It is definitely NOT for any public use whatever, nor intended in any way to be taken as advice for any medical or health condition.
Of all the nutrition issues that the GP has to consider, none is so prevalent as problems with weight. The prevalence of overweight and obesity rises with age, so that almost the majority of the middle aged-population is over the healthy weight range.
This problem is getting worse too - overweight and its sad cousin frank obesity is a public health menace the prevalence of which has worsened rather than improved over the last 10 years. Clearly the GP needs some practical strategies for dealing with it.
At the same time, however, we cannot overlook what is becoming something of an epidemic of eating disorders, particularly amongst young women and children. It is not just a question of the severe psychiatric disorder of anorexia nervosa, but it is also the more common problem of bulimic behaviour and an unhealthy obsession with trying to lose weight that the GP needs to consider. In some Australian studies of school children, for example, a frightening proportion of the girls and a worrying proportion of the boys considered themselves to be overweight and many of the females in particular were already trying restrictive diets and other unhealthy strategies to lose weight.
In this article we are going to look at two simple tips to incorporate into your routine patient management to help you to do something practical with the weight issue.
Step one: weigh patients annually and keep a record of their BMI.
Have your receptionist send every patient to the scales at least once a year. It is remarkable how many GPs do not keep regular weight records of their patients. Fewer still store this information together with the height in the form of the body mass index (weight kg/height metres
Make this record as much a part of your routine patient management as recording the blood pressure. Firstly, this will help you to identify the patient whose BMI is beginning to rise, whilst it is still in the reasonable range. During this early stage of weight rise, simple therapeutic measures (a little more exercise and less fat) may be all that is required to put things right. Once the BMI gets to more severe levels of overweight and obesity, treatment may be much more difficult.
The second advantage of this routine weighing approach is that it sends a message to your patient population without unduly emphasising to the sensitive patient that you think they in particular are too fat. This is important because research has shown that there is a strong degree of gender-based inappropriate perception amongst Australians about their weight. Women on the whole are much more likely to worry about being overweight when they do not need to, whilst men who are overweight and should be concerned tend to overlook the fact. This is accentuated by the disposition of men to accumulate weight above the pelvis (abdominal or apple shaped obesity), which is known to have adverse clinical consequences, whilst women are genetically predisposed more to fat deposits in the thighs and lower body (pear shaped.) This can be formally assessed by measuring the waist to hip ratio.
Step two: ask patients how they feel about their current weight.
During the annual or opportunistic check-up you may like to ask a neutral question such as "Do you feel comfortable with your current weight?". Be careful not to imply that you think a patient is overweight if they are not. This simple question incorporated in to the routine new patient history addresses two important agendas:
Further reading:
Article on weight management
Stanford Teaching Modules on obesity
Click here for links to more weight management sites.
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