By Ian Patton, Director of Advocacy & Public Engagement
We said it had to change—now it has. New Canadian Orthopaedic Association Recommendations on Elective Total Hip and Knee Replacement Surgery in Patients Living With Obesity mean the start of a better path forward for Canadians.
You deserve more than ‘come back when you’ve lost weight’
Imagine you’re living with pain every day. You can’t walk without discomfort. Stairs are nearly impossible. You’ve tried pain medications, tried physiotherapy, and finally—your family doctor refers you for joint replacement surgery. A glimmer of hope and relief.
But when you arrive at the orthopaedic consult, you hear: “We can’t help you. Your BMI is too high.”
That’s it. No follow-up. No meaningful next steps. No pathway forward.
This is a story I’ve heard far too many times. And it’s been quietly playing out across Canada—people living with obesity being denied access to hip and knee replacements not because of medical complexity, but because of an arbitrary number.
There are many valid reasons why surgery may not be appropriate for someone, and those must be assessed by the surgeon and the team in consultation with the patient. Perhaps there is a medical complexity that elevates the risk, or perhaps the surgical centre is not equipped to handle certain cases, but that does not mean that the individual is not deserving of care.
The issue is the lack of consistency and clarity for patients in this process. Patients are being told that the risk of infection post-operatively are too high for individuals with elevated BMI, yet in the next breath being told perhaps bariatric surgery, a much more invasive and higher risk procedure, is an option before the knee surgery. Patients are being denied outright at one center, being told that their BMI is too high but then find another surgical centre that will perform the surgery with no clarity on why there is a discrepancy in the standard of care. Patients are being told they need to lose weight—often significant (and unrealistic) amounts of weight—before they can perform the surgery, but then are not given appropriate evidence-based direction on how to do so, ultimately leaving the individual in limbo.
It was unfair, it was confusing, and it needed to change.
What sparked the change
Dr. Harman Chaudhry, an orthopaedic surgeon from Toronto, noticed something troubling in his practice: more and more patients were coming to him for second opinions after being denied surgery elsewhere. Their common thread? They were all living with obesity.
He spoke about this trend at our 2022 Connected Conference, and his message resonated with many of us. Obesity Canada had been hearing the same stories from our community. It was clear—we needed to take action.
The Canadian Orthopaedic Association (COA), in partnership with Obesity Canada, created a national working group to take a closer look at the problem. I had the honour of being invited to sit on the Steering Committee and help bring the voice of lived experience to the table.
Behind the scenes: consensus, collaboration, and uncomfortable truths
In October 2023, we held two national consensus meetings, bringing together 85 people—surgeons, physicians, nurses, physical therapists, and people with lived experience. The goal was clear: build best-practice guidance for care for individuals living with obesity, providing consistency and clarity and reflecting real-world care.
We didn’t all agree right away. There were hard conversations. Some biases were challenged. But we found common ground.
The discussions centered on three broad areas:
- Pre-operative considerations
- Intra-operative considerations
- Post-operative considerations
The result is a set of recommendations that will positively impact the community that Obesity Canada serves and addresses a significant issue many people living with obesity face. It was one of the most meaningful and collaborative experiences I’ve been part of in my advocacy work.
What’s in the new Canadian Orthopaedic Association recommendations?
Here’s what you need to know:
There’s recognition that weight bias and stigma is pervasive in the health care system
Surgeons must strive to communicate in a manner which is free from judgement, bias and discrimination. Communication forms the bedrock of the patient-provider relationship.
BMI alone is not a reason to deny surgery
Surgical decisions should be based on the whole person—their overall health, mobility, and goals. Not a single number on a chart.
Surgeons must ensure a handoff to care
If a surgical centre isn’t equipped for more complex cases, it is now their responsibility to guide the patient to someone who can help. No one should be left hanging.
Weight loss recommendations must be nuanced and thoughtful
There’s uncertainty in the evidence that acute, rapid weight loss improves surgical outcomes. If weight management is part of the care plan, it must be tailored to the individual, coordinated with their primary care team, and informed by evidence-based obesity management guidelines.
Build better systems for complex care
We need a network of properly equipped specialized obesity-arthroplasty centres that can manage more medically complex patients including those living with obesity.
Why this matters—for people living with obesity, and for all of us
For too long, people living with obesity have been treated as less-than in our healthcare system. These new recommendations begin to chip away at that injustice.
They send a clear message:
Your body size does not determine your worthiness of care.
You have the right to be assessed fairly, treated with dignity, and offered solutions—not shut doors.
This is a step forward in rewriting how our health system responds to people living with obesity—with science, with empathy, and with accountability.
What’s next
These recommendations are officially approved by the Canadian Orthopaedic Association Board of Directors as of June 11, 2025.
You can read the full recommendations on the Canadian Orthopaedic Association website— share them widely across your networks. We’ll also be advocating for provincial health systems to start aligning with this new guidance.
This is a moment for action, and we’re not slowing down.
Make your voice heard
Untreated obesity undermines Canada’s economic future, and has substantial impacts on everyday Canadians, including reduced productivity and lower workforce participation. Our Cost of Inaction report found that indirect costs as a result of obesity reached an estimated $21.7 billion, which includes:
- $8.2B in economic losses from reduced workforce participation
- $3.8B in reduced personal income among employed individuals with obesity
Tell your government representatives that this needs to change.
Final thoughts
Being told “you’re too big for help” is not just a medical judgment—it’s a deeply personal rejection. But change is possible when lived experience meets expertise and people are willing to listen.
We’ve made progress. And it’s only the beginning.
If you’ve been denied care because of your weight, know this:
We see you.
We’re advocating for you.
And we won’t stop until we’ve helped build a Canada where health is not defined by size but by the freedom to thrive.
