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Obesity: a job for GPs or the Government?

From Dr James Mather

Malvern, Worcestershire

Thank you for printing Dr Fisher's letter (30 March). He is of course absolutely correct in his two-component answer to the obesity public health disaster.

Behaviour change is the cornerstone of management and eating less calorie-dense food and burning off more calories is the firstline intervention in all cases.

But you have to enable people who want to change to do so. Finding the right patients to invest the precious time resources in is crucial. Just like addressing tobacco use.

As GPs we are able to signpost patients to interventions that can save lives (and their childrens' lives). A 10 per cent reduction in body weight produces huge improvements in surrogate markers for CVD risk.

Time spent helping people lose weight is a cost-effective public health intervention. So, I agree with the two-component plan, but there is a job to be done enabling patients to achieve the aims of the plan.

The National Obesity Forum has produced an interactive CD-Rom that can help primary care to do the job. The CD is available from the NOF site www.nationalobesityforum.

· From Dr Anand Deshpande

Westhoughton, Lancashire

Dr Simon Fisher is spot on when he says the cause of obesity is eating too much and doing too little exercise.

Apart from a few rare medical conditions (such as hypothyroidism, Cushing's syndrome and Prader-Willi syndrome) it is simply due to more energy getting into the body than the amount spent in exercise.

Many overweight and obese people think it is cruel, insensitive, counter-productive, and judgmental when this fact is pointed out.

My experience with anti-obesity drugs has been depressing. Unmotivated patients demand a quick fix and are disappointed when the miracle doesn't happen. Some even put weight on!

If the Government wants to get the nation into a shape, then close all the supermarkets for a year and issue everyone with a ration card. A controlled famine would do a wonderful job.

It is bizarre that eating behaviour is made a medical condition.

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