A-Z

Weight change & associated health problems

Experiences with GPs and practice nurses in primary care

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:
  • General Practice support with weight management for those with long-term conditions.
  • How people felt when their weight issues were addressed in the consultation
  • How the way GP appointments are organised affects discussions about weight

General practice support with weight management in the context of a chronic condition

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.
 

Kate asked her doctor if there was any alternative to taking statins and it was suggested that she lose some weight.

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Age at interview: 58
Sex: Female
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So two things changed it for me in February of this year and one was going to the doctor, [Health Centre doctor] where they have this amazing programme where they give you an MOT. They, I think it’s everybody over 55 they test their blood sugar, their cholesterol and their blood pressure and probably various other things. Anyway I was deeply shocked to find that my blood pressure was very high. And I, and there’s a history of it in the family but I always prided myself in being the slim one because I’ve got m-. Everyone else in my family is obese. And so I, I was very, very shocked. And they said, “Well you really should be on statins.” So I said, “Is there any other way that I don’t have to be on statins?” And it was suggested, and I grabbed this, that I lose some weight to see what would happen first. And so that was a huge incentive for me, absolutely massive because I don’t want to be taking statins every day.

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.
 

Maxine Mary’s GP suggested she see the nurse every week to get weighed and receive support. This helped her lose weight.

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Age at interview: 63
Sex: Female
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No. So talking to the GP she said, Well go and see the district nurse every week and get weighed. So this is what I did. And I, you know, I felt kind of guilty going to see the nurse because I’m relatively healthy and this lovely nurse was giving her time just to me. And she was weighing me and we were talking about diet and what I had had this week and what I think I’d done wrong. And it definitely helped and it got me through to the next level, you know, tick. So now I am Level 3. So if you want to go ahead and get bariatric surgery you’ve reached that point. But then I thought, “Nah, it’s not for me. I can’t do this to my body.” So here I am. Twelve months after I changed my eating habits I got rid of alcohol. I got rid of carbohydrates and I reduced my food, my portions. I haven’t really upped my activity because I find it really difficult to, do anything. I mean I can’t even walk. So that’s really. I can’t really walk more than a few yards.

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.
 

Lina says her GP and nurses have been “outstanding”. She emphasises the importance of getting the right GP.

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Age at interview: 49
Sex: Female
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I’ve been lucky. I’ve been lucky. My GPs, and the GPs, the nurses and everything have been outstanding for me. I hear different stories from other people. They don’t get the right GP and getting the right GP I think is the most important because they’re your first point of call when you’ve got anything wrong with you. So, if you’ve got a GP that you don’t like, your less likely to want to go and say, “Oh, by the way, something, this is wrong, that’s wrong.” But I was of the era when, you know, we didn’t need to go to doctors unless, you know, something was coming out of something that shouldn’t be [laughs] and then I started to realise you’ve been in pain for like, two weeks. This is not right, and I went to the doctors and said, “I’ve been in pain for two weeks. This is not right.” And he’s like, “No, this is not right.” And then we delved into more and more and then, obviously, started to find out there were more things wrong with me than I anticipated than I realised. But having him, having been able to call him and there is actually two doctors who I see, being able to just call and say, “Can you ask the doctor to call me?” and they say, “Oh they’re quite busy, but I’ll put a note in there.” And then they do call. It’s just, it’s just nice, it’s just nice to know, you know.

You have that support there?

Yes, absolutely, absolutely.
 

 

Myra finds the nurses at the surgery really helpful and has found her GP encouraging in relation to her weight before she had her hip surgery.

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Age at interview: 65
Sex: Female
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I think actually the nurses at the surgery are really helpful. I mean the GP, he’s so busy isn’t he and he tends to deal with the thing and we have had conversations about weight and he’s, he is very helpful now actually.

In which ways?

Encouraging and saying, before I went in for my hip, he said, “Look, just try and because they said they were happy to do my surgery the weight I was, but if I could lose a little bit more and I did lose a few pounds, you know. He said, “Well why don’t you just really concentrate on it until you go into hospital,” and, you know, he tries. But I think the nurses have a bit more time and they do, they do referrals to Slimming World and Weight Watchers, so you get a few weeks free.

