Putting GPs in gyms is a fantasy – and a fallacy
Dr Ellie Cannon
Apparently we’re all going to the gym. Not to de-stress after a day in clinic, but to see patients, as ‘leading health experts’ have claimed GPs should be stationed in gyms to tackle our pervasive obesity crisis and send people into Zumba classes.
The Royal Society of Public Health has called for this ground-breaking measure to persuade patients to sign up on the spot for exercise classes, and hand out prescribed exercise plans to gym goers or those afraid of working out.
What with the sugar tax arrival, Hugh Fearnley-Whittingstall’s Fat Fight and the constant barrage of pseudo-scientific celeb diet advice, this was just another headline that had my eyes rolling.
I was left wondering if ‘leading health experts’ have ever actually set foot in a GP surgery or witnessed a 10-minute GP consultation. Or in fact taken the time to understand the complexities behind the obesity crisis and those it typically affects.
This shows a total lack of understanding of the multiculturalism, deprivation and socio-economic strata GPs bear witness to
Not to mention the fact that right now, we don’t have enough GPs actually in GP surgeries, never mind any spare to put in the local gym.
The trouble with all these ‘radical’ obesity measures that GPs are supposed to adopt and commend is they don’t reflect real life: often the organisations proposing them are single-focus bodies (the gym idea came from Ukactive) who lack the pragmatism that health professionals, particularly GPs, have developed through dealing with actual patients and their complex lives and risk factors.
My patients who are suffering and ill as a result of their obesity are not going to pop to see me before Body Combat, because they are not in the gym. Gyms are full of a certain sector of society that generally excludes those in the grips of this obesity epidemic. Gyms can be incredibly daunting places for people to attend, whether to see your GP or anyone else.
I also totally resent the notion that gyms hold the monopoly on exercise when there are plenty of other (often free) options. It all looks a bit derisorily middle class from where I’m sitting: calling for us to be in gyms shows a total lack of understanding of the multiculturalism, deprivation and socio-economic strata GPs bear witness to.
I like the idea of lifestyle medicine, don’t get me wrong: I am aware that my patients need appropriate diet advice, exercise plans and realistic approaches to suit their lives, families and socio-economic status – but GPs cannot do that. It’s a nice idea. It can’t be done in 10 minutes; we are not trained in diet or exercise and of course, there is still so much else to do.
We have a whole profession of dieticians in this country that we underuse. Not celeb foodies or nutritionists, but NHS dieticians who are experts in nutrition, food and weight loss. Yet dietary advice is more and more confined to secondary care and very little is available for the community. If experts were to acknowledge the truly far-reaching aetiology of the obesity epidemic, we would have hundreds of dieticians lined up for primary care weight loss strategies. Sadly, none of the weight loss pilot schemes where I work were ever recommissioned.
Admittedly amongst the usual high-profile voices, celebrity chef Jamie Oliver has called for an environmental and multi-pronged approach to obesity to tackle the whole environment we are subjected to: the food industry, education, advertising and government need to be taken to task. This is more realistic and reflects Sir Michael Marmot’s conclusions: that health inequalities arise from a complex interaction of many factors and we need action across all social determinants of health. Society needs changing as well as the individual in their consultation with their GP.
While I was driving to clinic the other morning, I heard a doctor promoting the idea that children need to eat vegetables to battle obesity, suggesting with each meal parents get out the star charts and ensure consumption of a rainbow of colours. What do you do for indigo the presenter asked? You can buy purple sweet potatoes of course.
Exercise opportunities and good food should be there for all but that does not equate to telling everyone to eat organic black quinoa and take up HIIT. It means adopting the principles of Marmot: for all families to allow their children to grow up healthily means creating an environment for them where good food is accessible, bad food is avoidable, exercise is a necessity and the health landscape changes along with the individual. That will not happen by asking me to work in a gym.
Dr Ellie Cannon is a portfolio NHS GP in London and broadcast media doctor