PATIENTS who are overweight or smoke should be denied operations until they are fitter, the health secretary has declared.

Patricia Hewitt says it is right for doctors to order individuals to lose weight or give up cigarettes before they are treated.

In an interview with The Sunday Times she described the move as “best practice” because operations are less likely to succeed on people who are very fat or smoke heavily.

It is the first time the health secretary has explicitly endorsed the policy, which has been adopted by some health trusts.

Hewitt said the government wanted to see people taking greater personal responsibility for their health. But patients turned down for surgery because ofunhealthy habits should immediately be offered help to change their lifestyle.

Doctors are concerned that the policy could be exploited by some NHS trusts to save money. They also question the criteria that will be used to judge an appropriate weight for surgery. About one in five adults and 16% of children have a body mass index (BMI) of over 30, the level considered clinically obese.

Hewitt said she supported thetrend of GPs and surgeons to make decisions about whether it is appropriate, and safe, to operate on smokers or patients who were so overweight.

She said: “What I’ve been seeing . . . is more and more health centres and GP practices focusing on that kind of support. They will say to patients, you shouldn’t have this operation until you’ve lost a bit of weight and stopped smoking.”

Her comments are in line withguidelines published a year ago by the government’s drug rationing body, the National Institute for Health and Clinical Excellence (Nice). However, Nice emphasised that doctors should not discriminate on the grounds that a disease was self-inflicted.

Hewitt said it would be “dreadful” to deny treatment on the grounds that patients were to blame for their condition.

The type of operations likely to be refused to the overweightare hip and knee replacements, while smokers could be denied heart bypasses.

The British Medical Association described a BMI of 30 as a “rather low” threshold and warned that hospitals must not make judgments on financial grounds. A spokeswoman said: “We would not want to see blanket rules. What about people who diet down from a BMI of 40 to a BMI of 30 – would they still be denied surgery?”

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