They were the ones who referred you to start with?

Yes, I think it was actually. Yes, it was Slimming World. Yes, I got my first twelve weeks I think free which is, you know, a great help, you know.

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 lucky…with 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.

How people felt when their weight issues were addressed in the consultation

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:
  • The GP didn’t mention their weight at all
  • The GP didn’t seem interested in their weight
  • The GP seemed embarrassed to discuss weight issues
  • Weight was treated in a tokenistic way
  • The GP was keen to treat other ailments, but not weight
 

Carole has epilepsy, low thyroid, Multiple Sclerosis (MS), irritable bowel syndrome (IBS) and depression. She feels the GP isn’t interested in her weight, or is embarrassed to discuss it.

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Age at interview: 59
Sex: Female
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Well, I go, I have to go to the GP quite a lot for different health checks. I have epilepsy, low thyroid, the MS and all sorts of other things as well and they don’t seem to be interested in my weight. I often go and see, oh and I’ve also got bad depression at times and they just say, “Oh, we’ll treat this or that and don’t worry about the weight, don’t.” I think they’re embarrassed because I’ve got, because I’m obviously very big and they don’t really know what to say.
 
That’s very interesting?
 
It’s horrendous. You know, you go, you build yourself up to it because I feel so embarrassed being like that. I hate myself as I am and you psych yourself up to go and I sort of pour out what I’m saying and they say, “Oh well, don’t worry about it. We’ll treat the depression.” Or we’ll treat the pains of the MS or whatever, “and then, you know, then then that’ll be all right.” And you like pull your hair out really with it.
 
Has, at any point, someone, a health professional, suggested you losing weight and giving you some advice on how to do it?
 
They’ve they sent me to a dietician. And she was lovely and she looked, I knew all that she was telling me, bless her heart, you know, it’s all on the television now, what’s healthy, what’s not healthy and portion sizes and she was very good with me but it wasn’t what I needed. I needed some counselling, some, I don’t know what I needed, I don’t know what I need now but not what she was giving, bless her heart.
 
But the doctors, they don’t say, they never say to me, “You must lose weight.” They’ve never brought it up in a in a consultation. It’s only if I’ve gone to them and said, “Help me with my weight.” And that’s when they sent me to a dietician.
 
And that was insufficient?
 
Yeah, yeah.
 
Okay.
 
I went again just recently and they sent me to another dietician because I have irritable bowel as well and she was going to sort, she is helping with that but she said, “Oh it might, we might be able to, that might affect your weight but we’ll look at the weight link into if once you get sorted out with the IBS, with the irritable bowel.” But again, it was me having to ask.
 
They have told you are overweight but it’s.
 
Well, they weigh me. And then it’s like they then change the subject. None of them have ever said, “You need to lose.”
 
X amount?
 
Yeah or they haven’t given me thoughts of, ideas of how to do it or talk to me, they haven’t talked to me about it. You know, “Have you tried this? Is there anything that would help you?” And so it very much feels like brushing it under the carpet like you shouldn’t talk about it. You know, they’ll weigh me and see that I’m so big and that’s it. No no help.
 
Okay or they refer you to a nutritionist.
 
Well, it was the dietician, they did once, yeah, yeah. Yeah, yeah, once, well, twice but then, when I said it wasn’t helping, it was like, “Well, let’s look at the MS.” You know, I don’t know. It’s as if they’re too, it’s as if they’re too embarrassed about it and they don’t want to bring it up.
 
And I remember having one of those, you know when you get to a certain age they say you can have a free health check and so they did they did my weight, they did my blood pressure and the heart and she said, “Oh you’re, everything is fine.” And I went, “Well, it’s not fine is it, you know. I’m, you know, look at me, okay, my heart rate might be all right, my blood pressure might be fine but look at me.” She said, “Oh no, no, you scored all right on this. You’re fine.” And so then that makes it even worse, even harder to talk about [sighs] because it is embarrassing and so you then, I find it hard to bring it up, when they keep hiding it from me. Oh and they don’t want to talk about it.

