Obesity is a risk factor for osteoarthritis of the knee and hip, and many people being referred for joint replacement have elevated weight. All too often, I have had patients describe to me a terrible ordeal where they were sent home from the surgeon’s office, being told that their weight is ‘too high’ for surgery, and that they were sent home to lose weight (without any guidance on how) before they would ‘qualify’ for surgery.

Why are people with obesity being refused surgery? This stems from a couple of issues. As discussed in new Recommendations on Elective Totap Hip and Knee Replacement Surgery in Patients Living With Obesity, published in partnership by the Canadian Orthopaedic Association and Obesity Canada, research has shown that the risk of complications of surgery is higher in people with higher BMI, so blanket BMI cutoffs are often set above which a patient cannot access surgery, without considering each individual’s health status and candidacy holistically, and without considering strategies to minimize complications. There is also a weight bias and stigma that continues to pervade the health care system, which can result in blame, denial of care, and the completely useless instructions to go home and try again to ‘eat less, move more’ before surgery will be considered. Not only does this ‘advice’ directly contradict our natural human biology that defends weight, but in addition, severe osteoarthritis can impair ability to be physically active.

These new recommendations are an important step towards equitable access to joint replacement surgery for people living with obesity. They make recommendations that include these key points:

  • Weight bias: People living with obestiy deserve to be approached with compassion and empathy, and to be included as active participants in shared decision making. The health care team must communicate in a manner that is free of judgment, bias, or discrimination.
  • Equitable access: Obesity is not a reason on its own to deny people access to joint replacement surgery. A holistic assessment should be undertaken to understand risk/benefit profile for each person, and BMI should not be used as a limitation or cut-off threshold for surgical candidacy.
  • Weight loss before surgery: These discussions and advice should be individualized, including consideration of health holistically and access to treatments.
  • Collaborative care: A team-based approach is important to provide best care before, during, and afer surgery.

BOTTOM LINE: As eloquently written by Ian Patton, Director of Advocacy & Public Engagement for Obesity Canada on this topic,

You deserve more than ‘come back when you’ve lost weight’. Your body size does not determine your worthiness of care. You have the right to be assessed fairly, treated with dignity, and offered solutions. BMI is not a reason to deny surgery. Weight loss recommendations must be nuanced and thoughtful, and collaborative care amongst the health team is important to provide the best individualized treatment plan.

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