My patient was able to lose weight after her knee surgery | Zara Aziz

There are often excellent medical reasons for not treating people who smoke or are obese but referral criteria should not be too restrictive without good evidence

More than 80% of clinical commissioning groups (CCGs) now restrict routine surgery and other treatments for some patients unless they stop smoking or lose weight. Hip and knee replacements, fertility treatment and bariatric (weight loss) surgery are among the services affected.

Most referrals that I make to hospitals need to include information on smoking status and body mass index (BMI). For instance, a referral for physiotherapy is not accepted unless it includes BMI status. This is appropriate, as the outcome of this intervention is depends on many factors and the accepting clinician needs as much information as possible. However, with other treatments, a referral cannot be made at all if a patient’s BMI is over 30 (classified as obese) or they smoke. This criterion-based access applies only to routine and not emergency or urgent treatments.

Smoking cessation is the single most important lifestyle factor in disease prevention and improving health outcomes

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