 
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John X was diagnosed with sleep apnoea, which he knew was related to his overweight. Neither the hospital nor the GP discussed the benefits of weight loss.

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Age at interview: 67
Sex: Male
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But coming back to the issue of sleep apnoea there was no, nothing came. There were no suggestions about diets or how I might lose weight.

From, coming from your GP?

Or well the GP I barely see. Certainly not from the GP.

And not from the hospital you went to?

No.

No?

No not that I remember.

Ok so nobody at that stage mentioned?

Well I think it

Your weight or

No I don’t remember specifically any kind of dietary discussion. Of course I was aware sleep apnoea applies frequently to men who are overweight. I mean I was aware of that but I don’t remember I mean I hope I am not doing them an injustice but don’t honestly remember any kind of. The GP didn’t follow it up. There was no follow up about this.

Ok

And as I say once I used that, that piece of apparatus in my mouth to sleep with that made a huge difference and I used it for years.

Ok.

I used it for years.
 

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”.
 

Liz is surprised that doctors don’t seem interested in tackling people’s weight before it leads on to more serious complications.

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Age at interview: 54
Sex: Female
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Have you talked to your doctor, or to any doctor about this?
 
Yeh. They're not particularly interested really. And it's a bit surprising in a way because it's like with the diabetes, with my husband, you know they're very conscious about getting that to the best they can, because they know that further down the line, if they don’t support him now with his diabetes, he could become quite a strain on the system because of all the things that come with diabetes. But being fat's not very good for you either. It leads to all sorts of things like, you know, joint problems, your arteries, strokes. It can lead to so many things that eventually will become a strain on the system. But they don’t seem very interested in helping you tackle it now while you're relatively fit.
 
You raised the issue with them or?
 
Yeh, yeh. I spoke to... I've literally, this morning been to the doctors, and she is going to test my thyroid for me, and she's going to check me for diabetes as well because obviously, being overweight can lead to being diabetic. But that’s fine, and if she comes back to me and says, "Oh well, your thyroid's OK, you're not diabetic," but that would be it. I know that that would be it; it'll be like, 'Go away and go and lose some weight.' And I don’t quite know how to do that really; I don’t know where to go now.

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.”
 

A brief interaction with the GP about her weight was “one of the most unsatisfactory experiences” June had ever had.

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Age at interview: 60
Sex: Female
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Have you talked to your GP, your doctor about it?
 
Well I’ve only had one, one sort of discussion with a GP. I went with a different problem totally and while I was there, she mentioned my weight and actually it was one of the most unsatisfactory experiences I’ve ever had because she had somebody, a trainee doctor in the room and I felt she’d just put that question into our consultation just as a, an example of good practice or something and she, she asked me a couple of quick questions and I explained to her that I did eat well but time was a factor when it came sometimes, time could be my undoing as well and she just said to me, “Well, you know, if you make a small change like take a salad to work.” And I felt quite insulted really because she, I’d only ever seen her a couple of times before. I didn’t feel she knew anything about me and I know it’s a doctor’s duty to point out overweight, but I just felt it was like a tokenistic really. You know, because I’d just explained to her that where at that point I had fallen down on my lunch meals and it was because each day I was driving from one side of town to the other teaching in community settings and I was eating as I was driving and I thought if she’d have listened to that she’d hear what I was saying that a) it wasn’t generally my lunches that were a problem b) to eat a salad while you’re driving is, you know, not, not at all sensible and c) she totally ignored the bit about, you know, the chocolate and the snacks which is, was the key. So, it, it felt like, you know, I’ve read a little bit since about how doctors should intervene with patients.
 
And how should they?
 
Well they say it’s all about the language you use but I honestly believe that most GPs nowadays do not have the time. I think full stop they don’t have the time so if, if they feel it’s important then it’s up to their surgery or their health area to organise something where people can go to people who have got the time to spend. I just think it’s, you know, we’re, we’re told as patients, don’t bring a second symptom, a second problem into a five or ten minute appointment and then the doctor brings something in like that which is huge in an older person, weight person’s life. Huge thing and to think that anything a doctor might say like that, you know, about small changes or habits it’s scratching the surface.

