Fat patients in Britain say elective surgeries denied because of their weight

For two years, Frances Kinley-Manton says she lived with arthritis pain in her hips, a condition that kept her in a wheelchair.

She wanted hip replacement surgery. But doctors at Britain's National Health Service said she was too fat for the operation.

"They wouldn't even put me on a waiting list," Kinley-Manton recalled.

Her doctor told the 210-pound woman to lose about 30 pounds before he would consider her for surgery.

Unable to drop the weight through dieting, the 68-year-old Scotland resident took out a mortgage on her house to pay for a private operation on the Mediterranean island of Malta. She had her first hip operation in July. Now she's awaiting surgery on the other hip.

"I had no alternative," she said in a telephone interview from the island. "NHS said they wouldn't operate on me because I'm overweight, but I think they were just trying to keep their costs down."

Since the first operation, Kinley-Manton said she's lost about 10 pounds, is walking more and is less dependent on her wheelchair.

Patient advocates say that Kinley-Manton is one of a small but possibly growing number of patients being denied nonessential surgeries by British health authorities because of their weight. No statistics exist on how many people are in a similar position, but patients' groups say they are getting a steady stream of complaints.

Doctors say obese people are at higher risk for surgical complications like infections and pneumonia, and that asking patients to lose weight is a fair request.

In Britain, some doctors appear to be setting a body mass index of 30 — considered obese in Britain and the United States — as an informal cutoff point for elective surgery. In the U.S. there are no absolute limits, but American doctors seem to be more lenient. One U.S. orthopedic surgeon suggested that not until a patient has a body mass index of 40 — a category considered "morbidly obese" — would surgeons have serious problems.

Kinley-Manton's BMI was 35 — about 30 pounds over the obese level — when she sought her first hip replacement.

She produced a letter from one of her doctors citing her body mass index as the main obstacle to surgery. Two of her doctors in Scotland wouldn't comment on her case specifically, but said that due to concerns about anesthesia and surgical complications, non-essential surgeries were often denied to patients with a BMI of 35 or above.

Kinley-Manton's doctors in Malta said they were puzzled that her weight posed a problem. Hip replacements cost about $14,600 at the hospital where she had her surgery.

"It's evident that there are a number of (hospitals) with a large deficit who are making decisions that have no medical bearing," said Michael Summers, a spokesman for Britain's Patients' Association, an advocacy group. "This is a very disturbing trend."

The Patients' Association said it got dozens of complaints every month about the National Health Service, including the refusal of surgeries to overweight patients. Obesity advocates said the issue has been raised at national medical meetings.

"We have never issued any guidance discriminating against the obese," said Vicky White, a spokeswoman for Britain's Department of Health. "But if doctors genuinely believe that the operative results will be better if a patient loses weight first, that is a valid clinical decision."

Fat patients have a statistically higher risk for complications for almost any medical procedure. In some orthopedic surgeries, their risk can be five times higher than for a normal-weight person.

"In a hip replacement, if the patient is obese, the doctor might not be able to see everything he needs to see," said Dr. Timothy Bhattacharyya, an attending orthopedic surgeon at Massachusetts General Hospital and spokesman for the American Academy of Orthopaedic Surgeons.

There are also logistical problems: positioning the patient correctly on the operating table and putting the joint in exactly the right place is more difficult with an obese patient, Bhattacharyya said.

Besides the risk of complications, obese people usually need more time to recover, experts said, and might even wear out their new joints more quickly because of the greater stress from weight.

British officials at the West Essex Primary Care Trust, a group of hospitals in southeast Britain, said they help obese patients lose weight by offering "health trainers." They said none of their patients has had a surgery delayed due to weight.

Colin Waine, chairman of the National Obesity Forum, challenges that claim:

"I don't think we could put our hands on our hearts and say that across the U.K., everybody who needs surgery is getting it."

Kinley-Manton considers her own treatment discriminatory.

"It goes against my principles to have come to Malta, but I didn't think the surgery was ever going to happen in the U.K.," she said.