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Experience of weight management support within specialist health care
Managing one or more long-term conditions will usually mean contact with specialist services within the NHS. We asked people about their experiences of this in...
A GP or practice nurse can help people lose weight by: assessing their general health, helping identify the cause of a person’s weight gain, understanding how their weight may be related to other health difficulties, and by discussing a plan to help people lose weight, [NHS Choices website 28/2/19], which could include NHS treatment including a free referral to a weight management programme. In this section, we look at:
The people we spoke with said that their weight issues had sometimes been discussed in general practice after they were diagnosed with a weight related illness; or when discussing tests results.
Maxine Mary has joint hypermobility syndrome which affects all her joints. She has had hip replacement surgery, and is waiting to have her knees repaired. Her GP discussed her weight and referred her to a primary care nurse who saw her regularly and provided information and guidance about adopting a healthier eating pattern to help lose weight. Before being given weight management support, she thought that the only solution was to have bariatric surgery (gastric band). Now she feels happy to be able to lose weight in a less drastic way. Some people said they had received really good care from their GP surgery. For example, Tommy said he had ‘nothing but praise’ for his GPs, who he had seen over the years about his weight and other health issues. Around the age of 55, Tommy developed angina and was told by the GP to lose weight. Initially he was prescribed weight loss medication, but when this had no effect, the doctor recommended exercise. Tommy said, ‘The main help was the exercise. There’s no question of it, the jogging, throwing weights about and I say doing the half marathon, and that really helps’. When Tommy developed arthritis at the age of about 75, the GP referred him to an NHS-run weight management programme called ABL – ‘A Better Life’, where Tommy felt he received ‘straight’ and ‘sound’ advice. After her diagnosis of type 2 diabetes, Sandra was given some unclear information at ‘the clinic’ about what to eat but she said ‘I’ve been very, very luckywith the doctors. They’ve been really good to me. They really have and my doctor is really good I mean he phones me up at home’.Interview 11: When she was first diagnosed with diabetes Sandra thought that she had been advised to eat lots of fruit (and vegetables). She soon discovered that she was supposed to eat only small amounts of fruit.
In spite of many instances of good care, a recurrent theme among the people we spoke to was that their weight was rarely discussed when they went to see their GP. These reports included:
People we talked with often wondered if weight issues were not a priority for the GP. Stuart, Tommy and Hilary all suggested that weight was only discussed when other illnesses made it essential. Stuart said, ‘the problem is they don’t really talk about weight I think the GPs haven’t, unless you’re particularly obese and you’ve got a load of medical problems and losing weight is the only option to alleviate things, I don’t think your GP’s got the time these days to deal with it’. Tommy said the GP only advised him to lose weight when he got angina and later when he got arthritis, and Hilary said of her visits to the doctors: ‘not one of them had ever mentioned my weight until the diabetes’. A person’s weight is a complex and sensitive issue, which may be related to many factors that are not only medical but social, environmental and emotional. June was dissatisfied when the GP, who had a student doctor in attendance, asked her about her weight in an apparently tokenistic way, ‘just as an example of good practice or something’. Meeka and Julie both mentioned that their GPs didn’t even ask them how they were. Maxine Mary felt her doctor relied on weight loss as the go-to solution for every problem: ‘Every time I go to the GP it’s the standard answer for whatever. You know, I’ve got a headache. Oh you should lose weight.’ The lack of discussion about weight meant that people sought other routes to tackle their weight. Shirley said she found out about NHS-provided places on weight management classes from a friend rather than through her practice. She thinks the doctor never asks her in depth about her weight because she has told them she has joined these classes. Sandra, who has type 2 diabetes, said the doctor just told her to lose weight and follow the diabetic meal plans – these days GPs are expected to refer patients newly diagnosed with diabetes to the DESMOND programme to support self-management. Meeka was prescribed exercise at a local gym, but ‘there was no nutritional advice attached to that, whatsoever’; Lesley had already adopted a healthy lifestyle to lose weight but felt she needed more advanced nutritional advice from her GP. Heidi said, ‘It’s always been a fight to get believed, especially with this Lupus and especially with my mental health as well’. She found that doctors had not been forthcoming with information and she had had to research her health issues herself. She felt bad about herself when the doctor told her to lose weight but did not explain how she could go about it. Following her diagnosis of hypertension and type 2 diabetes Jane said she received ‘general advice’ about the need to lose weight, but no personal guidance on how to do it. Like many others we spoke with, Jane is pro-active in seeking advice and information from other sources. By contrast, some of the people we spoke to felt that doctors showed too much sensitivity around the subject and that they should be more direct in telling their patients to lose weight. Carole said weight ‘feels like a sort of taboo subject’ with the doctor, while Hilary wondered if it was only older, male doctors who didn’t feel comfortable addressing the subject of weight with a woman. She pointed out that because the GP had never told her she was overweight, she had not worried about it, until she was diagnosed with diabetes. Ellie wished her GP had been firmer in insisting she lose weight before she was eventually found to be diabetic. How the way GP appointments are organised affects discussions about weight
There are several reasons why GPs may not discuss weight during consultations. The people we spoke with were often very aware of the time and resource pressures facing the NHS, which led too:
Summing up why she hadn’t had a discussion with her GP about weight, Ria commented: ‘The appointments are ten minutes. It takes three weeks to get one, and you go in and say XYZ’s wrong and you get the little bit of advice, referred to somebody else, or a prescription. You know, there’s not a lot you can do in ten minutes, is there?’
Having got an appointment, the time available to talk to the doctor was frequently perceived to be too short to cover weight in the necessary depth or detail. This was because appointments were often limited to ten minutes or GPs were strict about only addressing one issue per appointment. To make matters worse, people wouldn’t necessarily see the same doctor from one visit to the next, and had to spend precious time repeating their history at each appointment. Colin commented that ‘there’s not many of the GPs that I feel I can talk to because they’re all new, so I don’t really know them’. The perceived pressure to be in and out of the consultation room as quickly as possible made it difficult for some of the people we spoke with to articulate their concerns about their weight. Paul Y said that because it felt like ‘a bit of a turnstile operation’ it was difficult to start a conversation about his weight history. Meeka suffers from tremors and said she found it difficult to get her words out in a stressful situation, such as a GP’s appointment. Kate, June, Alan and others said they didn’t want to waste the doctor’s time talking about weight because they knew resources were so stretched in the NHS. June said, ‘At the moment with the Health Service, I feel very conscious about that, you know, people might be really poorly and need appointments and my individual struggle with my weight shouldn’t take that time up.’ Maxine Mary (who had multiple health problems) said she felt guilty about taking up the GP or nurse’s time when she was ‘relatively healthy’. Finally, there was concern from some about the length of time a referral from their GP to a specialist service could take. For example, Joan said, ‘over a period of time I spoke to my GP and I said, ‘Look could you just refer me to the weight management service,’ and they was like, ‘okay,’ you know. But I mean it took about six months for me to get assessed for that. It was a long period of time.’Managing one or more long-term conditions will usually mean contact with specialist services within the NHS. We asked people about their experiences of this in...
The people we spoke with had a wealth of experience using the health service for weight-related issues and/or long-term conditions linked to excess weight. We...