[PHNUTR-L] U.K. curbs care for fat people
jgunn-mcquillan at nwhu.on.ca
Mon Dec 19 13:24:04 PST 2005
This is absurd. How is that for increasing the stigma and exclusion of
individuals in our communities. Wish the UK would consider a different
From: phnutr-l-bounces at mailman1.u.washington.edu
[mailto:phnutr-l-bounces at mailman1.u.washington.edu]On Behalf Of
Kathrynne Holden, MS, RD
Sent: Monday, December 19, 2005 3:14 PM
To: Public Health Nutrition List; Food and Nutrition Specialists;
Gerinet; gn at fiu.edu; ncc at list.empnet.com; Dietetics-L at sand.lyris.net;
Cc: Diabetes Care and Education DPG
Subject: [PHNUTR-L] U.K. curbs care for fat people
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U.K. curbs care for fat people
Local health authority near London says obese can't have hip or knee
Ipswich doctor cites financial constraints, says tight budget better
spent on slimmer patients
Dec. 17, 2005. 01:00 AM
SPECIAL TO THE STAR
London—Britain's cherished universal health-care system has started
denying treatment to fat people.
The first official move to refuse surgery happened last month when a
local health authority in Ipswich, northeast of London, announced that
obese people would not be given hip and knee replacements.
The move, which has been met with both praise and condemnation, comes
amid a story all too familiar to Canadians — hospitals facing cash
shortages at a time when the population is both growing and aging.
Dr. Brian Keeble, head of public health for Ipswich, acknowledged that
while the added risks of hip and knee surgery on obese patients were a
factor in the move, so was the reality of limited resources.
"We cannot pretend that this work wasn't stimulated by pressing
financial problems," Keeble said in a statement of the list of services
being reduced to save money, with joint replacements being the most
Keeble added that given the increased failure rate of the procedures on
overweight people, the limited amount of money available is better spent
on slimmer patients.
The Ipswich group has set a body mass index of 30 — the World Health
Organization's definition of clinical obesity — as the threshold at
which surgery will be denied.
Currently, one in five men and one in four women in the U.K. are obese.
Michael Summers, chair of Britain's Patients Association, a charitable
advocacy group, said the move amounts to discrimination.
"Obese or large people are as entitled to these surgeries as anyone else
because they pay for the NHS (National Health Service) just like
everyone else does," he said of the taxpayer-funded health-care system
set up in 1948. Along with social assistance, it's a key part of
Britain's welfare state.
"It is meant to be available to all; that was the entire premise. And
one might argue the elderly in need of hips and knees are even more
deserving because they have been paying for it even longer," Summers
said of the system.
The surgery limit has also ignited debate on whether or not smokers
suffering from lung ailments will be the next group to be denied
treatment if they refuse to kick the habit, and whether this trend
amounts to an attack on the poor, who have rates of both smoking and
obesity much higher than middle- and upper-class Britons.
"It's a slippery slope and it's not what doctors are supposed to be
doing with their time," Summers said of putting physicians in the role
But Tony Harrison, of the independent London think tank the King's Fund,
said the move amounts to a good dose of common sense given the reality
of limited resources.
"Rationing is a reality when funding is limited," Harrison said, adding
responsible health-service providers have an obligation to taxpayers to
get the most benefit out of the money they're given.
Harrison said the lower success rates for hip and knee replacements in
obese patients cannot be ignored.
"Ability to benefit is a key criteria. It is a valid point. If chances
of successful outcomes go down, you are wasting money."
The move is also tacitly supported by the government body charged with
giving guidance to local health authorities on what they should fund.
While stating in a new report that income, class or age should not be
factors in deciding treatment, the body, known as NICE (National
Institute for Health and Clinical Excellence), leaves room for doctors
to deny treatment based on cost.
"If, however, self-inflicted cause/causes of the condition influence the
clinical or cost effectiveness of the use of an intervention, it may be
appropriate to take this into account," it states.
In a scenario mirrored in Ontario in recent years, the Labour government
of Prime Minister Tony Blair has poured money — raised through a
dedicated tax — into the health system amid election promises to
dramatically reduce wait times for a host of procedures.
While most agree that the system has improved dramatically as a result,
local hospitals say they are being forced to make cuts in some areas in
order to deliver on wait time promises in others.
In Canada, federal Health Minister Ujjal Dosanjh hailed standardized
wait times agreed upon last week, which sets 26 weeks as the maximum
time a person should be expected to wait for a new hip or knee.
There are currently no formal weight restrictions for the procedure in
Canada, although it is not unusual for a doctor to advise a patient to
lose some weight before the surgery in order to reduce the risks
associated with the anaesthetics used and to speed recovery.
Dr. Peter Schuringa, president of the Ontario Orthopedics Association,
said Canada should not take any lessons from the British attempt to
ration health care based on a patient's lifestyle.
"Before we start telling people they cannot have a procedure because of
how much they weigh, we've got to find more creative ways to improve the
system and to finance more procedures," he said in a telephone interview
Schuringa stressed that finding new ways to fund more procedures in
Ontario needs to happen without punishing patients for being overweight.
"That's a very complicated issue, in part because people's ability to
exercise and lose weight is often severely compromised if they are
suffering from arthritic knee or hip joints," he said. But he added that
patients awaiting joint-replacement surgery are often advised to lose
weight before their operations
Most doctors also believe that replacement joints last longer if
patients are of normal weight. Schuringa noted that may reduce the need
for future surgery, saving patients pain and stress and the health-care
In Britain, the debate over how much patients can reasonably expect of a
taxpayer-funded health-care system has been raging in recent weeks over
both the joint-replacement issue and the death of soccer legend George
Best. An alcoholic, he received a liver transplant in 2002, but fell off
the wagon after his surgery and his health declined, leading to
rejection of the liver.
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
"Ask the Parkinson Dietitian" http://www.parkinson.org/
"Eat well, stay well with Parkinson's disease"
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
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