 

Meeka says the doctor has never spoken to her about diet and heart disease during her annual check ups.

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Age at interview: 66
Sex: Female
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The doctor has never spoken to me about nutrition and heart-related issues. Never. Even, I’m called in every year for what they call a heart check for a heart check and they take blood pressure and they take your bloods to see what your cholesterol’s like and if you, you know, if you’re online for diabetes. So, they do those checks and you’re in there for a few minutes and they never ask you questions. They don’t even ask you how you are. They say, “Oh right. Come in. Have your bloods done. Check your blood pressure. Right, come back to the doctors in ten days and discuss your results.” So, go back to the doctor, “Yes, it’s fine or it’s not.” I have a problem with fatty liver.

You have a problem?

With a fatty liver, so there’s that as well. They do that, and they tell you, “Yeah, this is up, that’s up. Just be careful with this, be careful with that.” And sometimes people try and increase some medication and I say, “No,” to that. Like he wanted to double my statins last time I went. I said, “No, I’ll deal with it through nutrition.”

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.
 

Lesley finds the GP’s mantra “you’ve got to lose weight” too simplistic and would like more detailed advice. She feels there is a lack of empathy, which sometimes makes her feel bad in herself.

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Age at interview: 60
Sex: Female
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I think the thing is every time you see a health professional if you are overweight, they’ll always tell you, “You’ve got to lose weight,” and, and that’s it and then they will say, “The….” It’s, it’s like a mantra of, “You’ve got to lose weight. Eat more veg and more fruit. Less carbs, less fat,” which is what I do and if I say, “Well, I do that already,” and they say, “Well, you’re not doing it enough.” There’s no alternatives. I think there’s a, they’re given a script to read in a way or script to say, “This is what you must do. You must lose weight and then you do this, this and this,” But if you say to them, “Well, I’m doing that. Can you suggest anything else or what can you…?” There is no further of advanced level of giving advice, you know, and because most, a lot of people find it very easy to keep their weight down and lose weight, I don’t think they can really understand somebody who’s overweight. They think it was your own fault. Whatever you’re doing is wrong. You are made to feel sometimes that it is your fault and there’s, there’s lack of empathy or understanding. I find, I find that and then you feel bad in yourself, think ‘Well, actually, I’ve got to try harder,’ and I can understand, you know, people can have, you know, eating disorders because, you know, you don’t eat all day and then you binge because you haven’t eaten all day and it’s not the health eating, not the three, three good meals a day or healthy meals a day rather than that, so I feel that that the, the sort of general GP level of it has good knowledge but not a specialised knowledge and they don’t look at the whole picture, you know, whether, is there stress? Is there medication? Is there …?

And you would like sort of a more advanced kind of level?

I think if you’ve, if you’ve had prolonged, you know, because of, you know, an incident, you know, and it’s been two years and you feel you’ve been living healthily and nothing’s changing then I think it should be looked at in, in the same way that you would look at my heart if my ejection faction was, was getting worse, they’d look at my heart. ‘Well can we look and see what’s happening with my weight if I tell you, keep my food diary and I show you what I eat? Where am I going wrong?’ Because from that more but I know that’s a bit of a luxury, you know, in this day and age in the NHS, I’m lucky to be here. I’ve good treatment. I’ve my medicine, so is that something that’s a bit….?
 

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.
 

After his wife died, Colin put on weight and went to see the practice nurse who ’was really quite rude’ to him.

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Age at interview: 72
Sex: Male
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The weight gain started roughly twelve months after or was noticeable twelve months after my wife died. I was so worried about it. I went to see the GP and the practice nurse about it and the practice nurse was really quite rude.

Really?

Yeah, oh yeah. She told me, “You’ll lose weight if you keep that shut.” [Gestures to mouth]

That’s what she said?

