Obese patients denied knee and hip replacements to slash NHS costs

Independent

31-05-2025

Obese patients are being denied life-changing hip and knee replacements and left in pain in a bid to slash spiralling NHS costs, The Independent can reveal.
One third of NHS areas in England and multiple health boards in Wales are blocking patient access based on their body mass index (BMI).
The move, deemed 'unfair' and 'discriminatory', goes against guidance from the National Institute for Care Excellence (Nice), which states BMI shouldn't be used to restrict patients' access to joint replacement surgery.
Patients are instead being told they must lose weight before they are eligible but waiting lists for NHS weight loss programs have ballooned, with some people waiting up to three years to be seen while other services have shut, unable to cope with demand.
The Royal College of Surgeons criticised the policy, saying that denying patients care could cost them their mobility and cause their health to deteriorate, while Tory peer and former health minister James Bethell called on the government to do more to tackle the obesity crisis and end the 'misery for millions'.
More than 64 per cent of adults in England were overweight or living with obesity in 2022-23, up from 63 per cent the year before, the most recent data from the Office for National Statistics shows.
The news comes as 7.4 million people were waiting for NHS treatments in March, while health service leaders have warned they are being forced to cut services to meet tough savings demands from the government.
The shocking revelation of surgery refusals was uncovered in an audit of referral criteria used by NHS bodies in England by the National Institute for Health and Care Research (NIHR).
It found 15 of 42 areas are restricting access to surgery by BMI, while The Independent discovered at least two health boards were doing the same in Wales. Thresholds varied by area, with some limiting access to those with a BMI of less than 35 (patients who are obese) or 40 (severely obese).
Dr Joanna McLaughlin, lead researcher and NIHR clinical lecturer at the University of Bristol, told The Independent that through her research, policymakers, commissioners and surgeons 'acknowledged that NHS financial pressures were a main driver for BMI threshold policy use, and that they didn't have confidence that the policies were based in evidence of health benefits'.
The research also found that NHS weight management support services were 'inadequate' and could not ensure that those excluded from surgery could be supported to lose enough weight. Some patients had resorted to paying privately for surgery.
Dr McLaughlin said: 'The variety in the BMI limits and in the requirements to prove patients have made attempts at weight loss chosen by different ICBs [integrated care boards] highlights the postcode lottery and inequalities created by these policies.'
Several ICBs identified by the study told The Independent that some patients with a high BMI could still access care if they passed an assessment, while others said they would need to prove they were 'fit for surgery'.
But medics told The Independent that BMI should not be used as a sole restrictive measure.
Tim Mitchell, president of the Royal College of Surgeons of England, said losing weight before surgery could reduce the risk of complications, and patients should be supported in this.
However, he said that 'BMI alone should not be a barrier', adding: 'We must not penalise those who are less fit but still eligible for surgery, as this approach is unfair and ignores clinical guidance.'
Mark Bowditch, president of the British Orthopaedic Association, said: 'Losing weight before surgery can be very difficult for people with limited mobility issues.
'Furthermore, obesity is more likely in people from certain socioeconomically deprived areas or ethnic groups, so care must be taken to avoid unintentionally disadvantaging certain patient groups.'
Deborah Alsina, chief executive of charity Versus Arthritis, said: 'We hear heartbreaking stories from people desperate for the pain to stop, and accounts from people who face barriers to access even when they are referred for the surgery they urgently need.
'We frequently hear of people denied a referral, or being taken off the waiting list because of their weight, with body mass index being cited as a rationale. We must make sure this discriminatory practice doesn't become standard.'
Lord Bethell said the row over BMI thresholds for operations showed the NHS 'needs to make a choice' over preventing disease with weight-loss jabs, which cost £100 a month, or to treat obesity-related diseases, such as those that lead to hip operations, which can cost £10,000.
He said the government has a choice to either crack down on 'Junk Food Britain' with a tough food strategy or to give the NHS a lot more money to pay for the consequences of a sick population.
He added: 'It's one or the other. Ducking this choice will cause misery for millions, the bankruptcy of our nation and the end of the Starmer administration.'
A Department of Health and Social Care spokesperson said it expected ICBs to comply with Nice guidance. They added that the department's 'Plan for Change' for the NHS includes rolling out weight loss drugs to 'those who need it most'.