An article has appeared in today’s Conversation suggesting that doctors need training to feel confident in bringing up their patients’ “excess weight”, so they can broach the topic more, including with patients who have come to see them for something that has nothing to do with the issue.
Doctors need to be taught how to discuss their patients’ excess weight
A link to the Conversation is sent daily by email to a large subscription list of academics and interested professionals, and the subject line of today’s email was “Why doctors need to talk more about weight”. I am used to reading articles from patients who desperately want doctors they go to see about an unrelated issue to stop feeling it is appropriate to initiate a conversation about their weight, so I was immediately shocked.
I note that the two authors work in obstetrics and neonatal care, not fields directly related to metabolism, nutrition or fitness. It is disturbing how the highly subjective diagnosis of “excess weight” – the term is used repeatedly throughout the article to emphasise that the authors are not referring exclusively to obesity (not that that would be ok either, but it shows how broadly they are applying the principle) – is pathologised in and of itself. A goal of behaviour change is assumed to necessary and desirable. The whole piece is framed around the assumption that anyone a doctor feels, on sight, is overweight A) has a problem B) is not aware of it and needs the doctor to tell them C) will be ‘fixed’ by behaviour change and therefore, by extension D) is currently engaging in unhealthy behaviours. The doctor’s job, the authors suggest, is to “help the patient begin to believe change is possible”.
The Conversation has open comments, and is receptive to refutation pieces by professionals in related fields. I do hope someone qualified is positioned to thoroughly take down this simplistic, irresponsible mess.
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So a neonatalogist is supposed to tell the parent of a newborn that is in a highly stressed state, that they are fat and need to do something about it?
And that their fatness is going to damage their child, yup, that seems to be the theory.
I have an interest in the area of birth and am unsurprised. Obstetricians have been suggesting (without any solid evidence that I’m aware of) that a combination of weight and age are almost single handedly responsible for the increasing statistics of interventions in birth, including caesarean sections, instrumental births etc. They don’t seem keen to accept actual evidence that continuous monitoring does little apart from drive up the c-section rate, that women are not allowed to push for as long as they used to, or that almost no obstetrician is properly trained in managing a vaginal breech birth, or vaginal twin birth.
Doctors do need to be taught how to talk to patients about “excess weight”. Of course, the entirety of that education can be summed up as “don’t”. Doctor starts talking about me needing to lose weight is a doctor that I tune out from and never see again; they’ve shown me that they’re not interested in my health, nor me as a person, nor even my symptoms. Just what they want to see.
Yeah the idea that somehow there is this general lack of confidence about telling people to lose weight…
I dumped one doctor because it seemed like, no matter what I came in for, “lose weight” was his combination diagnosis and treatment. I actually believe it would be good for me to lose weight. But he never went beyond that to anything like an actual treatment plan to do anything about it. It was like my weight was something I could get rid of like a broken chair (“put it out on trash day.”)
I mean, if a surgeon were to say, “you have an inflamed appendix. It might rupture. Do something about it” and then send you on your way, I think you’d be entitled to sue him (it’s always a him, isn’t it?) for malpractice.
I was fianlly inspired to unsubscribe from The Conversation by that email notification. Anything important/interesting enough that I really want to read, I’m going to hear about through other channels anyway. I feel much better for it!
I actually responded to the article on the Conversation with a pretty solid chunk of useful advice for any GP who actually does want to talk sensibly with their patients about weight. To summarise:
1) Accept they’re aware they’re fat.
2) Do some diagnostics and take a full medical history to determine whether they’re actually “at risk” (and what they’re at risk of) before spouting off the anti-fat party line.
3) Fix whatever they came for FIRST, before even thinking about mentioning it.
4) Allow them to be the experts about their lived experience – if they say they’ve tried to lose weight, believe them.
5) If you aren’t genuinely interested in helping your patient overcome obstacles to losing weight or becoming fitter, don’t bother mentioning the topic at all.
Did you get any sensible responses?
Well, I posted fairly late in the game, so I think I only got a response from one of the authors, who was replying to all the people who’d left a comment. A lot of the other discussion(s) had, I think, degenerated off into a two-way argument between a couple of guys about the merits of some eating plan or other. But the reply from the author was polite, and acknowledged what I’d said – particularly the last step, where I point out that if you’re not willing to help, you shouldn’t mention the topic at all.