A new study from the University of Oxford has found that the advice British general practitioners give their obese patients is “very varied and superficial, and often lacks clear evidence”.
UK general practitioners are in a trusted position as guides and custodians of health in the community. Expectations are often high for them. They are personal advisors, assessing a patient’s physical and mental health and providing individualized advice and treatment.
A formidable challenge in general practice over the last 50 years has been the rise of obesity. It is neither a disease nor a new phenomenon per se, but a serious potential threat to health.
It is widely known that obesity is not easily defeated by diet and exercise. In 1865, the English mortician and coffin maker William Banting published a combination of these two strategies that would help reduce the fat physique of Victorian England. Osler further elaborated on ideal diet and physical activity in 1892 in Principles and Practice of Medicine. Both pointed out that these approaches work slowly and require considerable motivation to be effective.
Globally, the number of obese children and adults remains high, and advances in prevention and treatment have been slow. Optimizing our diets, food supplies, and ourselves requires many individualized approaches.
Current guidelines in the UK encourage general practitioners to discuss weight with obese patients and discuss ways to lose weight.
In this latest study, published in the journal Family Practice, researchers analyzed 159 audio recordings of consultations between GPs and obese patients in which doctors gave simple weight loss advice (up to 30 seconds). . Records show he had 137 her GP surgeries between 2013 and 2014.
Word analysis of these conversations yielded surprising results. If the patient had followed the advice given at most visits, he would not have lost weight.
The most frequent advice we received was basically “eat less and do more”. He had only 30 patients for whom individualized advice was given. That is, the GP “considered the patient’s ability to follow advice, such as the patient’s physical mobility limitations and the impact of this on locomotion.”
In half of the interviews (78), GPs advise patients to access further support, such as follow-up appointments and gym referrals.
The advice the GP provided in the recording was not always accurate. Many elements of the advice included, for example, the idea that small behavioral changes could lead to significant weight loss.Banting noted that this was his early 19th century myth showed.
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Things have improved since 2014
In 2014, very few GPs were adequately trained in this area of counseling. More specialized areas, such as motivational counseling and setting realistic weight loss goals for patients, were also challenging. Therefore, the patient preferred to talk to her GP about her weight, but felt their GP was not qualified to do so.
Since 2014, the development and improvement of advice provided to patients has increasingly been addressed in primary care education and in guidelines from the UK National Institutes of Health.
New systems are being rolled out, such as the use of social prescribing, which allows GPs to recommend various “community referrals”, such as prescribing gym memberships. Sharing responsibility among people with higher expertise is powerful, reduces prejudice and promotes independence for overweight or obese people.
These approaches were reinforced by Public Health England’s campaign to help people make healthier choices. This includes the free NHS Weight Loss Plan app.
Health and weight advice is especially valuable and effective. Improving it can only support the very difficult task of tackling obesity.
