Francis Kinley-Manton has arthritic hips that have confined her to a wheelchair for two years. She wanted hip replacement surgery, but her doctor told her that she needed to lose 30 pounds before he would do the surgery. She lives in the UK, and the British National Health Service would have paid for the operation had she lost weight. But instead of losing the weight (she weighed 210 pounds at the time, and was asked to get to 180), she took out a second mortgage on her house and paid privately for a hip replacement in Malta. Her first hip was done in July, and she’s waiting for the second surgery.
This is apparently not a system-wide rule, but many doctors in the UK have a practice of delaying nonessential surgeries on patients with a BMI of 30 or more, asking the patients to first lose some weight. Kinley-Manton’s BMI was 35, putting her well into the obese category. She claims she was unable to lose the required 30 pounds through diet, so she felt that her only option was to go to Malta and pay for her own hip replacement. But I question her claim that she was unable to lose the weight. They weren’t asking her to get down to 130 pounds. Asking a 210 pound patient to lose 30 pounds before a surgery can be done seems very reasonable. It puts some responsibility on the patient to make a commitment to her own health and the success of the procedure.
Obese people don’t fare as well during surgery. The surgery itself is more complicated, since joints are obscured by layers of fat. Recovery time is longer, complications are more common, and in the case of joint replacement, some doctors cite the concern that very obese patients are more likely to wear out the new joint faster than a slim person would. A doctor can do a fantastic job at fixing a problem, but if the patient isn’t fully on board with the process, the chances of long-term success are low.
I recognize that losing weight is not an easy process when you’re confined to a wheelchair or having trouble walking because of a bad knee. In fact, losing weight isn’t an easy process even for a person without any other health issues at all. But nobody claims that it’s easy. Recovering from major surgery isn’t easy either, although losing the weight beforehand will make it a little easier.
The British National Health Service won’t deny essential, life-saving surgeries based on weight. But people are crying foul and claiming that obese patients are being discriminated against. I disagree. If a patient is expecting tax-funded health insurance to pay for medical treatment, the patient needs to show commitment to the success of the procedure. In obese patients, this means losing some weight first. There is nothing wrong with asking a patient to put themselves in the best possible position before the surgery.
Here in the US, doctors are more lenient, but many will still not perform non-essential operations on a morbidly obese patient (BMI over 40, as opposed to 30 in the UK). People can claim discrimination if they want, but a more effective solution would be to lose the weight required and give themselves a better chance at having a successful surgery. This is part of taking responsibility for our own wellness. Yes, everyone should have health insurance and access to quality medical care. But we also have to be willing to make an effort to keep ourselves healthy.
