This site is intended for health professionals only

That’s a weight on my mind

That’s a weight on my mind

So let me get this straight.  According to draft NICE weight management guidance, patients should first check their BMI, and if it’s less than 35 kg/m2, they then measure their waist-to-height ratio, and if that’s more than 0.5, they should come and see us GPs for ‘help’.

What could possibly go wrong with that? Apart from patients not being sure how to calculate that preliminary BMI, being unclear where their waist actually is, not having a tape measure, not knowing their height, being hazy on ratio maths, confusing numerator and denominator, and panicking that their ratio, as it approaches ‘1’, means imminent death. Oh, and the clever ones realising that the solution is growth hormone to make them taller.

Not that our more spherical punters need any encouragement to attend, as they already roll up with monotonous regularity. And no, I’m not being fattist here, I’m just saying it as I see it. And these patient are really easy to see.

Besides, what are we supposed to do after they’ve wedged themselves uncomfortably into the consulting room chair? What they need to do is, you know, lose weight, not look at me like I’m going to reward them with a biscuit.

OK, yes, I can check their HbA1c and score some Weight Management Enhanced Service points and put the pre-diabetics on metformin etc etc. But look, I’m super-busy already, I really don’t want to medicalise a lifestyle issue and I resent being ‘ideally placed to manage’ what is in reality a public health problem. Frankly, life’s too short, like many of my patients.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at



Please note, only GPs are permitted to add comments to articles

Patrufini Duffy 12 April, 2022 5:24 pm

NICE are worried that a food and energy poverty is going to make people fat. And that GPs and nurses have ample free time, twiddling their thumbs, to talk about how to move and what to put in your mouth. That warps anyone’s mind. Perhaps it is the Americans lining up more data for their bariatric service onslaught.

Stephen Fowler 13 April, 2022 6:57 pm

Perhaps it is the Americans lining up more data for their bariatric service onslaught.

Or their statin onslaught…

Darren Tymens 16 April, 2022 9:17 am

Daft, and patronising.
People know when they are overweight, eat badly and need to exercise more. They don’t need a doctor to tell them this.
It’s just the government/NHSE wanting to be seen to be Doing Something About It.
An ad hoc type 2 DM screening programme (if that is what they really want) doesn’t need to be GP work. A properly-funded public health campaign and a walk-in HBA1C run by pharmacists would do the trick – but would cost something. The reason it is coming to us is because we are free.

Simon Gilbert 19 April, 2022 2:41 pm

Guidance is often used as a proxy for actually commissioning work in #WonderfulNHS as not following a guideline is associated with increased clinician regulatory, civil and criminal sanction should a bad outcome occur.

Kevlar Cardie 22 April, 2022 12:03 pm

Gravitational field strength in every GPs room is only 8 m/ s2.


That’ why so many punters can’t resist asking “can I check my weight on your scales, doc ?” while their ticking off their shopping list.

Kevlar Cardie 22 April, 2022 12:03 pm


Rogue 1 27 April, 2022 3:17 pm

Nice one Tony