SMOKERS and overweight people face barriers to surgery after doctors agreed restrictions to routine operations.

In one of the first programmes of its kind in the country, GPs have supported recommendations by NHS Hertfordshire, that will force the obese to lose weight and encourage smokers to quit before they are allowed orthopaedic surgery.

Patients with a body mass index (BMI) of more than 30 will not be given knee or hip replacements until they have lost weight through a programme supported by GPs and other services.

A healthy BMI – a calculation of weight to height – for adults is 18.5 to 25.

Tony Kostick, joint chairman of the clinical executive committee at NHS Hertfordshire, and a GP, said the move was aimed at reducing the need for surgery, as well as decreasing complications and increasing recovery rates.

He said: “There is good evidence that weight loss can reduce symptoms and may avoid the need for surgery later.

“Weight loss clearly takes time and if patients are really unable to make progress over a reasonable amount of time then they could still be offered surgery.”

Smokers needing routine orthopaedic surgery are now asked to go on at least one session with a trained advisor to receive advice on quitting before they are added to a waiting list.

Patients who refuse to go to a clinic will still be added to a waiting list, Dr Kostick confirmed, but the dangers would be clearly explained as part of the consent process.

The GP said the changes were legally sound and based on “strong clinical evidence”.

“Patients are at a higher risk of complications associated with surgery if they smoke or are seriously overweight,” he added.

“This is about the best outcome for patients.

“Clearly there will also be some cost savings associated with this, especially if patients no longer need surgery as a result of weight loss.

“NHS Hertfordshire has a responsibility to make absolutely the best use of NHS resources and we know that the people of Hertfordshire would expect us to do this.”