guidelines are only for “non-urgent” surgeries, and won’t apply in cases where waiting for surgery would be more harmful. They will be implemented over the “coming weeks and months,” according to a press release.
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The U.K.’s Royal College of Surgeons condemned the move in an interview with The Telegraph. “Singling out patients in this way goes against the principles of the NHS,” said Ian Eardley, senior vice-president of the Royal College of Surgeons.
“This goes against clinical guidance and leaves patients waiting long periods of time in pain and discomfort. It can even lead to worse outcomes following surgery in some cases,” he told the Telegraph.
The Clinical Commissioning Groups said that they made these decisions after extensive public consultation and there was public support for the changes. “As we plan the implementation of today’s decisions over the months ahead, we will make sure that everyone who needs to make lifestyle changes, including those who need to lose weight or quit smoking, gets the information and support they need to succeed,” said Nicolas Small, chair of the Herts Valleys CCG, in a press release.
A 2016 report from the Royal College of Surgeons found that policies limiting surgery for patients with a high BMI and smokers were fairly common across England and Wales. Nearly one-third of local health boards had some policy based on BMI that would stop patients from being referred for routine surgery. Mostly, those related to knee and hip replacements.
The report said that surgeons and physicians should encourage patients to lose weight or stop smoking alongside surgical referrals – rather than not referring them for surgery.
A spokesperson for the College of Physicians and Surgeons of Ontario said that she had never heard of such a blanket ban in the province. Depending on their personal circumstances, a patient might be advised to lose weight before surgery in order to have a safer procedure, she said, but there is no ban that she knows of.
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