Great Britain is implementing policy changes that could preclude the availability of weight loss surgery for the obese. An article this morning read:

I always look to the United Kingdom’s National Health Service (NHS) for our possible futures, at least concerning healthcare. CNN highlights an interesting development on the other side of the pond; elective surgery will be withheld from current smokers (no surprise there) and the obese as measured by a BMI of 30 or more (for a 5’10” male 210 pounds). And this ban is permanent.

https://www.acsh.org/news/2017/11/02/no-more-surgery-patients-unhealthy-behavior-12077

This policy is illogical unless it contains a carveout for weight loss surgery.

UGH! These type decisions make me angry. First - BMI - is so ridiculous other than a broad indicator. One of my jobs at work is to interview potential living organ donors. One very handsome, athletic, man came forward to be a living kidney donor. He was initially rejected because of his BMI. He wanted to help his friend so much, he came to the clinic in person (initial interviews are over the phone) and the physicians were so impressed with how healthy he was - solid muscle. Muscle weighs more than fat for the same space. Beyond that, it is discrimination pure and simple. If we forbid everyone that ever had a "shortcoming" from surgery, we would have no surgeries. You are a diabetic - oh dear - were you 'compliant' 100% of the time? Did you take a medication that wasn't subscribed to you? Sorry! You have a past history of X, Y, Z - you are out. I do understand that certain behaviors or histories place you at greater risk. I also understand in a more socialized system, to stay functional/afloat, some restrictions have to be in place. But like James, the most effective treatment for morbid obesity requires surgery and can address a host of comorbid conditions. Any kind of ban would be counterproductive and discriminatory.

You need to read the article. It states that the obese patients need only reduce their weight by 10-15% over a 9 month timeframe in order to qualify for elective surgery. This wouldn't effect bariatric patients since we lose weight preoperatively anyway.

And smokers only have to stop smoking for 2 months prior to surgery.

It's a hurdle, but not an insurmountable one.

7 hours ago, Berry78 said:

You need to read the article. It states that the obese patients need only reduce their weight by 10-15% over a 9 month timeframe in order to qualify for elective surgery. This wouldn't effect bariatric patients since we lose weight preoperatively anyway.

And smokers only have to stop smoking for 2 months prior to surgery.

It's a hurdle, but not an insurmountable one.

It's actually kind of good...takes out the "magic bullet" appeal some people might think about it.

Well, I am not a fan of making healthcare HARDER to access. I think the point that @James Marusek was trying to make is that the changes coming are not good ones and run antithetical to better health. The changes in the British NHS have 0 to deal with health and everything to do with politics and money. If I had to hazard a guess, this is actually a play to begin to lower taxes for the wealthy and shift the burden onto the working class. By spending less money, the NHS would naturally need less money from the tax base so tax cuts can strategically happen for the wealthy. I'll bet England's wealthy elite have their eyes on what is going on in the States and they want some of those same tax advantages. Yes, I am more than a little cynical.

There are probably a few points.

One of the reasons why I had the surgery was that as I got older my metabolism began to self destruct. I adopted a regular exercise routine and dieted and still gained weight. So generally insurance plans in the U.S. place us on a 6 month diet and exercise program. Most of these plans do not mandate the percentage of weight to be lost pre-op but rather that we attempt it. I wonder how many people on this board lost 15% of their original weight during the pre-op stage. If this is adopted as a standard, how many would fail this test. And then suppose your knees gave out in the interim but because your BMI was above 30, that meant no knee surgery. It would be hard to do the exercise part of the program if you couldn't even walk.

Also the second point is that a BMI of 30 is a low number. My insurance plan says "Surgical treatment of obesity (bariatric surgery) is covered only if: clinical records support a body mass index of 40 or greater (or 35-40 when there is at least one co-morbidity related to obesity). Data published as a part of the World Health Organisation (WHO) study in 2014 indicated that 28.1% of adults in the United Kingdom were recognised as clinically obese with a Body Mass Index (BMI) greater than 30. That is an awful high percentage of people to deny elective surgery to.

Weight loss surgery can solve the obesity problem. If the health system really had the best interest of the people at heart, it would promote this health option by providing a carve-out.

Agreed, @James Marusek. If healthcare really cared about people instead of profits, they would do as you suggest.

Ok, so now we must talk about money.

I'm in the US, so don't have a national healthcare system and do have lower taxes than the UK. I have a middle class income.

I pay out about $5k a year in taxes. My surgery, done in Mexico, cost about $5k dollars. Total coincidence, I'm sure. But if 1/4 of the population went in for surgery and ended up spending all their tax dollars on their surgery, what that would mean for a nation's budget?

So, anyway, that is totally off the top of my head. Would make an interesting research project, utilizing actual facts and figures..

Basically, this is rationing to meet the needs of society. In some cases, it might be appropriate. Carrying the liver transplant patient analogy forward, some find the six-months abstinence rule offensive. However, a person can live without alcohol and will require anti-rejection drugs for life. If they cannot maintain compliance, they will die and the liver they received will have been wasted. There is a huge waiting list relative to the supply and living donation is more dangerous to the donor. Bariatric surgery does not require that another life be lost (i.e. deceased) or someone come forward to donate part of their own body. I believe one of the reasons follow-up for patients is critical for science is to provide evidence that supports practice. Would it be appropriate to deny someone a 2nd/3rd surgery? Perhaps -I don't know. We don't have unlimited resources and don't put enough efforts into prevention. Moving forward, how do we balance this? My fear is that those of us who struggle with obesity are viewed negatively and blamed for our own condition. I don't believe the answer is that simple, so I am not comfortable with a blanket policy without overwhelming science to support it.