BLOG Who’s responsible for helping people lose weight?

Credit: Matt Love, Maura Murphy

Are doctors missing opportunities to help people manage their weight?

Body weight is a sensitive subject for many people, particularly the 64% of the public who are living with overweight or obesity. These sensitivities result in few medical practitioners starting a conversation with a patient about their weight if that isn’t the specific reason for the consultation with them.

Many discussions around weight are typically led by GPs; however, with the advent of modern technology, GPs now offer alternatives to face-to-face appointments, such as phone consultations and automated systems that direct patients to online resources. Although this flexibility is welcomed by many patients, it could mean that some people will now go years without physically seeing their primary health care team, making it harder to identify those who would benefit from weight or physical activity interventions.

We can’t assume that every member of the public has access to accurate scales at home, is willing to monitor their weight, or indeed take action if their weight starts to creep up. This may mean that critical opportunities to help people manage their weight will be systematically missed, so we need to look again at which touchpoints within the NHS are used for weight-related conversations with the public.

As weight affects many health conditions, it should fall to all health care professionals under the ‘making every contact count’ guidance to support patients to maintain a healthy weight. When opportunities to support weight loss are missed, many of the medical conditions that patients present with such as diabetes, cardiovascular disease, cancer and mental health conditions may become more difficult to manage because they are negatively impacted by excess weight, lengthening treatment unnecessarily. With overweight and obesity related conditions costing the NHS over £6 billion each year and record NHS waiting list times for consultations with a doctor and for treatments, it is more critical than ever before that every opportunity is taken to support people to maintain a healthy weight and reduce their risk of diseases.

Several studies have highlighted the important role that health professionals can have when they take the opportunity to discuss weight in routine face-to-face consultations with patients. For example, the Bwel trial (Aveyard et al Lancet) showed that routinely screening all patients attending their GP surgery for their weight and then offering overweight patients access to commercial weight management programmes such as Slimming World was effective in reducing weight at 12 months. Patients also found this approach by their GP to be acceptable and they wanted their GP to raise the topic of their weight with them, and they were not offended when GPs did so.

Likewise, other studies have shown that it is acceptable to postnatal women to be routinely and regularly weighed and offered support by a nurse/GP when they attend their general practice to have their child immunised. In many countries pregnant women are routinely weighed throughout pregnancy and this information recorded in medical notes, and women who are of concern referred for additional support. So, it is entirely possible to achieve routine screening and monitoring of weight of populations, in the same way that health professionals routinely ask whether a patient smokes in consultations regardless of whether smoking is related to the reason for the appointment, highlighting that lifestyle questions/conversations, including ones about weight, can become a standard part of health care consultations.

Of course, we need to ensure that people are not only advised about their weight, but are sensitively supported to lose weight through improved nutrition information, affordable healthy foods and more opportunities to access exercise facilities to increase their physical activity. An important first step is to expand the opportunities to support individuals before their weight has a negative impact on their health and well-being. One way to achieve this is for all health professionals to take responsibility to routinely start conversations with people they know are overweight and need support within every consultation, so it just becomes a normal part of what is offered to all patients and what they expect to happen when they consult with a health care professional. 

Professor Amanda Daley

Professor of Behavioural Medicine and Centre Director

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