Elective Surgery? Stop Smoking and Lose Weight

Health Editor's note: An elective surgery is one that can be scheduled at any time by the doctor, patient, or hospital. Examples of an elective surgery would be a face-lift or breast augmentation. The surgery is not being done for an emergency. A part of England has adopted the practice of not doing elective surgeries on patients who are obese or smoke. The health care programs in England offer free help with losing weight and cessation of smoking. The idea is that the patient will be in a more optimal condition to allow for successful surgery without complications that can be caused by obesity and smoking. Complications from surgery add days to hospital stays and increase healthcare costs. Do you think this is a good or bad idea?


English county to bar patients from elective surgery unless they lose weight or stop smoking.

by Skeptical Scalpel MD November 24, 2017

The committee that plans and oversees medical care for the county of Hertfordshire in England announced recently that unless obese patients lose a specified amount of weight and smokers quit smoking for at least 8 weeks, they will not be allowed to undergo elective surgery.

Patients with a body mass index (BMI) greater than 40 must lose 15% of their weight within 9 months, and patients with a BMI over 30 must lose at least 10%. Free counseling for weight loss and smoking cessation is available to all.

Variations of these rules have been in effect in about one-third of England for quite a while. In some areas, similar rules have been waived if patients fail to meet their targets after a certain period of time. The Hertfordshire rules are unprecedented because they are in place indefinitely.

The idea is that losing weight might decrease hospital lengths of stay and the incidence of complications after surgery and lead to better outcomes while saving money for the National Health Service (NHS).

Opponents question the ethics of the decision, doubt that withholding surgery will work, believe the delay will cause more suffering, and even may be more expensive because patients might need more care while they await their operations.

According to a CNN story, the Hertfordshire committee countered that the policy would “encourage patients to take more responsibility for their own health and well-being.”

More than 60% of adults in Hertfordshire, a county of over 1.1 million, are overweight or obese, and almost 16% are smokers.

Surveys have shown that the public supports the committee’s proposal with 85% agreeing that people should lose weight and stop smoking.

However, some may be taking it a little too far. Back in September, the Hertfordshire Mercury reported a nurse was sanctioned by the Nursing and Midwifery Council for calling an obese patient “Jabba the Hutt.” She also told him he was too fat and wouldn’t let him have fish and chips for dinner.

According to Jane Brody in The New York Times, a survey showed that people “considered terms like obese, fat, and morbidly obese to be stigmatizing and blaming language used by doctors.” About 20% of those surveyed said they would find a new doctor if they felt stigmatized about their weight.

Free counseling probably won’t work either. Since November 2011, free weight-loss counseling has been available without co-pay or deductible for all Medicare beneficiaries. Only 120,000 seniors — less than 1% of those on Medicare — took advantage of that benefit.

I do not know if the Hertfordshire committee’s plan will result in people losing weight and stopping smoking before surgery. What I do know is, calling a patient “Jabba the Hutt” will not work.

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel. This post appeared on Physician’s Weekly.

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  1. Just walk down Any Street USA and take note of the condition of America: fat, obese dangerously obese, some, I wonder how they can even motivate except to walk into the nearest McClown burger and order a double supersize burger, fries and high fructose sweetened soda.
    Watch the Movie “Super Size me” and find out just how bad fast food really is. Then consider the massive profits the fast food industry rakes in every year.
    The consumption of wheat products. The wheat now grown commercially has no food value. It is all GMO, gluten, and contaminated with glyphosate, that has been proven to be one of the causes of obesity not to mention carcinogenic. Glyphosate enters the digestive tract and kills all the useful bacteria in the gut, therefore the absorption of nutrition no longer takes place. The individual then eats even more to make up for the loss of nutrients.
    The two main destructive additives in the American diet are High fructose Corn Syrup and GMOs, particularly wheat.
    To see the results of diets filled with such just look at school kids these days. far too many are over weight to the point of obesity. I see young women, still in high school with rolls of blubber hanging around their bodies. What boy would want to marry a woman like that? Let alone go out with? The damage being done at that early age can lead to fatal consequences later on: diabetes, cancer, heart disease and affects reproductive rates. I know many people who are struggling with diabetes, some dangerously so.
    What people put into their mouths affects their lives and their mental well being. If one chooses to consume, cookies, ice cream, candy and soda pop along with high intakes of wheat products, they should not be surprised at the consequences.
    Apart from far too many Americans who live a sedentary life style.

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