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Having conversations about weight

Dr Richard Roope

As many of us on the frontline know, it can be really difficult to have discussions about weight with our patients. It’s a sensitive subject, and many of us worry about how to deliver a message clearly without hurting feelings.

But these conversations are hugely important and can be life-changing. Being overweight or obese is the second biggest preventable cause of cancer, putting people at higher risk of 13 types of the disease. In comparison, smoking is a factor in 15 types. Thus, we have a professional duty to equip patients with the advice to make informed decisions.

You may have seen posters going up around the country this month, stating that obesity, like smoking, puts millions of adults at greater risk of cancer. And a new report from Cancer Research UK recently stated that excess weight trumps smoking as the leading cause of four cancers: bowel, kidney, liver and ovarian.

As a healthcare professional, you may well be asking yourself ‘what can I do about this?’ - especially as patients will have seen these posters.

With a Government pledge to halve childhood obesity by 2050, and targeted support and access to weight management in primary care included in the NHS long term plan, now, more than ever, GPs have an important role in talking to patients about excess weight.

Obesity has many causes and no single solution, but we are uniquely placed to raise awareness of the health risks and support weight management. Achieving and sustaining significant weight loss is not easy, so many patients would benefit from professional help and guidance.

Obesity has many causes and no single solution, but we are uniquely placed to raise awareness of the health risks and support weight management

For obesity, as for smoking, talking to patients about their cancer risk is about helping them make informed choices about their own health – not about stigmatising or blaming.

There are known barriers to having effective conversations, such as fear of damaging the patient relationship, or lack of sufficient local services to offer. But evidence is emerging that having structured conversations with your patients about their weight can have a significant impact.

Research published in The Lancet found that even a brief conversation between GP and patient can have implications for weight loss.

At the end of consultations about other health issues, GPs spent just 30 seconds advising patients that the best way to lose weight was to attend a local programme, and offered them an NHS referral. 40% of patients took up the offer, and crucially, less than 1% thought the intervention was inappropriate and unhelpful[1].

A recent Cancer Research UK roundtable with GPs and general practice nurses concluded that conversations about weight are most successful when conducted over a series of appointments once you’ve gained a patient’s trust. Attendees said that having practical aids helped to initiate conversations, and structuring the discussion using the 3A approach (Ask, Advise, Assist) could ‘plant a seed’ to get patients thinking about weight and ultimately better engage them in the future.

Cancer Research UK have also developed training with the RCGP about having effective behaviour change conversations. This is available for free here.

People who are obese now outnumber people who smoke two to one in the UK. Smoking rates have dropped dramatically over the years, and while healthcare professionals played a key part in educating people about the risks of tobacco, we must now apply the same awareness-raising efforts to tackling obesity and weight-related cancers.

Dr Richard Roope is senior clinical advisor at Cancer Research UK, national cancer champion at the RCGP and a GP in Hampshire 

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Readers' comments (11)

  • Mentioning plumpest, portliness, Rolls Royce or subtler allusions is seeking a complaint nowadays. I recollect a (possibly apocryphal) tale about a consultant who responded to the usual guff with ‘Madam, its not due to your slow metabolism, its due to your fast knife and fork’.

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  • National Hopeless Service

    'Over a series of appointments'

    Real world medicine only please.

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  • The government can have all the goals it wants- if the policies it sets are completely at odds with this then why should GPs pick up the pieces. Obesity is not an illness, it’s a lifestyle choice. No one forces food in peoples mouths....

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  • I sense another toolkit in the pipeline

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  • YFB,You ate all the pies

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  • FFS there are enough fat doctors and nurses to answer the question for us!

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  • We could transform the lobby in to a speak your weight machine that weighed people automatically as they stepped on the premises and told them out loud. I'd probably take the back door to avoid embarrassment

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  • Speak you weight/BMI machine,saying 'get off you fat b'stard you will break me'when the big o is reached.Lets give it the voice of Bozo I pay to see the reaction to that of my patients an I would have countless hours of fun!

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  • @ Turn out the lights | GP Partner/Principal20 Aug 2019 6:24pm

    'get off you fat b’stard...’ has a certain completeness and invites a cornucopia of embellishments.

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  • Obesity may be "Complex" but lets not forget it usually results from more calories in over calories out. by all means "Have the conversation" but we really must avoid Medicalising essentially a current social issue. If governments are so concerned then they need to get off the high horse, Tax the Fat and subsidise the alternatives. Clothe retailers need to stop adjusting dress sizes and revert to what was normal. stop fudging the issue, stop using PC terminology. We all need start singing from the same hymn sheet and provide consistent messages.

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