GPs who raise the issue of their patients’ obesity in the surgery will not offend them and are likely to help them reach a healthy weight, a new study has shown.
Doctors are notoriously nervous of telling people they are overweight and worry that initiating any discussion will lead to a long, fruitless conversation about failed diets and eating habits that will go on long beyond a 10-minute consultation.
But a trial of a 30-second intervention in which the GP suggests the patient’s weight may be affecting their health and offers them a place on a weigh-loss programme reveals advice can make a major difference, according to research published in the Lancet medical journal.
More than 130 GPs who took part in the trial, involving more than 1,800 patients, were asked to start a conversation that might go like this:
GP: While you’re here, I just wanted to talk about your weight. You know the best way to lose weight is to go to [a weigh-management programme such as Slimming World or Rosemary Conley] and that’s available free on the NHS?
Patient: Oh?
GP: Yes, and I can refer you now if you are willing to give that a try?
The patients were randomly assigned to be offered either an NHS-funded place on a 12-week weight-management programme or advice to lose weight. The researchers found that 77% of those offered a weight-management programme said yes, and 40% went to all the sessions. At the end of a year, those people had lost 2.43kg (0.38 stone) on average, while those given advice by the GP had also lost weight, but less, at an average of 1.04kg.
Prof Paul Aveyard from the University of Oxford, who is a practising GP, said GPs do not talk to patients about their weight unless that is the reason they have come to the surgery. “We weigh people and that’s it. Whereas with smoking, every time we see them, once a year, we have to tell them effective ways to stop smoking,” he said.
Trials from the 1970s had shown that if GPs tackled people about smoking, they were more likely to quit. But this is the first study to see whether it works in obesity too, he said.
“GPs worry a lot about offending people. It is a very personal thing. Secondly, they do worry that the conversation will go on a long time and not actually lead anywhere,” he said.
There was also the wish not to take on one more of society’s ills, Aveyard said. “The GP might easily say this is more than my job is about,” he added.
Although weight management programmes can be prescribed for free for those who need them on the NHS, patients are usually left to make their own arrangements. In the trial, patients left with a voucher and an appointment for the first of their 12 free sessions. More than half went to practically all of them, said Aveyard.
The average BMI of those in the trial was 35 – a BMI of over 35 is considered severely obese – which meant that people needed to lose 20 to 30 kilos to get down to a healthy weight. Obesity can lead to type 2 diabetes, heart problems, stroke and cancer.
Even losing a few kilos can make a difference to people’s health. Slow and steady progress in bringing weight down is the goal of programmes which aim to change people’s attitudes to food as well as what they eat. The rapid weight-loss from most conventional diets is short-lived and people tend to put it on again once the diet ends.
Dr Iain Turnbull, a GP in Swindon who took part in the trial, said one of the main reasons they do not mention weight when somebody arrives with a cough or a chest infection is constraint on time. “We don’t really have the opportunity to talk to them about weight management on top of everything else,” he said. “The reality of modern GP practice is that it is a terrifically high-pressured and time-intensive specialty.”
But the study enabled him to keep the discussion brief and his patients were not offended. “I didn’t have any negative feedback from patients. They seemed quite pleased that I’d brought up the issue.”
Paul Cooper from Northampton weighed 96 kg when his GP brought up the issue as part of the trial. “I couldn’t see my feet,” he said. In his case it was easier, as he was diagnosed with type 2 diabetes at the consultation. He chose not to go on a weight-management programme, but tackled his diet using a fitness app instead and is now 84 kg and continuing to lose weight in what he hopes is a sustainable manner.
He was not angered by the GP telling him his weight was a problem. “Personally I think the doctor is the only person you would accept it from,” he said.
Boyd Swinburne and Bruce Arroll from the University of Auckland in Australia have said the study calls for a rethink of how obesity is tackled in primary care everywhere. “It is surprising that this is the first study in primary care to investigate a brief intervention for obesity, perhaps reflecting the nihilism about weight loss that pervades medical care,” they write.
Tam Fry, spokesman for the National Obesity Forum, said: “The paper effectively runs a coach and horses through the excuses that GPs in general have trotted out when challenged to talk to their patients about losing weight. Their principal argument has been that it’s pointless since no good weight-loss programmes exist. Nonsense. They do and have done so for years.
“Now that the evidence is out in the open, family doctors should take action to prevent obesity and weight-related health problems that clog up their waiting rooms.”
Dr Alison Tedstone, the chief nutritionist at Public Health England, said: “It’s important that GPs talk to their overweight and obese patients about losing weight and help them to find further support, as many do already. An extra 30 seconds could make all the difference; it doesn’t take long and can be raised in a supportive and sensitive manner.”
GPs should not worry about offending obese patients, finds study
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