The UK, like many developed countries, is facing an obesity crisis at all ages largely due to a combination of poor diet and inadequate exercise. There has recently been the suggestion that GPs should be doing more to tackle this problem.
I think this is the wrong approach. While GPs do have a role to play in helping our overweight patients to tackle their weight problem, our role is relatively minor compared to the other changes required to tackle this major threat to the wellbeing of our society.
Weight gain is something many, perhaps most of us struggle with for much of our lives. It is not a disease in itself but of course we know that if our BMI rises sufficiently, and certainly from ‘overweight’ to ‘obese’ then it is very likely this will lead over time to the long term medical conditions that GPs are all too familiar with such as diabetes, vascular disease and arthritis.
Much of the recent debate has been about the suggestion that GPs should assess their patient activity levels and, for those deemed less active, give brief interventions on appropriate activity. This is a poor use of GP skills and time. If I could make one plea, it would be that there were no obesity management targets for GPs and certainly no obesity indicators in the Quality and Outcomes Framework. They would have little value for the patient and would reduce the activity to a check-box exercise that further de-professionalises our role. It would be far better if GPs continued to tackle individual patients about their weight problem when the time is right for the patient, and when they are able to make the connection between their health and their weight. They are then much more likely to do something about it.
Leading by example
So what are we to do in the UK if the GP’s role is largely one of making the connection opportunistically, and personally setting an example? I am attracted to the Academy of Medical Royal Colleges recommendations to tackle the nation’s obesity crisis in their recent document Measuring Up.
They make 10 recommendations broken down into actions for healthcare professionals, changing the obesogenic environment and making the healthy choice the easy choice. Their recommended actions include education programmes for healthcare professionals, increased investment in weight management services, nutritional standards for hospital food across the UK, the skilling-up of health visitors to deliver basic food preparation skills for new parents and measures to encourage breast feeding.
Tackling the obesogenic environment involves providing food skills in schools, developing recommendations on the control of fast-food outlets near schools and a ban on advertising junk food on television before 9pm. Changes to make the healthy choice the easy choice include a tax on sugary drinks, a unified system of traffic light food labelling, calorie indicators in restaurants and measures to encourage active travel and the protection of green spaces.
I would personally add that all schools should provide healthy lunches and that all pupils would be expected to eat with their classmates.
Our patients look to us for guidance and as health care professionals we need to set an example in terms of living a healthy lifestyle. I try to encourage patients to ‘do what I do’ so I started running when I was 42 as a means of maintaining fitness. Six years later I can say I am fitter than I was ten years ago. It was of course a struggle at first, but I keep a photo of me completing a half-marathon on the wall next to my patients consulting chair. This reminds me of the benefits of regular exercise (and the need to keep it up) and is frequently a talking point with patients.
Dr Andrew Buist is the deputy chair for the Scottish GPs committee of the BMA, and a GP in Blairgowrie, Tayside.