Is obesity a doctor’s problem?

It’s easy to point fingers when the subject of obesity comes up. Some say it’s the government’s fault. The failure to have a national obesity plan, combined with a lack of sports programs, nutritional education, cycle paths, and public transportation are the reasons Australians are getting bigger. Others say we only have ourselves to blame: we eat too much, too often, don’t exercise and live sedentary lifestyles.

And some blame doctors for not weighing patients at each consultation; taking the time to talk about weight and, if appropriate, recommending appropriate lifestyle behaviours and a healthy diet.

Recent studies have shown doctors aren’t weighing three out of four patients. The study of more than 270,000 patients between 2011 and 2013 found just 22.2% of patients had their weight recorded by their GP and only 4.3% had their waist circumference measured. The MJA study also found doctors had problems identifying obesity, difficulty discussing it with patients and did not have the appropriate training to manage it.

So, as Dr Karen Hitchcock suggests in her book Fat City, is obesity a doctor’s problem?

Like many health issues, doctors are at the coal face of obesity. We have a particular role to play in the prevention and early intervention of this epidemic.

But what makes obesity substantially more difficult to treat is that it is much more than just a health issue. Yes, eating too much and moving too little can cause weight gain. But embedded in the issue are genetics, psychological factors, social-economic and behavioural issues.

And what about the patients who resent being told by their doctor that they are overweight? Many people feel “fat-shamed” if they come in for consultation on a completely unrelated matter and their doctor forces them up on the scale. Twitter’s #fatsidestories abounds with hundreds of stories where patients have felt emotionally abused by doctors during consultations.

The other ‘elephant in the room’ is the issue of overweight/obese doctors. An Australian Health Survey published by the ABS in 2015 found nearly 60% of Australian doctors are overweight or obese. Are patients going to accept advice from a health practitioner who is clearly struggling with the same issue? Not according to the International Journal of Obesity, which found doctors who are overweight are seen as less credible than “normal weight” doctors, and patients are less likely to follow their advice.

And weight bias goes both ways. Studies show that individuals with obesity are perceived as lacking self control, unmotivated to improve health, noncompliant with treatment, and personally to blame for their weight. A report from the Australian Diabetes Society found this sometimes results in less desire from doctors to help overweight/obese patients compared with “normal weight” patients.

In this special edition of The NSW Doctor, we examine a few of these issues more closely and hear from the experts about potential solutions. There are no easy answers, but obesity is just too big to ignore.