text: Patients who are too fat could be denied routine operations to save money, a survey of health bosses has revealed. More than a third of NHS trusts are considering rationing some types of surgery and other treatments. Several have admitted they may impose 'eligibility' rules which could affect smokers as well as the overweight. More than a third of health trusts are considering rationing some types of surgery and other treatments to save money, according to a new study . The criteria for accepting patients for operations would be based on their Body Mass Index, which measures obesity. When senior managers at 67 Clinical Commissioning Groups – local health trusts – were asked, 39 per cent said they were planning to 'limit access' to routine treatment for financial reasons. Procedures affected include varicose vein treatment, hip and knee replacement, and breast reduction surgery. Others said smokers might be denied some treatments, most commonly IVF. Senior doctors criticised the plans and accused health managers of denying patients vital treatment simply because they were considered to be 'undeserving'. Dr David Paynton, of the Royal College of GPs, said: 'Decisions about whether our patients are eligible for surgery or treatment need to be made on a case-by-case basis and by whether surgery will benefit a patient's long-term physical and mental health. 'It should not be the role of CCGs to impose blanket bans on patients' access to surgery, nor to decide who is and who is not deserving of potentially life-saving treatments based on their lifestyle choices. Obese patients could be denied varicose vein treatment, hip and knee replacement, pictured, and breast reduction surgery, while smokers could be banned from having IVF on the NHS . 'Of course, some procedures cannot be performed on patients who are above a certain weight. 'In these cases, a clinical decision needs to be made about whether surgery would be beneficial if the patient lost weight – but this is a separate issue.' Katherine Murphy, chief executive of the Patients Association, said: 'Each case must be individually assessed and each decision must be ethical and in the best interests of the patient. 'It is easy to target vulnerable patients and we must be very careful not to unfairly discriminate against people who aren't always able to speak out.' A Conservative Party spokesman said: 'If health bodies stop patients from having treatments on the basis of cost alone, then we will take action against them.' There are 211 CCGs in England so the survey by the Health Service Journal covered just under a third. Last year, a CCG in Devon threatened to ban all non-urgent treatments for anyone severely obese with a BMI above 35. This is equivalent to a 5ft 6in woman of 16st or a 6ft man being 18st 13lb. After an outcry, the policy was dropped. A survey by GP magazine last month found that 80 per cent of CCGs ration at least one procedure to patients who are very obese. Doctors have blamed excess sugar and carbohydrates for the surge in obesity – not the lack of exercise. They said poor diet was now recognised as being responsible for more disease than physical inactivity, alcohol and smoking combined. Yet, said the experts led by cardiologist Dr Aseem Malhotra, the public wrongly believed that obesity was due to a sedentary lifestyle. The doctors claimed that obesity has rocketed in the past 30 years, despite little change in physical activity levels. ‘This places the blame for our expanding waistlines directly on the type and amount of calories consumed,’ said Dr Malhotra. ‘Let us bust the myth of physical inactivity and obesity. You cannot outrun a bad diet.’ In the British Journal Of Sports Medicine, the doctors added that the ‘false perception’ on the cause of obesity stems from corporate marketing ‘chillingly similar’ to that used by the tobacco industry. They cited Coca-Cola associating its products with sport ‘suggesting it is OK to consume their drinks as long as you exercise’. Dr Malhotra, who works at Frimley Park Hospital, Surrey, is an adviser to the campaign group Action on Sugar. Around two-thirds of Britons are overweight or obese. The Government’s obesity adviser Professor Susan Jebb said the doctors failed to note that the best way to lose weight was combining a better diet with physical activity. ‘Rather than trade one off against the other – sugar vs fat, diet vs activity, individual vs population – we need to take action across the full range,’ she added. Tackling obesity without addressing physical activity was ‘tying one hand behind our backs’ said the professor. ‘It makes good sense to seek to change both diet and activity behaviours.’
target: More than a third of health trusts are considering rationing some surgery .
  Several admit they may impose 'eligibility' rules refusing some patients .
  Obese patients could be denied knee and hip replacements and breast ops .
  While smokers may be told they cannot have IVF procedures on the NHS .