Dr David Haslam, a GPSI in obesity and medical director of the National Obesity Forum, said NICE public health guidance on obesity released on Wednesday made him ‘furious’.
The guidance calls on organisers of GP education and CPD to provide training in how 'to identify when to raise weight management with someone and to do so confidently, but with empathy'. GPs should raise weight issues with patients in a ‘respectful and non-judgemental’ way, NICE said.
Dr Haslam said: ‘I think what GPs do incredibly well is be compassionate and communicate with patients; that’s the core curriculum for our job.
‘We knew when we took the job... that communication was what we needed to do, and so to be told we need to do better by someone who’s never met a patient in their life is pretty galling.’
Although he welcomed the guidance's emphasis on promoting community weight-loss interventions, which he described as ‘good, evidence-based and effective’, Dr Haslam disagreed with advice calling on GPs to measure BMI to identify obese patients.
‘The best way of judging whether someone is obese is by looking at them, not taking their BMI or measuring their waist circumference,’ he said. ‘If someone looks as though they’ve got an excess weight problem, they have, simple as that.’
A 'duty' to raise concerns
Dr Haslam agreed that GPs should raise concerns about an overweight patient’s health during unrelated appointments, however.
‘If someone came into surgery with a [cigarette] in their gob, we’d soon tell them to put it out and tell them how bad it was for them, and if they come in with an obese abdomen we should be just as alert to the risk factors that that comes with.'
He added: 'Even if little Johnny comes in with tonsillitis and his dad is obese, we should raise the subject with dad, even though he’s not the patient. I think it is reasonable to deal with this blindingly obvious health problem they have.’
Following the publication of NICE's guidance, media reports suggested GPs would be required to refer all of their obese and overweight patients to weight management services.
But NICE confirmed to GP this would not the case. A spokeswoman said GPs should consider referral on an ‘individual case-by-case basis’, taking a patient's needs and the clinical context into account.
There would be ‘no point' referring to the service a patient who it wouldn’t suit and who wouldn't want to go, she said.
The guidance is the first time NICE has recommended a consistent, national approach to referring patients to weight management programmes.