Don’t mention the (obesity) war?

4 minute read

A prohibition on doctors bringing up weight as a health issue is taking body positivity a step too far.

I just shouldn’t have read it, really.

The headline – “Doctors urged to tread lightly when talking about weight” – should have been enough to tell me it would only annoy and frustrate me.

Did you read it? In this Nine newspapers story, body positivity advocate and Australian of the Year Taryn Brumfitt warned GPs to avoid bringing up the topic of weight in a standard consultation with patients who have “larger bodies”. She said we were adding to the weight stigma and making people feel shame, and driving patients away from engaging with the health system.

Now I am totally on board with Ms Brumfitt’s motivations. I’m all for feeling good in your own skin and I’m sure she has done much more for humanity than I’ll ever do, but this is just way off the mark.

We are not running a day spa – we are talking about health.

I don’t think a week goes past without some new study, guideline or finding showing the adverse effect obesity has on health. And while the article (rather disingenuously) quoted a recent US study that showed a higher BMI was not associated early death, I’ll happily quote dozens of other studies that show obesity’s link with cardiovascular disease, type 2 diabetes, asthma, osteoarthritis, bowel cancer, breast cancer etc.

Even if a patient is perfectly happy being a size 20, that does not make it less of a risk factor for their future health, and if the opportunity arose I would think it negligent of me not to raise the issue. Ms Brumfitt cites the example of a larger patient going to visit a GP for a sore knee and coming out with a “prescription” for a diet. Ask any rheumatologist or orthopaedic surgeon for the most effective way an obese patient can reduce the pain in their arthritic knee …

And as for the claim that GPs do not have enough training and experience to have complex conversations about, food, movement and other health behaviours, and a standard consultation wasn’t long enough to support sustainable behaviour change – she is missing the point entirely.

We don’t expect to solve any major lifestyle issue in a single 15-minute consultation – be it weight, smoking, fitness, alcohol or any one of the myriad other health-affecting lifestyle choices. But the conversation has to start somewhere, and if you read any guideline or public health policy, almost without exception, the finger for this initial conversation is pointed at the GP.

Interestingly, the article also quoted a Monash University professor who said that GPs were taught to use “opportunistic intervention” to discuss weight in overweight and underweight patients. “Every patient I’ve ever spoken to has had this happen at one time or another,” she said.

Isn’t that a good thing? The article strongly implies it’s not. That’s just ridiculous.

As for not knowing enough about the ins and outs of foods and exercise, she’s probably right, but we are great conduits to accessing those people who are.

And with regard to our ability to manage behaviour change, that just shows complete ignorance of what we do. We know better than anyone about the challenges of changing lifestyle. We know it takes commitment and time – and what GPs can offer when they raise an issue such as the need to achieve a healthy weight (not attractive weight – healthy weight) is ongoing support, access to added professional services and even pharmacotherapy.

GPs aren’t out to alienate their patients, Ms Brumfitt, but we’re not prepared to abrogate our responsibilities by adopting an ostrich mentality when there is a health issue that needs to be addressed.

Dr Linda Calabresi is a Sydney GP and editor-in-chief of Rheumatology Republic’s sister publication, The Medical Republic.

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