Evening Standard, London April 30th 2007  [Colin Waine]

Millions of patients could be denied some NHS treatments because they are overweight or smoke.  The controversial policy has already been adopted by around one in ten hospitals - many of them battling to claw back huge cash deficits. Health Secretary Patricia Hewitt has stirred the row further, saying a ban on surgery to replace problem joints is "perfectly legitimate".  Doctors say the risks of operating on obese patients are higher and the treatment may be less effective, with new hips and knees wearing out sooner. Smokers can have a higher risk of complications.

But the spread of the policy has brought angry protests from obesity experts, Opposition MPs and patient groups. They say patients are being denied treatment to save money, rather than on clinical grounds, and point out that problems with joints can often be a reason for obesity, as sufferers cannot exercise. Dr Colin Waine, called the move 'very distressing' and said Miss Hewitt appeared to regard obesity as a "self-inflicted problem of which she can wash her hands".

A survey of 116 primary care trusts by Sky News found that nine are refusing joint replacements to obese patients and four have blocked orthopaedic surgery for smokers. The trusts, which cover six million patients between them, are almost all heavily in debt.  Miss Hewitt has endorsed their decisions, insisting that hospitals are "absolutely entitled" to set their own treatment guidelines.
Health trusts in Suffolk were among the first to say that obese people would be denied hip and knee replacements as part of an attempt to save money.

The survey found those with a specific policy of denying joint surgery to obese patients include North Staffordshire, Stoke, Lincolnshire, North Lincolnshire, Milton Keynes, Hereford, West Hertfordshire, East and North Hertfordshire and Suffolk.  North Staffordshire, Lincolnshire, North Lincolnshire and Milton Keynes are also refusing to perform joint surgery on smokers.

Surrey, South Staffordshire, Dorset, and Central and East Cheshire say they expect doctors to consider body weight and tobacco use before referring patients for surgery.  North Staffordshire has the toughest restrictions. To qualify for any routine operation, patients must have a body mass index below 30 and not have smoked for three months.

But Dr Waine criticised the use of the BMI system, which would rule out around one in five adults. He said experts now prefer waist circumference or waist-to-hip ratio as guides to obesity as they highlight abdominal fat.  He pointed out that rugby star Jonah Lomu had a BMI of 32 in his prime.
Dr Waine added: "Until you get to people who are very seriously obese there is very little evidence that outcomes of surgery are any worse. This is simply being used as an excuse for rationing."