For me one of the hardest parts of GP training was realising that there are several problems you deal with in primary care that have factors about which you can do precisely nothing - housing, employment, education. They all have a huge impact on people and their health but they are all beyond our reach. Yes, I know I can vote, I could even become a councillor or an MP, but (beyond the rhetoric) how often does anyone ever make a real impact on these issues? And so to this week's political hot potato - obesity. One condition where most of these untouchable factors come together and profoundly affect the health of an individual. Newspapers have been packed with obesity-related stories - new NICE draft guidance that we must be respectful, recognise the stigma associated with being overweight and not blame the patient, other leading doctors saying we should all 'man up' and no longer pussy-foot around the problem and the 14-year-old child who has had a gastric bypass.
The NHS figures from February 2013 are not pleasant reading: men classified as obese rose from 13% in 1993 to 24% in 2011 and women from 16% to 26%. The proportion of men with a raised waist circumference increased from 20% to 34%. During the same period, the proportion of women with a raised waist circumference increased from 26% to 47%. Obviously these groups have increased risk of health problems - high blood pressure was recorded in 53% of men and 44% of women in the obese group - and their knock-on increased risks, such as cardiovascular disease.
Adults with 'hormone problems' tend to have children with 'hormone problems' too: around three in ten children aged 2 to 15 were also classed as either overweight or obese. This was clearly visible to me last week, as I left our local swimming pool. The primary schools were filing in for their swim classes and as I stood and watched, I counted approximately seven out of 10 that were 'well padded'. Some even had a tummy that overhung their swim shorts. The trouble is, this size is fast becoming 'the norm'. I remember my primary school class quite well. There was one 'big girl' - out of about 25. I even remember her mum, she was 'big-boned' too, but they were exceptions, rather than the rule.
Haven't we been preaching the healthy-eating, 5-a-day, regular exercise message loud enough? Household sales of fresh fruit and vegetables have fallen year on year and only 36% of adults participate in sport at least once a week for 30 minutes at moderate intensity. It's those pesky untouchable factors again - economics, big companies, family finances. Consider - seven 'value' apples from a well-known low-cost supermarket are £1.55 usually, £1.00 during promotions. This is only 20% of one person's 5 a day, which means a family of four could be spending £20 + just on fruit and vegetables. Sadly, this is beyond many and they naturally seek out cheaper, processed food that will fill their families' tummies. The results are everywhere - just look.
There are rarely easy answers and it is difficult to see how prescriptively instructing doctors 'to be nice' will contribute in any meaningful way. We will continue to use the knowledge we have about the families we care for, to tailor how we advise them. There are many unhelpful euphemisms for obesity (see above) but politely saying a person's weight is affecting their health, is simply a statement of fact. People need facts and understanding before they are able to make important decisions that affect them. I will always provide this service, no matter how I am advised.
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