NHS BMI policies linked to surgery health inequalities

A new study has revealed that policies introduced by NHS clinical commissioning groups (CCG) pertaining to a patient’s body mass index (BMI) may have influenced the reduction in knee replacement surgeries.

The study, led by the University of Bristol and funded by the National Institute for Health and Care Research (NIHR), has implied that regional NHS CCG policies that partially restrict a patient’s access to knee replacement surgery, based on their BMI, are contributing to health inequalities.

Such policies were introduced over the last decade, with some regional sites enforcing a policy dictating that patient’s would be denied access to elective hip or knee surgery until their BMI was below a certain threshold.

The researchers analysed the rates of knee replacement surgery of 481,555 patients between January 2009 and December 2019 by using information obtained from the National Joint Registry and then compared regions with and without the aforementioned BMI policy.

Dr Joanna McLaughlin, NIHR Doctoral Fellow at Bristol Medical School and lead author of the study, said: “NHS policy on whether people can immediately access referral for knee replacement surgery if they are overweight or obese varies depending on where you live in England.

“Our study raises the concern that these policies are linked with worsening health inequalities with fewer NHS operations for the least affluent groups in society when policies are introduced.”

Whilst the research suggests that NHS policies might be inadvertently reinforcing health inequalities in the least affluent areas, a link has also been drawn to a rise in patients choosing to opt for private surgery.

The rate of surgery fell in all patient groups – not just those who are overweight or clinically obese who the rule changes were targeted at.

As a result of these revelations, the research team in question have subsequently urged the commissioners and policymakers to “reconsider restrictive policies that affect access to elective surgery as a matter of urgency.”

More information about study is available here.

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