Treatment denied based on BMI

Can anyone point me in the direction of a NHS document/policy that states that people will not be treated for lymphedema if their BMI is beyond a certain number? I suspect that this may be a local policy versus national. I am a therapist (Aussie, living in US at the moment), and just read a post elsewhere from a UK lady saying she has been denied treatment based on her BMI. I feel angry and sad for her. We can't discriminate based on sex, religion, race etc but now BMI can be used as a tool to turn people away from necessary treatment. Anyone know anything about this, and how this lady can get the required treatment? Many thanks.

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  • You could try contacting the LSN via their website - there are some papers available, but limited, as the protocols vary between health authorities in both private and NHS hospitals. Patients with Lipoedema are faced with even more of an uphill struggle for diagnosis because of the obsession with BMI.

    As you are in the US, see if you can glean any support from lymphaticnetwork.org

    Xx

  • OMG I hope not I am already facing battles with doctors over this issue regarding other health problems. for example 7 years ago when I weighed a lot less and was pretty fit I damaged my knee exercising. It took over a year for a gp to send me for an xray and then to a consultant where I was told to my face I could not have knee replacement because I was "too fat" the consultants actual words and I have faced abuse like this since from various health professionals. Because they didn't help me then my mobility has reduced further and I have put weight on and now I have other health issues. I think this is just an excuse to avoid treating people who need help just to save money. After all if someone is over weight it is always seen as their own fault even if it isn't. Easy targets. Still discrimination.

  • Hi Hebden, I don't think this policy is at every lymphedema clinic - but I've seen this type of discriminatory talk happen before between professionals - it's not professional nor fair. So I've suggested this lady keeps hammering away at the clinic, to break down this barrier.

  • I think a majority of doctors if you are overweight think to themselfs what does she expect everything I went to doctors about they nagged me to lose weight so I thought I would do what they said and lose weight the doctor booked me in to a weight control class I enjoyed it a lot as I met people and made friends I was going there for a year and basicly we were told that's it leaving us to deal with it on their own a lot just did not bother anymore but I was determined to succeed and kept it up over the period of four years I lost twenty five stone as you can tell I was mega over weight as I weight sixteen stone now I was admitted to hospital in 2013 to find out I had heart condition liver count was 1300 when it should normally be about 290 many trips to hospital to sort that out the doctors said losing weight would help with my mobilty before I lost weight I had high blood pressure and lymphoedema now on top heart problem and mobility is near zero I can hardly move I said to doctor I am worst now than I ever was my heart problem could be due to losing weight too fast I only followed what they told me to do the doctor even said I did not need to go to hospital I admitted myself the hospital gave me the weekend to live as my heart was in such a state if I had not gone myself and believed in the doctor I would have died so all I can say to this doctors do not always give you good advice and argue with if you feel they wrong not just do what they say after all you know how you feel

  • Thank you for replying to my post Brandish54. Ive been trying to lose weight and keep it off since I was 16 years old. I could never get below 12 stone even when all I ate was grapefruit and water. My weight increased further after having children. Ive tried loads of different diets and hardly lost weight with any of them and always put all the weight lost back on plus more and am now at my heaviest ever and classed as morbidly obese (I hate the words). I think all the dieting Ive done over the years has caused the problems I have now including unexplained weight gain, osteoarthritis, fibromyalgia and I believe thyroid problems. Ive just had a health check and the nurse and gp were surprised that my blood pressure, glucose and cholesterol were all good. They completely ignored my lymphoedema and ever increasing TSH (thyroid measure). I know I eat healthily as I have seen several dieticians who have said so. I have now been at weight watchers 2 weeks and I have lost 1 pound which I think could be where I had lighter shoes on and no coat. You are right what you say doctors always think they are right but half the time they don't listen. Good job you listened to yourself and went to hospital.

  • Play them at their own game, and ask for help in reducing weight - citing that reduced mobility has caused you to gain weight.

  • I am, at the request of my gp going to weight watchers and following their plan I have lost 1 pound in 2 weeks. Last year I attended obesity clinic (again sent by gp) where the only help offered was bariatric surgery and after 5 months attending I had put more weight on. I refuse to have bariatric surgery because it causes nutrition deficiency which I am already struggling to keep optimised on supplements and I have other health issues to contend with. Also I could not get a proper answer from the health professionals about after care. The year before this I attended 12 weeks of a private weight loss clinic (again gp) and lost 2 pound in 12 weeks. I also truly believe after many years of diets my weight issue is not food related but hormone and other health problems.

    They seem to ignore the fact that I cannot walk without pain or even my concerns over thyroid issues and lymphoedema.

  • Hi Hebden - weight loss is incredibly difficult for you. Weight watchers is great but maybe not enough. I don't know if you can get more support - a dietician that takes the time to really get to know you and help identify things that will improve your food choices, and an exercise physiologist (that is trained in helping people with difficulties in moving and other health issues). And this forum.

  • This is crazy! My weight has steadily increased over the last couple of years as swelling has got worse. I've tried to lose weight, but only managed to maintain it over the last few months. I see weight increase as a complication of lymphedema. Surely we can't be effectively punished because of something lymphedema causes/doesn't help with. I mentioned my weight loss problem at my 1st clinic appointment, they didn't put any pressure on me to lose weight even though I'm at the top end of 'overweight'. So, a regional issue? So wrong though. Even if they do support you/refer you for weight loss help, what if you don't lose weight? They're playing with people's lives. LSN for guidance? Lobby your MP?

  • Thanks KJ - yes, I suspect it may just be the local clinic that is the culprit. The lady who has been denied treatment has plenty of ideas now on how to either get into the clinic (advocate, gain support, question, contact MPs etc) - or just go elsewhere. I've recommended she keep questioning them - cos discrimination just ain't fair, and a number is not always enough to decide if someone is 'fit for service'.

  • I had a BMI around 44 and wasn't refused NHS treatment, even for surgery. I'm a broad shouldered male so the BMI is flawed for the likes of me, if I was the "ideal" weight for my height, I would be ill. However I have reduced my weight, and BMI, to 38 and I feel great AND my leg has reduced from 59% bigger than my good leg to 39%. According to my consultant the excess weight on your stomach acts as a tourniquet to those deep lymphatics that are so important, reducing the weight helps open up the lymphatic channels and improves the effectiveness of compression.

    I am useless at losing weight because someone tells me I'm overweight however explaining the biology of it was all the incentive I needed.

    We lymphies are never going to be the skinniest but taking a little weight off can easily help reduce the swelling

  • Thanks Syrup - well done. Yes, losing weight can have a dramatic effect on lymphedema.

  • Great post Doctor Life!

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