The advice general practitioners give to patients with obesity in the UK was found to be "extremely variable, shallow and often without an apparent evidence base", according to a recent study from the University of Oxford.
GPs in the United Kingdom hold a trusted role as health advisers and managers in their communities. Expectations are frequently high: they are the personal advisers, assessing their patients' physical and mental health and providing individualized advice and treatments.
Obesity has been a formidable test of general practice over the last 50 years. Not an illness in and of itself, not a new phenomenon, but a substantial potential health risk.
Obesity, as we all know, does not respond well to diet or exercise. In 1865, William Banting, an English undertaker and coffin maker, developed a mixture of these two tactics to help English Victorians lose weight. In The Principles and Practice of Medicine, William Osler, an Oxford University professor of medicine, expanded on optimal meals and physical activity in 1892. Both pointed out that these tactics were sluggish to function and required a lot of drive to be effective.
Globally, the number of obese children and adults continues to rise, while progress in prevention and treatment is gradual. Many different ways are required to optimize our meals, food supplies, and ourselves.
In the United Kingdom, current recommendations encourage GPs to talk to obese patients about their weight and discuss options to decrease weight. Even brief chats can result in weight loss, according to research.
The current study, published in the journal Family Practice, examined 159 audio recordings of GP encounters with obese patients in which clinicians provided brief (up to 30 seconds) weight-loss counsel. The recordings were made in 137 GP surgeries between 2013 and 2014.
The results of word analysis in these discussions were unexpected. Patients would not have lost weight if they followed the advice offered in the majority of sessions.
"Eat less and do more," was the most common piece of advice. Only 30 patients were given individualized counsel, that is, when GPs "took into account patients' capacity to implement the recommendations, such as a patient's limited physical mobility and the implications on this for exercise".
In half of the interviews (78), doctors also advised patients to seek additional help, such as a follow-up appointment or referral to a gym.
The advice given by doctors in the recordings was not always correct. Many pieces of advice featured the notion that tiny behavioral adjustments could result in significant weight loss. Banting disproved this fallacy in the early nineteenth century.
Since 2014, things have gotten better.
Few GPs were well-trained in this field of counseling in 2014. Setting realistic weight-loss targets for patients and providing motivational counseling were also problematic. As a result, while individuals would prefer to speak with a doctor about their weight, those doctors felt unqualified to do so.
Since 2014, developing and refining patient guidance has been a focus of primary care education and guidelines from the UK's National Institute for Health and Care Excellence.
New mechanisms are being implemented, such as the use of social prescribing, which allows a doctor to offer various "community referrals," such as a gym membership. This shared responsibility among individuals with more expertise is effective in reducing stigma and encouraging independence in those who are overweight or obese.
Public Health England's initiative to help people make better choices, which includes the free NHS Weight Loss Plan app, has reinforced these approaches.
Advice on health and weight is especially valuable - and it works. Improving it can only help with the challenging task of combating obesity. This lengthy, slow journey necessitates our participation.
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