Despite obesity being on the rise, patients well above a healthy weight are having to travel for essential surgeries due to anaesthesia safety concerns.
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In a letter to all surgeons and proceduralists dated May 8 this year, the director of medical services in Bega and Cooma said following a review by the anaesthetic department, hospitals "will not be routinely undertaking any patient with a BMI (body mass index) over 45".
"So if any of your patients fall into this category, there is really no point in putting in a request for admission as they are going to be rejected," the letter states.
Royal Australasian College of Surgeons chair Ken Loi, who is also treasurer of the International Federation of Obesity Surgeons, said while the letter "is a bit blunt" and "nihilistic", patients with an above healthy weight "do carry extra risk".
Body mass index is a physical measurement used to calculate a person's total amount of body fat by dividing their weight in kilograms by their height in metres squared.
According to the Australian Bureau of Statistics, the average height of an Australia is 1.75 metres, which would mean if they had a BMI of 45, the person would weigh 138 kilograms.
The Southern NSW Local Health District said the closest hospital for patients with a BMI over 45 in need of surgery is Canberra Hospital almost three hours drive from the South East Regional Hospital.
"As patients with a body mass index of more than 45 are at a greater risk of respiratory failure, stroke and sudden cardiac death during surgery, we do not routinely admit these patients," a health district spokesperson said.
"In line with worldwide clinical guidelines, they should be admitted to a tertiary-level hospital, with 24-hour support from a specialised team."
State government data shows the rate of obesity in the health district has almost doubled since 2002.
Dr Loi said he routinely treats patients at St George Hospital who are transferred from hospitals on the South Coast. He said while patient safety must come first, transfers are an inconvenience.
He said while obesity is a "broad issue" which includes discussions around topics including a sugar tax and increased health funding, the upskilling of specialists as well as hospital upgrades would help rural patients.
"From an anaesthetics point of view they do carry risk, but they [the government] are aware people are getting bigger," Dr Loi said.
He said better monitoring and intensive care and post-operative recovery availability in rural areas would help patients who he said already can suffer from complex health issues including diabetes and heart failure.
The World Health Organisation estimates global obesity has tripled since 1975, with 650million people now classified as obese.
The organisation blames an increased intake of energy-dense foods high in fat, "increasingly sedentary nature of many forms of work", changing modes of transportation, and increasing urbanisation for the increase.
It also blames a "lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education" for compounding the issue.
According to the ABS, in 2015 almost one in ten children and almost 30 per cent of adults in NSW were considered obese.
The NSW Health data shows 28.3 per cent of patients in the t in 2017 were found to be obese, with women slightly more likely to be obese than men.
The Australian Institute of Health and Welfare estimated in 2011-12 obesity cost the Australian economy $8.6 billion, and is responsible for seven per cent of the total national health burden.
