Obesity is a serious global concern and has been linked with many different illnesses and conditions, causing excess healthcare expenditure and costing countries in the form of lost productivity. It is believed to affect two-thirds of the adult population in the UK, and according to recent reports, over 1 million people in Britain are claiming sickness benefit as a result of their weight.
There are some operations which patients are advised not to undergo if they are classed as obese, as excess weight is known to affect how well patients can recover from surgery and the NHS’s recent rationing measures will mean that severely overweight and often even mildly overweight patients will just not have access to joint replacement surgery through the NHS.
Interestingly, a recent study has found that total hip replacement surgery is still a more cost-effective option than other means of managing a patient’s pain and lack of mobility as a result of joint wear and tear, whatever the weight of the patient. Results of this Canadian study have been published in The Journal of Arthroplasty and make interesting reading.
It is accepted that the risks associated with total hip replacement increase for overweight patients, but the report suggests that despite these risks, the outcomes are still more positive compared with the available alternatives.
Some surgeons feel that it is simply a case of weighing up the risks against the potential benefits. In terms of managing the decision-making process, it is important to fully discuss the risks and rewards with patients in higher risk categories, such as those with a high BMI, so that the patient and surgeon can agree on the most suitable course of action and manage the risks accordingly.
Obesity and hip replacement surgery: using weight as a screening factor for hip replacement
The report authors suggest that obesity, as assessed by the Body Mass Index (BMI), is being used as a screening technique to help manage budget constraints, in the face of limited financial resources. BMI is one of the factors used by NHS purchasers when assessing patients’ suitability for this type of operation.
Study co-author Edward Vasarhelyi explains that “many developed countries are facing increasing budgetary pressures across the spectrum of healthcare. We have seen changes in funding models, such as bundled care payments. These models have put pressure on clinicians and administrators which, in some healthcare systems, has resulted in the refusal of surgery for patients above arbitrary BMI cut offs.”
Many feel that restricting life-changing surgeries such as total hip replacements for those who are carrying too much weight is not the solution. They recognise that obesity is a challenge for patients and for the NHS and that more needs to be done to reduce the number of people who are classed as overweight.
For patients, making subtle changes to lifestyle can have a marked effect. Paying more attention to what is in the foods we buy and taking steps to cook with fresh ingredients, rather than overly processed meals is a great starting point. Couple this with efforts to exercise more, for example, walking rather than taking the car or bus, and patients will soon notice differences to how they look and feel.
Losing weight before a joint replacement is ideal, as taking steps to try and lose weight will give them a greater chance of a faster, simpler recovery, with reduced complications. Mr Simon Bridle understands that this is often difficult for people with limited mobility and that patients will decide that the potential benefits of surgery outweigh the risks.