Obesity - yet another doomsday scenario
It's the New Year and millions of resolutions have been made and broken already. One of the most common among my patients is to lose weight - and sadly, it's often just as likely to fail as the resolution to stop smoking or get your half an hour of exercise five times a week.
Tackling obesity fills every GP with trepidation - I've lost count of the number of patients I see who have lost weight several times, only to find it creeping back on again, and who become more and more resistant to any offers of help. We know all too well the health risks associated with obesity - type 2 diabetes, heart attack, stroke, osteoarthritis, even cancer. This carries a real financial cost to all of us - obesity rates have doubled in under 20 years, and a major study seven years ago suggested that by 2050, obesity levels would rise to 50% of UK adults and cost the country £50 billion a year.
We're also well aware that being overweight often comes with low self-esteem. But my heart really sinks when some well-meaning committee announces that as a result even doctors shouldn't comment on a patient's weight in case it upsets them. I've said it before but I'll say it again - there is no level of overweight or obesity that's free from health risk, and doctors don't just have a right to explain this to their patients, they have a duty.
That's why the new report from the National Obesity Forum, while it makes for truly scary reading, has some nuggets which are music to my ears. On the down side, the study suggested that even a 50% obesity figure by 2050 may be an underestimation. On the plus side, they argue that GPs should have not only a major role to play in tackling obesity but the support they need to help their patients succeed in the long term. At the moment, all GPs have targets for recording levels of obesity among their patients - but no guidance about what they should do with that information.
Far from banning us from broaching the subject on the grounds that it might offend someone, the report recommends that 'GPs should be encouraged and indeed required to make every contact with patients count'. That means not just discussing the issues with the patient and working out what might motivate them to make changes, but giving GPs direct access to support services.
I have lots of weight management services in my area. But they're usually pilots or short-lived schemes, and by the time I've worked out how useful they are for my patients they've often been shelved. The goalposts for who qualifies for referral seems to change constantly, and if I can't get my head around them, what hope is there for my patients? The Academy of Medical Royal Colleges has backed a call to invest £100 million a year in extending access to a full range of weight management services. There is a vast industry out there trying to entice my patients to buy junk foods, and seemingly ever more pressures on our time which make it harder to prioritise exercise and a healthy diet. For many people, personalised tools such as MyHealth can be invaluable. But for others, more formal support is needed too. Let's put pressure on government to invest in helping people who want to help themselves - and stop shifting the goalposts for the services we have.