More than one in four PCTs are implementing so called ‘fat and fags’ measures which could restrict access to treatments for people who are obese or smoking.
Restricted treatments for obese patients include hip and knee replacements and IVF treatments. The terms of the restrictions vary between different PCTs. NHS Bedfordshire requires patients to achieve a BMI below 35 or to lose 10% of body weight to being eligible for hip and knee surgery. NHS Hertfordshire has drawn up more severe restrictions, preventing patients with a BMI over 30 receiving any routine (non-emergency) surgery.
The restrictions have raised questions from GPs and patients over whether the restrictions are discriminatory, pointing out that obesity has higher prevalence amongst the less well off. Dr Clare Gerada, chair of the RCGP, commented: ‘It’s becoming the deserving and the undeserving. I think it’s discriminatory and I find it astonishing. The Government should determine what should be applied universally.’
The restrictions on account of obesity are likely to affect a significant number of people with type 2 diabetes and prediabetes who may need surgery. Smokers have also been targeted for restricted access to surgery, within some care trusts, unless they start a smoking cessation course.

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