Should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts

Fron Jackson-Webb, The Conversation

Australian of the Year and body positivity advocate Taryn Brumfitt has called for doctors to avoid discussing a patient’s weight when they seek care for unrelated matters.

A 15-minute consultation isn’t long enough to provide support to change behaviours, Brumfitt says, and GPs don’t have enough training and expertise to have these complex discussions.

“Many people in larger bodies tell us they have gone to the doctor with something like a sore knee, and come out with a ‘prescription’ for a very restrictive diet, and no ongoing support,” Brumfitt told the Nine newspapers.

By raising the issue of weight, Brumfitt says, GPs also risk turning patients off seeking care for other health concerns.

So should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts.

Brett Montgomery – GP academic

Yes, sometimes – but with great care.

I agree that weight stigma is damaging, and insensitively raising weight in consultations can  hurt people’s feelings and create barriersto other aspects of health care.

I also agree people can sometimes be “overweight” yet  quite healthy, and that common measures and categories of weight are  questionable.

On the other hand, I know obesity  is associated with  heart disease, joint problems, diabetes and cancers.

GPs should be ready to help people with their weight when they want help.  Our assistance somewhat effective, though sadly dietary efforts often have minimal effect on weight in the long term. Meanwhile, treatments causing larger weight changes (surgery  and  some medicines  are often financially inaccessible.

I feel safe discussing weight when my patient raises the issue. Fearing hurting people, I often avoid raising it myself. I focus instead on health rather than weight, discussing physical activity and healthy diet – these are good things for people of any size.

Emma Beckett – Nutrition scientist

No. It’s not likely to succeed. Large systematic reviews bringing together multiple studies of multiple weight-loss diets show weight loss is not generally maintained long term (12 months  to  four years).

The idea that weight is about willpower is outdated. The current body of evidence  suggests  we each have a weight set point that our body defends. This is determined by genetics and environment more so than education.

There may be associations between weight and health outcomes, but losing weight  does not necessarily equate  with improving health.

Fat stigma and fatphobia are  harmful too  and can  compromise access to health care.

Instead, consider asking a better question. Healthy eating reduces disease risk  regardless of weight. So maybe ask how many vegetables are your patients eating. Would they like to see a dietitian to discuss strategies for a better-quality diet?

Liz Sturgiss – GP/researcher  

No. A  US study  estimates it would take a family doctor 131% of their work hours to implement all preventive health-care recommendations. It’s impossible to address every recommendation for preventative care at every consultation. One of the key skills of a GP is balancing the patient and doctor agenda.

Weight stigma  can deter people from seeking health care, so raising weight when a patient doesn’t have it on their agenda can be harmful. A strong  therapeutic relationship  is critical for safe and effective health care to address weight.  

Weight is always on my agenda when there is unexpected weight loss. If a patient has rapid weight loss, I am concerned about an undetected  cancer  or infection. Additionally, I am increasingly seeing patients who are unable to afford food, who often have  poor oral health, who lose weight due to  poverty. Weight loss for the wrong reasons is also a very concerning part of general practice.

Nick Fuller – Obesity researcher  

Yes. GPs should play a role in the early detection of weight issues and direct patients to evidence-based care to slow this progression.  Research  shows many people with obesity are motivated to lose weight (48%).  Most  want their clinician to initiate a conversation about weight management and treatment options.

However, this conversation  rarely occurs, resulting in  significant delays to treatment.

Starting the conversation presents challenges. Although obesity is a complex disease related to multiple factors, it’s still  highly stigmatisedin our society and even in the  clinical setting. Sensitivity is required and the wording the clinician uses is important to make the patient feel safe and avoid placing blame on them. Patients often  prefer terms  such as “weight” and “BMI” (body mass index) over “fatness,” “size” or “obesity”,  particularly women.

Measuring weight, height and waist circumference should be  considered routine in primary care. But this needs to be done without judgement, and in collaboration with the patient.

Helen Truby – Nutrition scientist  

Yes. A high body weight contributes to many chronic conditions that negatively impact the  quality of life and mental health  of millions of Australians.

Not all GPs feel confident having weight conversations, given the sensitive nature of weight and its stigma. GPs’ words matter – they are a  trusted source  of health information. It’s critical GPs gain the skills to know when and how to have  positive weight conversations.

GPs need to offer supportive and affordable solutions. But effective specialist weight management programs are few and far between. More equitable access to programs is essential so GPs have referral pathways after conversations about weight.

GPs’ time is valuable. Activating this critical workforce is essential to meet the  National Obesity Strategy.

Fron Jackson-Webb, Deputy Editor and Senior Health Editor, The Conversation

Image credits: Getty Images

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