While including obesity in the GMS quality framework this year is restricted to compiling a register, there is little doubt that it will be more prominent in future. This is therefore an appropriate time for GPs to hone their consulting skills so that they have more success in persuading obese patients to shed weight.
Raising the issue
Linking weight to an existing medical condition is often a good way of raising the subject. For example, saying: 'Are you aware that losing weight will improve your diabetes, lower your BP and so on?' and listening carefully to the response will give you some insight into how motivated they are to do something about the problem.
However, when the patient has consulted about a separate complaint, it is better to ask them to make a further appointment than to try to deal with their weight problem on the spot.
Not offending patients is almost impossible if you use the words 'fat' or 'obese' but this does not mean you should never use them.
Being fat is still largely seen by society - and indeed many patients - as simply an aesthetic problem that reflects on personal appearance. Many do not regard it in terms of a health risk that reduces length of life or recognise that it is a contributory factor to many long-term conditions such as type-2 diabetes.
Patients will often know they are overweight, while being less keen to accept they are clinically obese. This needs to be spelled out in terms of health risk. In a recent poll of over 100 male truck drivers in Manchester, 78 per cent of the men seen were obese with a BMI over 30 or waist measurements over 40 inches, but only 10 per cent regarded themselves as obese.
Train the team
Team members responsible for improving obesity services must be trained to do so effectively, not opportunistically. Auditing weight loss is difficult if you do not have a well-run service that records clinical measurements on a regular basis. Dietitians and diet sheets are rarely the answer.
Failure to lose weight
Patients who are ready to lose weight should not only have their weight and BMI measured (eight quality points) but also their waist measurement, cholesterol, blood sugar or HbA1c and blood pressure. This will enable you to monitor health improvements.
Those who have failed to lose weight despite every effort should be considered for medication such as Reductil or Xenical. Many GPs see these drugs as an expensive alternative to diet and exercise, but they should only be used short-term. All patients on anti-obesity drugs should be monitored regularly.
When a patient is seen at a weight reduction clinic, they need to understand that they are making a contract. If they fail to lose 5 per cent of excess weight at three months or 10 per cent at six months, they should not continue at the clinic as they are clearly not ready to make the changes necessary.
In this case, I recommend suggesting that they join a commercial organisation.
- Jane DeVille-Almond is an independent nurse consultant, a director of the National Obesity Forum and vice president of the Men's Health Forum.
OBESE PATIENTS: TOP TIPS
1. Never try to deal with a patient's weight during a consultation for another health problem: patients do not respond well to this.
2. If you rather than the patient raise the issue of obesity, ask the patient to make another appointment to discuss their weight.
3. If a patient is not willing to do this, the likelihood of weight loss is remote. Explain the health risk and encourage them to return.
4. Always refer to the risk factors associated with obesity so obese patients see their weight as a serious health issue.
5. Referring to a patient as overweight rather than fat or obese will make the patient think that they do not have a problem. Causing some offence may be inevitable.
6. Patients may not see themselves as obese so they need to understand exactly where being overweight ends and being fat or obese begins.
7. Obesity is a big issue for men as well as women so take this into account when setting up services.