Australian of the Year and body positivity advocate Taryn Brumfitt has called for doctors to avoid mentioning patients’ 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 five experts.
Three out of five said yes. Here are their detailed responses.
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 barriers to other aspects of health care.
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 is 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
The idea that weight is about willpower is outdated.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 than education.
There may be associations between weight and health outcomes, but losing weight does not necessarily equate with improving health.
Instead, consider asking a better question. Healthy eating reduces disease risk regardless of weight. So maybe ask how many vegetables your patients are eating. Would they like to see a dietitian to discuss strategies for a better-quality diet?
Liz Sturgiss, GP/researcher
A US study estimates it would take a family doctor 131 per cent of their work hours to implement all preventive healthcare 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, and 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
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 per cent). Most (68 per cent) want their clinician to initiate a conversation about weight management and treatment options.
Starting the conversation presents challenges. Although obesity is a complex disease related to multiple factors, it’s still highly stigmatised in 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
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, seek consent and acknowledge its complexity.
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‘s goals. But we need to fund primary care so GPs are remunerated for incorporating prevention discussions into consultations.
Fron Jackson-Webb is a deputy editor and senior health editor at The Conversation, where this piece first appeared. The experts interviewed for this article have different professional and personal interests in weight loss. Please see the article on The Conversation’s website for a full list of disclosures