Mrs Enormous and the gastric hurdle

The subtle vibration of the building upon its foundations tells me that Mrs Enormous is here. Her hopelessness, even larger than the woman herself, precedes her as she edges in through the door, a manoeuvre that achieves nothing as she is wider in silhouette, and I make sure she has the chair with no arms. These consultations are difficult enough, without us requiring the fire brigade to get her out.

Usually we have a demoralising chat about pies and thighs, but this week she has a question. Will she get a hospital appointment?

She had requested two referrals, one for gastric bypass and one about her knees. Mrs Enormous’ knees have put up with a degree of load-bearing that most Himalayan yaks never contemplate.

Orthopaedic surgeons have previously refused to operate, and now local referral guidelines prevent me from even asking again until her BMI is less than 30, a target slightly less achievable than my own early ambition to be crowned queen of a small African nation.

I had hoped, though, for gastric bypass — but while NICE suggests offering this where the BMI is over 40, this week’s news is that at PCT level this is likely to be raised to 50. Mrs Enormous’ BMI is an unshiftable 49.4.

‘I’ve written,’ I tell her, not wanting to offer false hope, ‘but it’s possible you won’t qualify because of your weight.’

‘That’s it then,’ she says despondently, ‘you know I can’t lose any.’ I shake my head and explain: ‘Actually that’s not quite it…’

A change comes over Mrs Enormous. She leaps from her chair and the fire brigade stand down. ‘I’m not big enough? Seriously? Give me 48 hours.’

She skips from the room to find a pasty, clearly feeling, for the first time in years, some sense of power over the situation, and I eye my next patient sadly. Miss Thin has a BMI of 14.5, amenorrhoea, lanugo and denial. Funny old world.

- Dr Selby is a GP in Suffolk.

You can write to her at GPcolumnists@haymarket.com

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