Terrible idea to withhold non-emergency surgery from smokers, obese people.

Alocal health authority in the United Kingdom has decided to withhold non-emergency surgery from people who are obese and people who smoke. These patients won’t be able to have a medical operation under the National Health Service (NHS) until they “improve their health.”

This seems harsh given that being in poor health is usually the reason people seek medical treatment, not a disqualifying characteristic. But don’t worry. The change is being made “to support patients,” according to the Hertfordshire clinical commissioning group (CCG) that implemented the guidelines.

So, if you live Hertfordshire and suffer from one of the two more common human foibles, all non-urgent surgery is off the table for you (so to speak) until you are able to drop significant weight and/or stop smoking over a period of nine months.

The discouraging new policy is an example of how bad mainstream medicine remains at understanding what drives unhealthy behaviour.

The Hertfordshire CCG seems to think that losing weight and quitting smoking are just matters of willpower.

The reality is not so simple. Both endeavours do require willpower, of course. Significant will power. But willpower is far from enough.

Though society remains cruel to and disapproving of people who are significantly overweight, researchers have come to understand that environment and genetics are the most significant contributors to obesity — not people’s irresponsible approach to food and exercise.

Ironically, for the significantly obese, the only thing that evidence shows leads to very noticeable and lasting weight loss is not dieting and physical exercise, no matter the effort, but bariatric surgery. Yes, surgery. That thing the obese in Hertfordshire are being told they can’t have.

Quitting smoking can be similarly complex, since smokers must battle not only their minds, but a very real physical addiction to nicotine, as well. Not even eight per cent of smokers who try to quit without drugs or nicotine replacement therapy are able to do it. Those who do use drugs or nicotine replacement therapy are much more likely to succeed than cold turkey quitters. (Everything’s relative.) But we’re still talking about a very low chance of quitting — nowhere near 50 per cent.

For the purposes of this article, suffice it to say that smoking is considered one of the most difficult unhealthy behaviours to kick, and that’s not because smokers just aren’t trying hard enough.

Science and experience show that obesity and smoking aren’t problems that are going to be solved with simplistic solutions (Eat less! Move more! Butt out!). Conquering them takes significant support and intervention, in large part because they involve many different intricate biological systems, and the choices involved aren’ t totally rational or conscious.

What isn’t complicated is that trying to change habits by punishing patients through the indefinite withholding of necessary health care is not only unfair; it’s also a poor strategy.

First, the fairness side: the U.K.’s National Health Service is supposed to provide care to everyone.

As a universal publicly funded system, its job is to ensure that no person in Britain is denied free medical treatment, regardless of his or her income or circumstances or gender or disability or marital status or religion or belief, etc.

Surely that principle of equality was not intended to have exceptions made for smokers and obese people, as though these individuals are somehow morally undeserving of having their suffering relieved, perhaps because they’ve behaved badly.

The NHS itself says, in its Constitution, that is has a social duty to “pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.”

Smokers and the obese are such groups. Does paying attention to them mean refusing to serve them? If so, it’s not going to help.

The Hertfordshire CCG argues that reducing weight and quitting smoking lead to better surgery outcomes.

What it doesn’t address is how delaying needed surgery can lead to worse surgery outcomes.

Delaying surgery can also lead to lost months of work (if not lost employment), greater dependence on pain medication, the development of depression and anxiety, and — ultimately — a more complicated surgery than would have been needed at the outset.

Incidentally, all of the above make losing weight and quitting smoking a more difficult endeavour.

Predicting human behaviour is hard and changing human behaviour is even harder — just look how well the war against illegal drugs is going. If the Hertfordshire CCG really thinks the key to improving the wellbeing of its least healthy residents is banning them from surgery, it’ s either extremely ignorant or extremely arrogant ... or both. Whatever the flaw, it’s the people already struggling with a major health issue who will pay.