A grandmother-of-three who needs a hip replacement has been told she must lose weight or she can’t have the operation.
Carol Bishop has arthritis and is in severe pain and very immobile. She fears without surgery she will suffer permanent disability.
The 73-year-old, who weighs 17 stone, claims medics told her she must lose three stone because of the increased risk that comes with operating on overweight patients.
But she has accused the NHS of ‘fat discrimination’ and said she was operated on previously when she was the same weight.
If it was an ethnic group they were saying this to there would be an outcry
Carol Bishop
The retired day centre worker said: “It’s a lot of weight to lose at my age. It’s fat discrimination. If it was an ethnic group they were saying this to there would be an outcry.
“I think they are saying it to save money.”
A spokeswoman for Yeovil Hospital said staff were led by national guidelines, and “being overweight significantly increases the risk of complications”.
A report found that most overweight patients in England face being denied surgery, even when this goes against national guidelines on clinical best practice.
The Royal College of Surgeons is concerned that patients are being left in pain and distress unnecessarily.
Fears of deterioration
I’m not ready to be in a wheelchair and have people do everything for me
Carol Bishop
Carol, from Mudford, Somerset, had her right hip replaced on the NHS around 13 years ago. “I’m wearing the same clothes now as I was then, so I know I am the same size,” she said.
She was referred to Yeovil Hospital for a pre-surgery appointment in July where medics told her she had to lose weight before they’d operate. She said she initially lost around a stone, but the surgeon told her to lose more.
Carol fears that without the operation, her health will deteriorate further.
“I’m in pain. I’m not even that comfortable in bed. I can’t even have a bath now because I can’t get out of it,” she said. “I’m worried I’m not going to be able to get up the stairs soon.
“Once the hip goes they can’t do anything about it. I’m not ready to be in a wheelchair and have people do everything for me.”
Carol says she is trying to lose weight, but thinks three stone is unachievable – and she is afraid she will be left with hanging skin.
“I’m as active as I can be. I had a phone call from our medical practice. She said ‘have you thought about going to the gym?’ I said ‘pardon?’ I can hardly lift me foot off the ground, how can I go to the gym?”
A spokesperson for Yeovil Hospital said it could not comment on individual cases but added: “Hip replacement surgery is an invasive procedure and being overweight significantly increases the risk of complications during surgery, while under anaesthetic, and in recovery.
“This is always taken into consideration when deciding on whether surgery is the best treatment option for a patient at that time.”
It’s about cost, say critics
CCGs are increasingly frank that it is all about cost
The Patients’ Association
In December 2017, the BBC’s Reality Check team asked the 213 local clinical commissioning groups (CCGs), responsible for planning and buying healthcare services, in England whether they limited funding for surgery on the basis of body mass index (BMI).
BMI is a popular measure of body fat based on height and weight but health experts say isn’t always the best way of determining healthy body weight.
It was found that of the 170 CCGs’ policies analysed, 133 – 62 per cent of all CCGs – said they were using patients’ BMI to limit which surgeries they would fund.
Treatments restricted include hip and knee replacements, breast reduction, varicose vein surgery and other plastic surgery including removal of excess skin.
The National Institute for Clinical Excellence (NICE), which sets guidelines for the health service, states that obesity and smoking “should not be barriers to referral” when it comes to joint surgery.
Critics argue that CCGs lowering their BMI thresholds is motivated by cost-saving rather than patient safety.
The Patients’ Association, a charity representing the concerns of people using health and care services, told the BBC: “Any decision to withhold a treatment should be assessed on an individual basis and be in the best interests of the patient.
“However, CCGs are increasingly frank that it is all about cost. In a wealthy nation, cost is no justification for a patient not receiving the healthcare they need, and particularly not relatively simple procedures which are known to be effective.”