Focusing on weight not necessarily most effective strategy for managing obesity

Some healthcare professionals have argued that focusing solely on weight loss when managing overweight and obesity can be detrimental to patient health. This is because it may be an unrealistic goal for some, causing pressure and distress that can result in further weight gain.
 
Does the argument have any validity for managing overweight and obesity in general practice? Dr Georgia Rigas, GP and Chair of the RACGP Specific Interests Obesity network, believes it does.
 
‘I agree the emphasis should be on improvement in a person’s overall health and wellbeing. Weight loss might be a side-effect or a consequence of this rather than the primary goal,’ she told newsGP.
 
To this end, Dr Rigas believes it is beneficial for GPs to promote health-related goals other than weight loss.
 
‘We need to encourage goal-setting on things such as improvement in diabetes control; less shortness of breath when walking or running, so increased cardiac fitness; less pain when walking up and down stairs, so increased function and mobility; and more regular menstrual periods, hence improving fertility,’ she said.
 
Dr Rigas also cautions that ‘you can’t judge a book by its cover’. After all, she said, there are patients whose body mass index (BMI) and waist circumference meet the ‘normal’ criteria, yet are unhealthy.
 
‘As GPs, we need to look at the whole person – medical and family history, risk factors – and then decide what is in the patient’s best interest, engaging them in the discussion and decision-making process,’ she said.
 
Dr Rigas recommends using a tool such as the Edmonton Obesity Staging System (EOSS) to help identify individual risk of mortality. It may also be important to follow up with these patients on a regular basis.
 
‘We know from a number of longitudinal studies that people with overweight or obesity find themselves on a weight-gain trajectory,’ Dr Rigas said. ‘These patients need to be monitored at least six-monthly, as per the RACGP Red Book, and management plans should be put in place.’
 
While Dr Rigas acknowledges that a minority of patients with overweight and obesity may be healthy, she hesitates when asked whether she endorses a social movement such as ‘Healthy at every size’.
 
‘The WHO [World Health Organization] defines healthy as “a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity”,’ she said.
 
‘When patients share personal experiences such as being reluctant to travel by plane because they’re embarrassed that they need an extension belt or will spill over to the adjacent seat, or they miss out on promotions despite being adequately qualified because of size discrimination in the workforce, you know their emotional health has been affected.’
 
However, Dr Rigas also believes modern culture needs to foster better understanding of the causes behind overweight and obesity, and work to dismantle weight-based stigmas.
 
‘Some individuals have a genetic disposition towards developing obesity, coupled with our current environment, which includes an abundance of cheap, calorie-dense and nutritionally-poor food, technology that makes life “easier” but also more sedentary, stress, poor sleep patterns, medications, changes in the gut microbiome and other factors,’ she said.
 
Dr Rigas counsels that, ultimately, any homogenous approach will be likely inadequate when managing this condition.
 
‘Treatment needs to be tailored to the individual person in front of you,’ she said. ‘It shouldn’t be a prescription, as one size does not fit all.’

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