The committee that plans and oversees medical care for the county of Hertfordshire, 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 “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 retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last 8 years, he has been blogging at SkepticalScalpel.blogspot.comand tweeting as @SkepticScalpel. His blog has had more than 3,000,000 page views, and he has over 18,000 followers on Twitter.