25 February 2019

O? No! – and don’t say the F-word either

Obesity RACGP

Obesity is about more than just body weight, says a new position statement from the RACGP in which the college commits to using “person-first” language in dealing with the stigmatised condition.

Calling for further support and funding for GPs to prevent and manage obesity, the RACGP urges “that the focus of the health message be on ‘gaining health’ rather than simply ‘losing weight’”.

The position statement warns that “well-intentioned but insensitive comments or policies” that focus only on weight may do more harm than good, citing evidence that people with obesity may avoid healthcare if they feel shamed about their weight.

Australia is in the OECD’s top five countries for obesity – behind only the US, Mexico, New Zealand and Hungary – and has recognised the condition as an Australian National Health Priority Area since 2008.

Obesity is especially common in Aboriginal and Torres Strait Islander communities and is estimated to account for 16% of the health gap between indigenous and non-indigenous Australians. Health inequity, which is both a cause and a consequence of obesity, is a particular concern in indigenous communities, where access to healthcare and affordable fresh food is often limited.

Despite the condition’s prevalence across Australia – affecting about 29% of adults and 10% of children – only an estimated 1% of general practice consultations are primarily about obesity, according to the General Practice Activity in Australia 2015-16 report.

The RACGP statement says access to bariatric surgery, the most effective treatment, is too low, with only 12% of procedures being performed in the public system.

While some patients are obese as a result of genetic/epigenetic or medical reasons, it says, environmental factors are a principal cause for the majority. Clinicians should be especially aware that psychotropic medications often cause weight gain.

Individuals must increasingly fight against the obesogenic modern environment in which they live in order to sustain healthy nutrition and activity levels, and public policy in response therefore needs to draw together not only the healthcare sector but also town planning, transport, nutrition and education into a whole-of-systems approach. This should be combined with targeted approaches for groups deemed at higher risk.

The college says GPs are uniquely placed to tackle chronic diseases that straddle public health and primary care, and that while many have the specific skills to advise patients on the condition, more education and support is needed, especially in awareness of inequity and stigmatisation.

The Medical Benefits Schedule supports GPs through the use of chronic disease management plans for individuals with complex obesity.