Surgery is safer after fat patients lose weight

SIR – It was with great concern that we read your report, “Denying surgery to the obese is cruel, say medical chiefs” (March 3).

There are clinical situations in which it is necessary to operate on obese patients urgently, in order to remove disease or alleviate symptoms. However, in many elective surgical groups, obesity is linked to such poor outcomes, prolonged hospital stays and increased costs that it is not only reasonable but also clinically desirable to reduce weight prior to surgery.

In patients with big abdominal hernias, there is overwhelming scientific evidence that operating in the face of morbid obesity significantly increases surgical complication rates and hernia recurrence rates.

It is unfortunate that Professor Derek Alderson, president of the Royal College of Surgeons, has felt the need to describe the refusal of surgery in such situations as “draconian and discriminatory”. Furthermore, it is simplistic of him to think that patients with poor mobility are unable to lose weight before an intervention. Control of calorie intake is much more important than trying to exercise off calories that have already been consumed.

The key to good surgical outcomes is to understand patients and tailor surgery to their needs. Part of that process involves optimising their health and clinical condition before surgery. Denying surgery under these circumstances is not cruel: it makes good clinical and surgical sense.

A C J Windsor FRCS

British Hernia Society

London NW1

SIR – You report (March 6) that manufacturers of food products may be told to reduce portion sizes.

I was recently in a self-service cafe in Sweden with a Swedish friend. As we queued, I pointed out how small the displayed cakes and buns were.

“Oh”, said my friend, “I was just thinking how big they are.” Sweden does not seem to have such a problem with obesity as we do.

Chris Andrews

Doncaster, South Yorkshire