27 August 2018

Young folk missing the weighty questions

Clinical General Practice Obesity

Young overweight and obese patients aren’t talking about their weight with their doctors, missing out on one of their best chances to change the trajectory of their long-term health.

An Australian study found that three in four young patients with a BMI over 35 had not spoken with their GP about their weight in the last 12 months.

But the proportion who were talking about it was greater than for their peers at lower weights, with only one in eight patients with class I obesity (BMI of 30 or more) in the 15- to 24-years age category having the weight conversations.

Study author and Tasmanian GP Professor Mark Nelson said that GPs tended to avoid asking about issues they didn’t think they could influence, and that there was “a lot of evidence that anything short of surgery doesn’t have a profound effect on long-term weight loss”.

Given the choice between managing elevated blood pressure, where interventions had proven effectiveness, or elevated weight, which doesn’t, it was understandable GPs concentrated on the former, he said.

Australian guidelines have long recommended routine waist and weight measurement, and weight-related advice to overweight patients.

But research indicates that this does not happen commonly in clinical practice.

This survey of 15,000 overweight and obese individuals appears to support these findings, with the University of Tasmania and the Menzies Institute for Medical Research investigators finding that only around one in 10 of the patients at any age over 15 had talked about their weight with their GPs in the last year.

Professor Nelson’s analysis of the National Health Survey data showed that older patients and those with health problems related to their weight or psychological distress were more likely to have spoken with their doctor on the topic.

But adolescence and early adulthood was the age that people began establishing their lifestyle habits, and people tended to gain half a kilogram per year as they grew older, the chair of general practice at the University of Tasmania said.

In previous surveys, GPs have listed the major barriers to asking about weight loss as: a lack of training and confidence in navigating the tricky and stigma-filled topic; a lack of time and resources; self-efficacy; and fear of jeopardising patient relationship.

But Professor Nelson said that clinicians shouldn’t be put off by the social stigma around weight and asking about weight, saying there was evidence that patients welcomed the conversation as they recognised weight was a health issue.

The fact that excess weight was a risk factor for many medical conditions provided a good entry into the conversation, he said.

The paper pointed out that brief, opportunistic interventions, even when patients did not visit for that specific reason, had been shown to be effective.

For example, in a woman with a BMI of 31 and osteoarthritis of the knee, weight became “part of the explanation of why she has the condition (mechanical stress due to weight bearing and possible increased circulating cytokines due to insulin resistance) as well as the basis of treatment (the benefit of exercise and weight loss)”, Professor Nelson said.

When it came to resources for further training, the doctor suggested any behaviour modification training, such as that used for smoking cessation, could be helpful.

It was also important to be sensitive about weight discussions with younger, potentially vulnerable, people, he added.

The investigation also found that when people underestimated their weight, they were less likely to discuss it with their doctor.

As the authors pointed out, as our community becomes heavier the benchmark for a normal weight was likely to increase. This could further widen the gap between the people who needed to begin managing their weight with their GP and those who actually did.

Obes Res Clin Pract; 19 July