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Independents' Day

One in three GPs have offended patients by talking about their weight

Exclusive A Pulse survey of over a thousand GPs saw 32% of respondents answering yes to a question about whether they have offended a patient by raising the issue of them being overweight.

Some 63% said their patients had not been offended, while 5% said they did not know.

It comes as current NICE guidance says GPs can refer any overweight patient (with a BMI over 25 kg/m2) to lifestyle weight management services, particuarly adults who are obese (with a BMI over 30 kg/m2).

Are patients offended when you raise the issue of them being overweight?

Yes - 32%

No - 63%

Don't know - 5%

The survey was launched on 9 November 2016, collating responses using the SurveyMonkey tool. The 29 questions covered a wide range of GP topics, to avoid selection bias on one issue. A total of 1,141 GP partners answered the question above.

NICE guidance also says that health professionals should 'be aware of the stigma that adults who are overweight or obese may feel or experience' and 'ensure the tone and content of all communications is respectful and non-judgemental'.

Despite this, many GPs told Pulse patients are often offended, with a careful balance to be struck.

East London-based GP Dr Tope Ajayi said he has seen 'many a patient with chronic knee pain who have been clearly overweight' but he has 'weighed up whether or not it's worth bringing up the fact the patient's weight may be contributing to their pain for fear of it negatively affecting my relationship with the patient'.

But Dr Ajayi said that not broaching the subject could lead to unnecessary medical investigations when 'in fact [the patient's weight] should be addressed first'.

He added that he has also 'hidden' on-screen QOF prompts from patients including the word 'obese' so that the patient 'didn't feel bad or assume it was the doctor that had written obese on their notes'.

And a GP from Surrey, who wished to remain unnamed, said: ‘Patients are often resentful when GPs say weight is the cause of their problems.

'Some patients have declined to see some of our GPs whom they feel pressurise them about weight, but patients are often more upset at being fat than at the discussion.’

Another GP, based in Kent, said that discussing weight was not an issue if they had an established relationship with a patient but could have a negative impact if coming from an unknown doctor.

They said: ‘As I know my patients well I can do this at the right time [but it] will be counterproductive if done at the wrong time by a GP in the hub.'

But they added that they do not think discussing weight issues is 'a role that should be pushed onto GPs' when it was a social, rather than a clinical issue.

'I am a doctor, not a social secretary,' the GP said.

NICE's QOF panel last summer recommended a new indicator that would see GPs incentivised for recording the BMI of all adult patients, however the GPC and Government have agreed for there to be no changes to QOF in 2017/18.

The panel rejected a proposed indicator that asked GPs to ensure any patient with a BMI over 25 was given appropriate weight management advice within 90 days of their BMI being recorded.

Who is responsible for solving the obesity problem?

GP leaders have called on the Government to do more to stem the rising tide of obesity via public health interventions such as introducing a sugar tax.

They particularly criticised the long-awaited childhood obesity strategy when it was published last year, for being 'weak and watered down'.

The Local Government Association has called on GPs to ‘prescribe’ exercise in a bid to help reduce obesity and diabetes.

And a study published in the Lancet last year said GPs should not be concerned about offending patients and opportunistically offer patients 12-week weight management programmes during consultations.

But Pulse has revealed that councils have cut weight management services as part of public health funding cuts.

NHS England has said that it is playing its part in the wider fight against obesity by launching the type-2 diabetes prevention programme that expects GPs to find five million patients at risk of developing the disease.


Readers' comments (13)

  • this is ridiculous we have to all stop being so politically correct and if we offend patients bad luck if weight is the problem tell them so ! if they dont want to hear they will go elsewhere.

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  • I agree - given the vast amount of evidence that demonstrates obesity as a risk factor for many medical conditions it should be addressed - just like smoking and drinking.
    There are probably persons who are fit, active and overweight but these are in the minority.

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  • I don't think it's difficult to address in a non-offensive way. "...of course your risk will be lower if your weight is lower. Have you tried to lose weight in the past?"

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  • Spuds

    If people are overweight then they generally expect their GP to mention it. We're not a flattery service.

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  • @Dylan: No, Dylan, you are wrong there.
    Please learn right here and now that some patients will be offended no matter how you discuss it with them. Some patients don't like you from the start, have had a rubbish day, a rubbish life, rubbish sex.
    Finally, if you are not convinced, try an accent for a day.

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  • I'll give you 8 to 1 that fatso will eat a pie during your consultation

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  • 2 complaints in the last 10 years from people offended that I mentioned their weight (both had BMI north of 40) as a risk factor for all sorts of illnesses. Both complained that my observation was "not relevant to their problems (knee pain and back pain)". So now I dress any observations up in some generic guff about lifestyle and leave it to the diabetic nurse to cross the flabby rubicon.

    As has been said many times by Pulse, we are a defeated profession.

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  • David Banner

    2 in 3 GPs are being too soft on obesity.

    It's the biggest health problem of the 21st century, if you are too worried about offending the patient then you are failing them.

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  • Vincenzo Pascale

    Do you remember lieutenant Colombo series ?
    He always talked about his wife (she was never seen in the series)to justify some bad arguments with the suspect of a crime. Well I use the same. I say that I was very fat and had to lose weight for my knee. Or that my wife had to start a diet without fats because her cholesterol, and so on. This start immediately a stream of empathy with the patient. It works perfectly in Italy, Spain, Ireland and Angola.... and I imagine it would work in the UK too...

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  • I would rather have angry patients than an angry wife!

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