Controversial U.K. Policy Withholding Surgery from Smokers and Obese Patients

The United Kingdom’s county of Hertfordshire has expanded a controversial health care policy that withholds surgery from patients who are obese or who smoke. The policy was originally implemented in 2011 and, at the time, only applied to hip and knee operations. In 2012, it was expanded to include other non-urgent routine surgeries. Under the policy, patients were banned from having surgery for a specific period of time as an effort to urge them to improve their health by losing weight or quitting smoking in order to become eligible for surgery. However, the most recent expansion of the policy is labeled as an “indefinite” ban on all routine surgeries until the patient’s health is improved.

Proponents assert that the expanded policy will help patients improve their health while also alleviating the county’s health care budget and reducing length of hospital stays. Opponents, however, argue that the policy is unethical.  One professor of psychology, Robert West, has expressed that “[r]ationing treatment on the basis of unhealthy behaviors betrays an extraordinary naivety about what drives those behaviors.” Although reducing obesity and smoking prior to any surgery is beneficial to a patient’s recovery, it remains unclear whether withholding surgery altogether is actually successful in improving overall health.

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The Impact of Obesity on Nursing Homes

Nursing homes in the United States are finding themselves both overwhelmed and unprepared to accommodate the recent influx in moderate to severely obese patients, whose numbers increased over 10% between the years 2000 and 2010. The inability of nursing homes to accommodate these patients has been attributed, at least in part, to the lack of specialized equipment necessary to care for severely obese patients, such as motorized lifts and larger wheelchairs. Although the Medicaid program covers over 60% of all nursing home residents nationwide, Medicaid does not generally cover the specialized equipment required by obese patients, placing the economic burden of purchasing such equipment on nursing homes without providing reimbursement.

Unfortunately, due to the economic burden of caring for obese patients, some of the nation’s largest nursing home chains, such as Genesis HealthCare, have begun to close bariatric care programs. As a result, hospitals must find alternatives to nursing home care for obese patients who cannot be safely discharged back to the community. Although some experts argue that obese patients may be able to challenge denials of nursing home admission, the issue is “far from settled” and finding new methods of transitioning obese patients from hospital care to community care is poised to become a pressing issue of public concern.


Childhood Obesity May Be Underreported

The body-mass-index measure (“BMI”), a calculation based on a person’s height and weight, is commonly used to screen for obesity as an indicator of a person’s body fat. However, a recent study revealed that BMI measures are failing to identify up to 25% of children who have excess body fat. According to the Center for Disease Control, “about 18% of children ages 6 to 9 are classified as obese based on their BMI”. However, some experts think that this number is much higher because children’s height and weight do not increase proportionately with age, making BMI measurements less reliable. Although more accurate methods of measuring body fat do exist, the BMI measurement is likely the most accessible.

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New York’s Highest Court Rejects NYC Sugary Drink Ban

In June, the New York State Court of Appeals ruled against New York City’s ban on selling sugary drinks larger than 16 ounces. The Court held that the city’s Board of Health “exceeded the scope of its regulatory authority” with the regulation.  This is the third time that New York courts have decided against the “big-soda ban” and was the final blow to the regulation. Although New York City Mayor Bill de Blasio indicated that his administration would consider other ways to curb the obesity epidemic, no new proposals have been announced.

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Doctors May Be Less Empathetic Toward Fat Patients

According to a recent study published in Obesity, physicians may be less empathetic toward obese and overweight patients.  The study did not find that physicians provided less quality care to obese and overweight patients.  However, the “lack of emotional rapport” can significantly impact whether a patient follows his or her physician’s medical advice.  As a result, Dr. Kimberly A. Gudzune, the lead researcher on the study, believes that physicians should increase efforts to empathize with overweight and obese patients. Providing this type of emotional support can play a critical role in developing a long-lasting healthy lifestyle.

Read the original article here.

Cass Sunstein Reviews “Against Autonomy: Justifying Coercive Paternalism”

In Against Autonomy: Justifying Coercive Paternalism, author Sara Conly rejects the concept of autonomy as absolute. Specifically, in light of recent behavior studies and social psychology, Conly rejects John Stuart Mill’s confidence in individuals as the most capable decision makers.  As a result, Conly writes that coercion in the form of government mandates and bans is an acceptable means of achieving public health.  According to Cass Sunstein’s review of the book, Conly’s argument is convincing, and emphasizing autonomy may be inappropriate when individuals continue to impose serious risks on themselves while ignoring the consequences of their actions.  Read more about Sunstein’s review here.

Social Pressure and the Fight Against Obesity

Daniel Callahan of the Hastings Center has authored a controversial article appearing in the the January-February edition of the Hastings Center Report. The article urges several methods to combat the public health problem presented by rising obesity rates, such as increasing government regulation, business initiatives, and social pressure. This last method, increasing social pressure, is arguably the most controversial prevention method discussed in the article. Although Callahan argues that increased social pressure has been effective in the fight against smoking, numerous responses to the article find Callahan’s argument objectionable. The objections primarily focus on the impact of stigmatization and the demeaning effect on individuals struggling with being overweight or obese. The Hastings Center is inviting additional responses to the article here and more about the responses to the article can be found here. Read the actual article, Obesity: Chasing an Elusive Epidemic, here.