Adults with obesity are being denied hip and knee replacements in a bid to relieve NHS financial pressures, a new study has revealed.
To reduce spiralling NHS costs, more than 33% of NHS areas in England and some health boards in Wales are stopping people with a high BMI from receiving a hip or knee replacement.
However, this is not supported by the National Institute for Care Excellence (NICE) which states that “BMI shouldn’t be used to restrict patients’ access to joint replacement surgery”.
Adults with a high BMI are now told to shed the pounds before they can undergo hip or knee replacement surgery.
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NHS weight loss programmes have however skyrocketed in popularity, with some people waiting up to three years to be seen.
“Denying patients care could cost them their mobility and cause their health to deteriorate,” said the Royal College of Surgeons of England.
In 2022-23, nearly 65% of adults in England were overweight or living with obesity, data from the Office for National Statistics has revealed.
According to health service leaders, they have no other choice but to cut services to meet tough savings demands from the government.
An audit by the National Institute for Health and Care Research (NIHR) highlighted the shocking revelation of surgery refusals.
The NIHR audit results have shown that 15 of 42 NHS areas are restricting access to surgery by BMI, with some limiting access to those with a BMI of less than 35 (patients who are obese) or 40 (severely obese).
First author Dr Joanna McLaughlin said: “NHS financial pressures were a main driver for BMI threshold policy use, and that they didn’t have confidence that the policies were based in evidence of health benefits.
“The variety in the BMI limits and in the requirements to prove patients have made attempts at weight loss chosen by different ICBs [integrated care boards] highlights the postcode lottery and inequalities created by these policies.”
Tim Mitchell, President of the Royal College of Surgeons of England, said: “Losing weight before surgery could reduce the risk of complications, and patients should be supported in this.
“BMI alone should not be a barrier. We must not penalise those who are less fit but still eligible for surgery, as this approach is unfair and ignores clinical guidance.”
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Mark Bowditch, President of the British Orthopaedic Association, said: “Losing weight before surgery can be very difficult for people with limited mobility issues.
“Furthermore, obesity is more likely in people from certain socioeconomically deprived areas or ethnic groups, so care must be taken to avoid unintentionally disadvantaging certain patient groups.”
Deborah Alsina, Chief Executive of Versus Arthritis, said: “We hear heartbreaking stories from people desperate for the pain to stop, and accounts from people who face barriers to access even when they are referred for the surgery they urgently need.
“We frequently hear of people denied a referral, or being taken off the waiting list because of their weight, with body mass index being cited as a rationale. We must make sure this discriminatory practice doesn’t become standard.”
