All attorneys who handle medical malpractice cases know that juries have negative attitudes about patients who smoke or who are obese. In focus groups, we have found many who automatically blame a poor outcome, especially in cases involving surgery, on the patient who smokes or is obese. Part of that is the tendency of juries to blame patients in general, because they don’t want to think that any encounter with a doctor involves risks of poor outcomes for themselves. Part of it is the feeling that people should be personally responsible for their bad outcomes in life and not blame others. Surprisingly, in focus groups this attitude is persistent even for those who themselves are obese or smoke.

A recent development in England shows that health care providers share the negative view of smokers and obese people, but it is based on their perception that surgical outcomes for such patients are, indeed, less favorable. According to a story on CNN, a large county in England recently announced that it would not authorize elective surgeries unless obese patients lost a specified amount of weight first, and smokers quit smoking for at least eight weeks. The idea is that this would decrease hospital stays, have better outcomes, and save money for the National Health Service. Along with the requirement for pre-surgical changes was an offer of free counseling.

Many people disagreed, saying that it won’t work, may cause more suffering, and may even be more expensive because patients might need more care while they await their procures. Other reactions were based more on social attitudes. According to an article in the New York Times, a survey indicated that people “consider terms like obese, fat, and morbidly obese to be stigmatizing and blaming language used by doctors.” The procedure used in the English county seems to run counter to a recent trend to avoid “fat-shaming” or other negative attitudes about people who are different.