‘I am sorry, doc. I never came back to tell you what I eat.’
Waiting outside a yoga class, I was accosted by a smiling, fit-looking man in his late 50s. Trawling my memory, I remembered our consultation to share his new diabetes diagnosis more than 18 months ago. I pictured the depressed, obese man, tearful in his victim role. He had been made redundant, his wife had left him, and things were not going well. By the time I’d let him tell his story, introduced our diabetes clinic, and weighed him, our 10 minutes were more than over. ‘Choosing to make changes to your lifestyle can improve your diabetes. If you want to explore this, why not write down everything you eat and drink for 3 days, and come back and tell me what you learn.’
And of course he never did!
However, on that day after the class, he expressed his gratitude and credited me with inspiring him to ‘turn his life around’. Our very brief conversation had prompted him to get out of his armchair and into the gym, at a reduced rate for the unemployed. He enjoyed the structure it brought to his life and the opportunity to meet people. He realised how bad his diet had become, made some changes, and began to lose weight and feel better. His new body brought new confidence, which must have been visible to potential employers. He was back in full-time employment and a new relationship.
Driving home, I reflected on how tempting it is in busy general practice to become disillusioned, to feel our efforts to tackle obesity and its prevention are pointless, and to slowly give up—stop weighing people, stop making time to ‘talk change’. To think gloomily about what little impact we have. This man made me realise that we have absolutely no way of knowing who we will influence, and indeed what unseen influence we have already had.
Most of us have consultations where we consistently make time to ‘weigh and talk weight’: obese women planning a pregnancy (an opportunity to influence two generations);1 people with impaired glucose regulation, where changes can prevent progression to diabetes;2 obese women seeking contraception, where efficacy or choices are influenced detrimentally by weight.3 And
if someone has a condition triggered or worsened by obesity, such as OA knee4 or sleep apnoea, how can I do my job properly if I prescribe but do not encourage weight loss?
Do we delude ourselves that people don’t want to talk about weight, when it is really we who feel unprepared for this conversation? If we were trained to raise the subject and to motivate behaviour change, would we do it? Are we really too busy to recommend the NHS Choices website5 or other potentially life-changing resources?
In this case, I take no credit. But if we cannot predict who is ready to make lifestyle changes that can lead to healthier lives, how can we justify not raising weight with everyone where it’s appropriate? If we all ‘made every contact count’,6 might we together turn the tide of the obesity tsunami?
Dr Pam Brown
- NICE. Weight management before, during and after pregnancy. Public Health Guideline 27. NICE, 2010. Available at: www.nice.org.uk/ guidance/PH27
- NICE. Preventing type 2 diabetes: risk identification and intervention for individuals at high risk. Public Health Guideline 38. NICE, 2012. Available at: www.nice.org.uk/guidance/PH38
- Faculty of Sexual and Reproductive Healthcare. UK medical eligibility criteria for contraceptive use. FSRH: London, 2009. Available at: www.fsrh.org/pages/Clinical_Guidance_1.asp
- NICE. Osteoarthritis: Care and management in adults. Clinical Guideline 177. NICE, 2014. Available at: www.nice.org.uk/guidance/cg177.
- NHS Choices website. Live well: lose weight. www.nhs.uk/LiveWell/ Loseweight/Pages/Loseweighthome.aspx (accessed 6 August 2014).
- NICE. Physical activity: brief advice for adults in primary care. Public Health Guideline 44. NICE, 2013. Available at: www.nice.org.uk/guidance/PH44G