Diet and exercise advice is not enough; patients need better access to bariatric surgery and effective medicines, says the physicians’ college.
The chair of the RACGP’s obesity management group says GPs need to ensure obese patients are receiving equitable care, amid calls from the RACP for better access to bariatric surgery and more subsidies for obesity treatments.
Whether GPs should discuss weight is a hot topic.
While some suggest that it can deter patients from seeking help, others maintain that ignoring obesity is abrogating their responsibilities as a GP.
The chair of the RACGP’s obesity management specific interest group Dr Terri-Lynne South said tailoring care was key.
“Obesity is a delicate area for GPs and patients to navigate. We live in an era of social media comparisons and people suffering from body image pressures, so providing the right kind of care and support is crucial,” Dr South added.
According to Dr South, there remains a way to go in education for medical professionals.
“Every patient is different and I’m mindful of research which finds that some health professionals may not fully understand the negative impacts weight stigma can have for some people.
“If a patient has had bad previous experiences with a health professional and feel a sense of shame, they may be reluctant to reach out and seek help and that is the last thing we want.”
Dr South added that additional training on weight stigma and the biology of weight control might help.
Despite wanting to avoid stigma and discrimination, GPs can’t avoid the weight chat, she said.
“[Obesity] is a growing problem in Australia, with 67% of the nation’s adults falling into the categories of being overweight or obese alongside of a quarter of children and adolescents.
“So, clearly this is something that must be front of mind for GPs and practice teams, and that includes helping people to take the steps necessary to improve their health and wellbeing rather than just focussing on the numbers on the scale.”
But the RACP said that “asking patients to improve their diet and exercise simply isn’t enough”.
“We need a new model of care for treating patients with obesity, and this includes a balance of prevention measures and accessible, effective treatments.”
However, patient access is limited by the cost of these medicines the college added.
“In some cases, we’re even hearing about patients who are emptying their superannuation funds just so they can get the surgery through the private system,” said RACP President Dr Jacqueline Small.
“It should not have to come to this, when we know there are important health consequences if patients can’t access treatment,” she said.
Dr Small added that, while prevention is important, improving access to treatments such as bariatric surgery and increasing PBS subsidies for obesity and diabetes medicines – two inextricably linked conditions – should ensure patients in need “aren’t left out in the cold”.
Dr South concurred that the aim should be equity of access to suitable care.
“The aim for GPs is to ensure people who are overweight or obese are seeking healthcare and that they are getting the same investigations or treatment as someone who’s not living in a larger body,” Dr South said.
“The focus needs to be on healthy and helpful conversations so that we can help patients improve their health trajectory. GPs will not talk about weight in isolation; instead, we provide holistic care and look at the patient’s entire health history and life circumstances.”
Dr South suggested covert methods of bringing up weight – such as asking for permission to measure their weight – may allow GPs to look for clues about people’s sensitivity to discussions of weight.
The RACP said it was time to hold institutions accountable for providing equity of access to obesity care, rather than continuing to “stigmatise obesity as an individual problem”.
“The more research we do on obesity, the more we learn about the environmental and systemic factors that are causing high obesity rates in the population. It’s also clear that there’s more we could be doing to bring the current rates of obesity down,” said Dr Small.
Dr South encouraged GPs to sign up to this year’s WONCA conference which will be held in Sydney from 26 to 29 October to voice their experience with obesity care.
