New consent guidance for patients with obesity from the Society for Obesity & Bariatric Anaesthesia
In June 2020, the journal Anaesthesia published an editorial about the potential problem
of inadvertently ‘fat shaming’ patients with obesity when discussing the legally-obliged
risks related to anaesthesia [1]. Naturally this article caught the attention of our Society
(SOBA); we responded to the journal stating that we were keen to contribute towards
finding solutions to the problem, and outlined our plan to improve the consent process.
This new guideline is a step towards that goal. We joined forces with Dr Tanya Selak, one
of the authors of the editorial, to identify which risks need to be discussed as well as tips
for how to gain consent in a more sensitive, patient-centred way.
Assessing the current understanding
around consent and obesity
We initially carried out a survey to assess the current level of
confidence and knowledge among anaesthetists regarding
consenting patients with obesity for anaesthesia. The survey was
distributed via our membership base and on social media, with
much help from Dr Selak’s extensive anaesthesia Twitter following
under the handle of
@GongGasGirl.
We received 518 responses from anaesthetic trainees, SAS doctors
and consultants, most of whom do not regularly anaesthetise for
specialist bariatric surgery but frequently anaesthetise patients
with a high BMI for other reasons. Despite this, less than half of
respondents ‘often’ or ‘always’ consent patients for risks related
to having a BMI > 40, and around a third did not feel confident
talking to patients about the anaesthetic risks associated with a
BMI > 40. Reasons given for this included “It is embarrassing to
have the discussion”, “Not wanting to stigmatise” and “Obesity
isn’t accepted as a medical condition in the way heart disease and
COPD are”.
We felt that these results represented an opportunity to improve
education around consent and raised BMI, both in terms of how
the discussion can be conducted and the types of risks that should
be included. Obesity is a medical problem that is now highly
prevalent in the population, and it is essential that anaesthetists
are able to give accurate information about risk to allow shared
decision making and to empower patients to be involved in their
recovery after surgery.
Developing the guideline
We presented our key survey findings at the SOBA Winter
Annual Scientific Meeting 2020 and went on to develop the new
guideline. We reviewed current literature on the risks associated
with obesity in the peri-operative period and also evidence on how risk should be communicated to reduce stigma and increase
acceptability. We also sought assistance from a patient advocate
to ensure that the style and language of the guideline was neutral
and appropriate for patients living with obesity.
We hope that this work will give anaesthetists confidence in the
information that they give to patients, and also encourage them
to think about how to gain consent in a way that is sensitive to the
specific needs of this patient group.
Acknowledgements
We would like to thank Paul Chesworth, our patient advocate, for
his thoughtful input and feedback.
Laura Pengelly
ST7 Anaesthetist, Northern General Hospital, Sheffield
Kiran Chima
ST7 Anaesthetist, St Mary’s Hospital, London
John Cousins
Consultant Anaesthetist, St Mary’s Hospital, London
Tanya Selak
Consultant Anaesthetist, Wollongong Hospital, Wollongong,
Australia
Andrew McKechnie
Consultant Anaesthetist, Lewisham and Greenwich NHS Trust,
London
Twitter: @ljpengels, @DrJohnCousins, @GongGasGirl, @SOBAuk,
@Admckdoc
References
- Selak T, Selak V. Communicating risks of obesity before
anaesthesia from the patient's perspective: informed consent
or fat-shaming?
Anaesthesia 2021; 76: 170-3.