Ruling from UK’s ASA impacts cosmetic surgeons

A ruling from the Advertising Standards Authority (ASA), the UK advertising regulator, is a warning to all cosmetic surgeons.

The Committee of Advertising Practice (CAP) is the sister organisation of the ASA and is responsible for writing the Advertising Codes. ASA and CAP are committed to regulating in a way that is transparent, proportionate, targeted, evidence-based, consistent and accountable.

Ad description

A website for cosmetic surgeons The Harley Medical Group (THMG) was seen by the complainant in July this year. Under the subheading ‘Why Choose Us’ was a sub-section ‘Helpful Links’ and a link to a body mass index (BMI) calculator. The link led to a page that provided a tool to calculate BMI based on height, weight and age. For the BMI ranges ‘Healthy’, ‘Overweight’ and ‘Obese’, the text beneath results stated “You are suitable for either a surgical procedure or a non-surgical treatment. Please see below for the treatment options available to you”.


The complainant believed the claim “suitable for a surgical procedure or a non-surgical treatment” encouraged people with a healthy BMI to undergo surgery, and challenged whether the ad was irresponsible.


THMG Limited, t/a The Harley Medical Group, said they aimed to provide their clients with enough information to make informed decisions about procedures, which they used when areas of their bodies could not be changed by exercise, diet or other traditional methods. They said the calculator was used to inform clients if they could safely undergo surgery or other procedures, that it did not appear on the home page and that those clients who navigated to it were already likely to be considering surgery.

The Harley Medical Group said BMI was one of many factors used to determine if a client was suitable for surgery and that they prided themselves on when to say no to clients. They said there was a video intended for clients on their website titled “Knowing when to say no”, they gave clients a cooling off period ahead of any decision making as well as ensuring procedures were suitable. They said they maintained other resources on their website which assisted clients to make decisions about cosmetic surgery.

The Harley Medical Group said clients would speak to an advisor, visit the clinic for consultation and consult with a surgeon before a firm decision to undergo surgery went ahead. They said having a normal BMI between 17 and 32 was a safe range for undergoing surgery and that a healthy BMI was crucial both for safety and to ensure the best results were achieved. They referred to a statement made by Oxford University Hospitals Trust, which stated having a raised BMI when undergoing a surgical procedure put patients at higher risk when anaesthesia was given. Increased risks included deep vein thrombosis, or blood clots in veins, breathing problems, low oxygen levels, complications with pain relief and longer recovery times.

The Harley Medical Group said the word “suitable” was used to communicate whether or not an individual was eligible for aesthetic surgery, not whether they should proceed with surgery, as many other factors were involved in making that decision. They provided the example that just as a toy may not be suitable for children under three years of age, their procedures were not suitable for anyone with a BMI below 17 or above 32.

The Harley Medical Group said their web page contained links to a variety of procedures and treatments offered, not just those which were bariatric or weight loss-related, and that all treatments offered by The Harley Medical Group were elective.


The ASA noted the ad appeared under two sub-sections of the website titled “Why Choose Us” and “Weight Loss”. The ASA noted that the tool invited users to input their height and weight to generate a figure for their BMI. Where a user’s BMI showed them to be underweight (BMI 18 or below) or obese (BMI 30 or above) the tool advised them that they were not suitable for surgery.

BMI is not the only way of assessing whether people were a healthy size and weight, a BMI of 19–24.9 inclusive was considered to be healthy. Customers whose result was in that healthy range received an analysis from the tool which stated, “You are suitable for either a surgical procedure or a non-surgical treatment”.

While the message was intended to indicate that a customer was more likely to be able to undergo a procedure safely, the statement and particularly the word “suitable”, appeared under a sub-section of the website titled “Weight Loss” alongside a number of images and statements that depicted and described weight loss procedures including tummy tucks, liposuction and fat reduction treatment. Those elements in combination had the effect of suggesting that patients who had a BMI within a healthy weight range should consider undergoing weight loss surgery.

So, the ASA concluded that the claim that patients with a healthy BMI were “suitable for a surgical procedure or a non-surgical treatment” was irresponsible and breached CAP Code (Edition 12) rule on social responsibility.


The ad must not appear again in its current form. The Harley Medical Group must ensure that their marketing does not suggest that consumers who are otherwise healthy should undergo weight loss surgery.