Headlines: March 17th, 2006

Obese patients deserve the same health care as those who are not overweight, according to an editorial article today in the medical journal “The Lancet”. It says that while denying a service to a customer is a business decision, medicine is not just any business.In November last year three primary care trusts in Suffolk announced that obese patients – those with a body mass index over 30 – would not be considered for certain operations such as hip and knee joint replacements. Consultants and family doctors in the area came up with a list of 10 conditions for which they said there should be a threshold before surgery would be performed.

Today’s Lancet leader, though, criticises the decision saying it is “not only ill-considered but also sets a very unwise precedent”. It is concerned, too, that the trend towards treating obese patients differently. Some surgeons in the United States were refusing operations or insisting that patients lost weight first. American hip and knee surgeons are working on guidance on the issue which will be produced later this month. “The Lancet urges that patients’ concerns be given top priority in these deliberations,” the leader writer says.

It says it is fair for surgeons to point out that obese patients are harder to operate on and that in a fee for service environment operating on fat people costs more. As the general population gets fatter, it adds, demand for joint replacements will increase.

The leader also refers to the fact that the British Medical Association has agreed that rationing is appropriate for obese patients and for those who smoke and drink whose choices have affected their health and should influence decisions on treatment. It concludes that while denying a service may be an appropriate business decision, medicine is not like any other business and obese patients deserve care just like their non-obese counterpart