Friday, 11 November 2016

"While you're here, I just want to talk about your weight"

The important Doctor-Patient relationship
In a slight departure from the typical material discussed on this blog, I want to briefly direct readers to the paper by (Prof) Paul Aveyard and colleagues [1] and results suggesting that: "A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight."

The title of this post comes from some of the media coverage of the Aveyard study summarising how general practitioners (GPs) in particular, might be ideally placed to bring up the topic of 'weight issues' when seeing some of their patients for other health matters.

Minus any charges of plagiarism, I'd like to particularly draw readers attention to the example given in the Aveyard paper of a 'typical physician intervention'. So:

"Physician: While you're here, I just wanted to talk about your weight. You know the best way to lose weight is to go to [Slimming World or Rosemary Conley] and that's available free on the NHS?
Patient: Oh?
Physician: Yes, and I can refer you now if you are willing to give that a try?
Patient: Yes, ok.
Physician: Ok, what you need to do is take this envelope back outside to the person who weighed you and they will book you into the weight loss course now.
Patient: Ok.
Physician: Good, but I'd like to see how you're getting on, so come and see me again in 4 weeks, please. Ok?
Patient: Ok, see you then."

In these days of the 10-minute consultation combined with something of an 'epidemic' of obesity and overweightedness I like the idea that a 30-second chat from an authority figure like a GP with a patient can potentially transform lives, even if only a proportion of the intended market. Despite the fact that only 40% of those offered weight reduction classes actually attended, there are some pretty decent statistics included in the paper to suggest that for this group, weight change was better than for those who weren't offered any additional support ("mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg"). And with decreasing weight, so the risk of various other health complaints also decreases accepting the old/new adage of 'not out-running a bad diet' [2].

In these days of the soundbite and 140-characters or less, it makes me wonder what other health promotion advice might be amenable to a very brief chat from someone like a GP?

To close, lest we forget...


[1] Aveyard P. et al. Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. Lancet. 2016. Oct 24.

[2] Malhotra A. et al. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med. 2015 Aug;49(15):967-8.

---------- Aveyard, P., Lewis, A., Tearne, S., Hood, K., Christian-Brown, A., Adab, P., Begh, R., Jolly, K., Daley, A., Farley, A., Lycett, D., Nickless, A., Yu, L., Retat, L., Webber, L., Pimpin, L., & Jebb, S. (2016). Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial The Lancet DOI: 10.1016/S0140-6736(16)31893-1