Is it okay to bring up someone’s weight?
This is a question that GPs face on a regular basis.
But recent headlines proclaiming that a “30-second chat can trigger weight loss” suggest that starting this type of conversation shouldn’t be a cause for worry.
The reports followed new research, part funded by Cancer Research UK, looking at the role GPs can play in discussing bodyweight with their patients. And the findings suggest that a chat might be just what the doctor ordered.
The study, published in The Lancet last week, found that 8 in 10 overweight or obese people thought it was appropriate and helpful for their GP to suggest that losing weight would be good for their health.
And just a 30 second chat, or a very brief intervention to give it its technical name, is all it takes for GPs to encourage people to shed some pounds.
What’s a brief intervention?
A ‘brief intervention’ is a technique that GPs often use to encourage people to think about their health. Take smoking, for example. A GP might ask a smoker questions with a view to encouraging them to stop. Or they might simply offer help with stopping. The patient’s reason for the original appointment doesn’t have to be smoking related, so the GP can bring it up out of the blue.
A brief intervention might take only 5 minutes. And a very brief intervention can take as little as 30 seconds.
This approach has already been shown to be effective in encouraging people to stop smoking, but what about encouraging people who are obese or overweight to lose weight?
Why is this important?
Obesity is the second biggest preventable cause of cancer after smoking, which we’ve blogged about recently.
And being overweight is linked to 13 different types of cancer.
At the moment it’s not clear whether losing weight will reduce your risk of cancer. The research is limited, but it does suggest this might be the case. As well as the possibility of reducing your risk of cancer, losing weight has a number of other great benefits, such as improving heart health.
Can a chat encourage weight loss?
This new study is the result of the BWeL (Brief intervention for weight loss) trial, which involved around 1800 obese people from 57 GP practices in England.
They all had their height, weight and body mass index (BMI) recorded, and were randomly assigned to one of two groups. In the first group, the GP told the patient they would benefit from losing weight, and offered to refer them to a weight management group, like Slimming World. In the second group, the GP just told the patient they would benefit from losing some weight and left it at that.
It took 30 seconds or less for the GP to have either of these discussions – that’s the ‘very brief intervention’ part.
And according to Professor Paul Aveyard, who led the study and is a practising GP and Professor of Behavioural Medicine at the University of Oxford, the fact these are such short conversations is the key.
“In designing this study, we were clear that whatever we asked GPs to do, we could only ask them to spend a few seconds doing it,” he explains. “In our research, we tested whether a 30 second chat from the GP could motivate patients to take action on their weight, how patients felt about it, and whether this would lead to weight loss in the longer term.”
And the findings were encouraging. Patients in both groups lost weight. But those offered referral to a weight management programme lost on average 1.4kg more after 1 year than those who hadn’t been referred. This is despite the fact not all the patients who were offered a referral actually attended the programme.
This means even a short conversation between a GP and a patient about losing weight, which might involve referral to a weight loss programme, can be extremely effective.
Is it okay to chat about fat?
Now it gets really interesting. The researchers also wanted to know what the patients thought when the GPs brought up their weight as an issue given it can be a touchy topic.
I wasn’t offended when my GP discussed my weight with me. In fact, I’m glad he brought it up, as it’s something I hadn’t ever thought was an issue and I feel it has encouraged me to lose weight
– Jim, 70, who took part in the study
Aveyard explains: “Immediately after the consultation, we asked patients whether it was appropriate and helpful for GPs to bring up their weight in this way. The large majority said it was, and almost nobody thought it wasn’t.”
In fact, 8 in 10 people found that it was both ‘appropriate’ and ‘helpful’ for GPs to suggest losing weight would be good for their health.
Jim, 70, is from Cirencester and was invited to take part in the BWeL trial after seeing his GP for an unrelated health problem.
“My GP brought up the topic of my weight during the consultation. He calculated my BMI and told me I was in the ‘obese’ category. I was really shocked because I hadn’t considered myself overweight before,” he says.
Jim was allocated to the group that was referred to a weight loss management programme, and lost 2 stone in 12 months.
“I wasn’t offended when my GP discussed my weight with me. In fact, I’m glad he brought it up, as it’s something I hadn’t ever thought was an issue and I feel it has encouraged me to lose weight, which I’m really happy about.”
What does this mean for GPs?
A study published in 2013 looked at the percentage of overweight and obese patients who had been told by a health professional they’d benefit from losing weight. And in that study just 4 in 10 people remembered having been told to lose weight.
Since taking part in the trial, I feel more comfortable addressing any issues related to patients’ weight and I’m more aware of the impact it can have in encouraging someone to lose weight
– Dr Paul Hodges, a GP who was involved in the study
It’s not easy to have these conversations. And there are certain challenges that may hold GPs back. Some of these include not having enough time, thinking that just a brief discussion won’t help, and worry about offending a patient.
Dr Paul Hodges is one of the GPs who was involved in the BWeL trial. He’s been working as a GP in Gloucester for 23 years, and feels that taking part in the study has changed his outlook.
“Since taking part in the trial, I feel more comfortable addressing any issues related to patients’ weight and I’m more aware of the impact it can have in encouraging someone to lose weight,” he says.
So this new study should be reassuring for GPs. It’s okay to bring up this sensitive subject. Even better, the discussion doesn’t have to take long, which is good news for GPs with a waiting room full of patients.
“It’s a quick conversation that’s a really important part of my role as a GP,” says Hodges. And one that he thinks GPs should be having more often with their patients, along the lines of advice on giving up smoking.
What does this mean for you?
When you see your GP, don’t be surprised if they bring up your weight. Some people, like Jim, might not even be aware they are overweight or obese.
A simple 30 second chat with your GP, which might involve pointing you in the direction of weight management services, could be the kick start you need to lose a few pounds. And if you’re concerned about your weight, don’t hesitate to mention it to your GP.
Keeping a healthy weight can reduce your risk of cancer and other health problems.
As Professor Aveyard says: “We all know we need to do something to improve our health, but sometimes a reminder from the GP and the offer of help can be just the thing we are looking for to get us going.”
Obesity is a complex problem that doesn’t have a simple solution so we need to work together with our GPs on this.
And the power of a 30 second chat shouldn’t be underestimated.
Jasmine Just is a health information officer at Cancer Research UK
Moz December 2, 2016
A GP told me I could do with losing a bit of weight. I had been ill with various symptoms for some time, which the practice failed to diagnose – that turned out to be gastritis, stomach ulcers and diverticulitis – and resulted in an operation and losing a foot of bowel. I just felt fobbed off. It’s too easy for doctors to look at an overweight person, not see beyond the obvious and not listen properly. It was negligent.
Chris Szumilo November 6, 2016
I was a fat kid. My GP hated fat people and used to punch me in the stomache whilst humiliating me in front of my mother. He certainly didn’t do me any favours. But I do believe that GP’s do have a duty to be concerned and express their judgements where necessary no holds barred, with the exception of physical violation. Obesity might have a link to cancer, but then again it also affects non-obese people too. I was a fat kid, lost weight and became fit. I had testicular cancer in my 30’s followed by kidney cancer (metestatic) in my late 40’s so maybe it’s not just down to being obese (all of the time).
Pawan November 4, 2016
This is a really interesting paper – it would be helpful to know if the VBA delivered by practice nurses and HCAs will have the same impact. For smoking it does seem to work.