In November 2021, the Society for Obesity & Bariatric Anaesthesia published new guidance for anaesthetists on talking with patients living with obesity about perioperative risk and providing informed consent in a way that is accurate and sensitive to the specific needs of this patient group. We spoke with Maggie Clinton, OEN Champion and patient advocate, and Dimitri Pournaras, Consultant in Bariatric Surgery at North Bristol NHS Trust, about the new guidance and its role in ending weight stigma in anaesthetics and beyond.
Why was this guidance needed?
Dimitri: People living with surgery often undergo elective or emergency surgery requiring an anaesthetic. For the clinicians leading this part of their care, obesity can add risk, increase the complexity, and require specific interventions.
Maggie: It is important that all patients’ specific needs and risk factors are considered. These guidelines will help to ensure that patients who suffer from obesity receive the best possible care to minimise and prevent complications. Furthermore, it is now widely acknowledged that professionals bring their own prejudices, including weight-based stigma, to their practice and consequently stigmatise the patient affected by obesity. This is unacceptable.
What do the guidelines cover?
Dimitri: The guidelines provide a blueprint for the discussion of care considerations around obesity highlighting specific risks and providing tips on how to communicate these effectively and compassionately.
Maggie: The guidelines outline a standard of care which is based upon the viewing the patient not simply as a ‘problem’. It highlights the vital importance of the language anaesthetists use when communicating with the patient.
Why are the guidelines important for the field of anaesthesia and patient care?
Maggie: It is so important to feel safe as you go to surgery. But people affected by obesity rarely feel safe as patients. For example, I have experienced staff in the anaesthetic area ‘huffing and puffing’ when they found it hard to find a vein. I have felt their frustration and found myself wondering, ‘…if they can’t find a vein, how will they keep me alive under anaesthesia…?’ I hope that the guidelines will result in improved safety for patients living with obesity.
Dimitri: They provide a shift in the language used, but also the approach. The communication with the anaesthetist is often at a stressful period either in the pre-assessment clinic and the day of surgery for elective procedures or just before surgery in the emergency setting.
Does this guidance have relevance for other medical specialties?
Maggie: All human beings at times demonstrate stigmatising and prejudicial behaviour. Such guidelines should be introduced for discussion for medical students as well as post-graduate training for entering the field of anaesthesia. The essence of this guideline is, and should be, transferable to all areas of practice.
Dimitri: This model can be translated in other medical specialties and subspecialties as obesity affects multiple branches of medicine and with the current obesity pandemic most clinicians around the world treat people livening with obesity on a regular basis.
You can read the guidance here.
Links to further reading and resources:
This post was published as part of OEN UK’s ‘Stand Up to Weight Stigma’ campaign. Read other posts published for the campaign:
- Weight Stigma in Employment
- Weight Stigma at Work: Moving from analysis to action
- Weight Stigma in the media
- Thin = happy + successful: the impact of stigmatising media content on people living with obesity
- Framing obesity, ending stigma: The change we need to see in the media
Dimitri Pournaras is a Consultant in Bariatric Surgery at North Bristol NHS Trust.
Maggie Clinton is a Champion and Founding Member for OEN UK.