How should GPs discuss weight with their patients?

Michelle Wisbey

13/07/2023 4:25:41 PM

A high-profile body image advocate wants doctors to stop raising the issue, but clinicians say there are ways to sensitively approach the topic.

GP talking to patient
Australian of the Year Taryn Brumfitt says doctors should not discuss weight with their patients.

In an age of social media comparisons, body image pressures, and weight discrimination, GPs say more training is needed to help clinicians embark on healthy and helpful conversations around their patients’ size.
However, they have stopped short of endorsing recent comments from current Australian of the Year and body positivity advocate Taryn Brumfitt, who this week called for doctors to stop discussing weight with patients, labelling it the ‘last remaining legal form of discrimination’.
Rather than avoiding a discussion about weight altogether, RACGP Specific Interests Obesity Management Chair, Dr Terri-Lynne South, told newsGP doctors should instead be given the tools to bring it up in a sensitive way.
‘Ask somebody, “Would it be okay if I measured your weight?” and then leave it at that,’ Dr South said.
‘And then look for the clues from the patient as to whether that is something that they might be concerned about.
‘Take the time. If this is an issue that a patient wants to talk about, get them to come back for a separate, dedicated discussion where that’s all you talk about, not have it tacked on to a presentation where they came in for something else.’
Overweight and obesity are becoming increasingly prevalent in Australia, with 67% of the country’s adults falling into these categories, alongside 25% of children and adolescents.
But while two thirds of Australia’s adult population is living with overweight or obesity, new Monash University research suggests that many health professionals may not understand the negative impacts weight stigma can have patients.
‘They don’t want to ask for help because of their previous experiences that have been very negative from a stigma and shame point of view,’ Dr South said.
‘They have less access to screening, they have less access to seeking help and then when they do, there may be biases within that healthcare facility or healthcare practitioner which means they don’t get the same investigations or treatment as someone who’s not living in a larger body.’
She also believes social media is wreaking havoc on society’s collective body image.
‘We still live in a world that has a thin ideal, a very narrow range of expectations and standards from an aspirational point of view,’ Dr South said.
‘If we can improve people’s perceptions and acceptance of different body shapes and sizes and move away from the stigma that a certain body shape or size is suggesting healthy or unhealthy, I think that would be very important.
‘Trying to help someone who has the genetics to live in a larger body to arbitrarily meet a target BMI or target healthy weight range that is not actually based on good evidence for an individual just sets people up for failure.’
RACGP Vice President Dr Bruce Willett agrees, but told newsGP doctors cannot ignore the health impacts sometimes associated with being overweight or obese.
‘As health professionals, were obliged to look at that, it’s really part of our job,’ he said.
‘In terms of the how to bring it up, it’s important that it’s done sensitively, and really, as a GP, what we do and need to do is judge every patient’s readiness and willingness to discuss it.
‘We know that [weight] is all multifactorial, so to simplify it and say people just did the wrong thing is really cruel.’
It comes after a concerning study was released earlier this year, surveying 900 healthcare students attending 39 Australian universities.
‘Students believed that obesity was within a person’s control and that people living with overweight or obesity lacked willpower,’ the study found.
Both GPs said more education needs to be rolled out to students and clinicians to ensure patients are respected and offered the highest quality treatment.
‘There needs to be separate training in regard to stigma, discrimination, bias, and then also separate understanding of the biology of weight control,’ Dr South said.
‘It’s about a lot more than [personal choices around] eating less and moving more.
‘We need to work out some sort of healthy middle ground that is being led by patient values and then backed by evidence.’
Dr Willett said with the right training, GPs can be ready to provide advice in a meaningful but non-judgmental way.
‘I think we have had an ability to confront our own biases and I think, on the whole, people aren’t good at that,’ he said.
‘It’s not all about scales, all other lifestyle things are important. Recognising that weight is not the be all and end all in the measurement of health.’
Monash University is recruiting for a new study with a focus on how GPs and other health practitioners discuss weight with patients. More information is available online.
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Dr Annette Hackett   14/07/2023 9:13:33 AM

As soon as you mention weight in any context in a consultation, a larger person will assume you think they are too fat, that they are lazy and greedy, and that you will prescribe them a diet. I know. I'm fat. No one wakes up one morning in our society and says 'geez, I'm fat, how did that happen?'. By far the majority of your larger patients have been on numerous diets and found that, surprise surprise, diets don't work. The biggest risk factor for weight gain is dieting. 97% of people who diet regain that weight within 5 years (and this includes medications, all types of diets, and many bariatric surgeries). 67% of those who lose weight will regain more weight post diet. Many will develop an eating disorder. Most have developed an overwhelming sense of shame around their bodies.
To think that you can give advice in a non-judgemental way is ludicrous - to mention weight (as if the person has no idea about their weight, or how it is perceived by the GP) IS to make a judgement.