Yeah, and that’s as much as she said, and I mentioned it to one of the GPs on a subsequent visit and they just laughed it off. But she was deadly ser-, I, tend to know when people are joking because I can be quite sarcastic and quite joking myself at times. I think sarcasm is something of a release as far as I’m concerned and she was deadly serious. She looked me in the eye and said, “Keep your mouth shut is the one way that you will lose weight.”

But she didn’t give you any...?

Didn’t give me any advice on how I should change my diet or anything or, you know, anything similar.

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.
 

Ellie faulted her doctor for being “too nice” because he didn’t impress upon her the consequences of not losing weight.

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Age at interview: 69
Sex: Female
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It’s so sad and I think that maybe the doctor should be a bit sort of more brutal and when you’re starting to put on weight say, “Look, this is what’s going to happen.” Nobody ever said to me, “Look, you’ve got to lose weight.”

No?

No, they’d say, “Well, you’re a wee bit chubby,” and I was at that time.

Oh yeah. In fact, I used to get tested every six months and every time I, I was tested I would think, ‘Phew, made it. I’m okay.’ And the time that he said, “You’re definitely diabetic. They never said, “You’re pre-diabetic or you’re liable to diabetes.” I just kind of knew that myself but if the doctor had stressed that I would have done something about it. I think.

So, they tested you for diabetes?

Oh, for the last maybe, before I was diagnosed, about five years. Twice a year.

Were they telling you that you have to lose weight at the same time?

It was never a big deal. It was never, “Look you’ve got to lose weight.” It wasn’t, it was just, “Maybe you could do with losing a little bit of weight.” And I would say, “Oh, I’ll try.” But if they’d been more firm and explained what could happen, maybe people would pay attention. I just felt maybe it’s my doctor, he’s too nice. I don’t know but I think they have to be a bit more brutal…

Okay, that’s the….

...and make you aware of what can actually happen.
 

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:
  • Difficulties getting an appointment
  • Short appointment times
  • Lack of continuity with a named GP
  • Lengthy referral time for specialist services

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?”
 

Alan sees GP appointments as “like gold dust”. He isn’t surprised that GPs don’t seem to have time for a discussion about weight.

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Age at interview: 48
Sex: Male
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You sounded surprised when I said, 'Have you talked to your GP about your weight issues,' and you said they don’t have time.

Yeah

Can you elaborate a little bit more on that?

Well, GPs have got very limited time to speak to you. The slot size you get to speak to somebody is related to having one problem which can be resolved by either a referral or a prescription. They don’t have time for a discussion. And to be fair, if you took time for a discussion, slots with GPs are hard to get so you're depriving somebody else of something that they might need for, you know, to get medication or something like that. So, going in for long, you know, conversation type advice is not the sort of thing that I would think is the good use of GP's time, unless they said, "We will have a clinic," or something which says... which is aimed at people who need, you know, advice on X or Y or Z, whether it's diabetes or heart condition or exercise, or whatever it happens to be.

Or weight control?

Yeah. But for standard GP appointments, they are... they're like gold dust, and you’re very lucky to get one really. I mean for instance, if I wanted a GPs appointment tomorrow, I would have to be online on their website at seven thirty in the morning to book a slot for that day, and goodness knows what happens if you're an older person who doesn’t have internet access, for instance – I don’t know how you do it, because by the time the receptionists come online, half past eight, all the slots have gone. So, that tells you, you know, you don’t want to waste the GP's time in that respect.

 

Paul X thinks the NHS doesn’t have the time to plan individual health care “It’s a totally different NHS today than it was.”

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Age at interview: 57
Sex: Male
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Has your diet changed since you were diagnosed with heart problems?

Has my diet? I carried on drinking when I was diagnosed and so when I was drinking to excess then my diet, well it wasn’t even a diet. It would be whatever was first to hand. Not, not, it certainly wasn’t, “Right, now, let’s sit down and do a plan.” Nobody, nobody has ever done it with me at the NHS. I’ve always been surprised that somebody hasn’t called me in to say, they call me in enough for my heart and I’m thankful for that, but nobody’s sat down and said, “Well, let’s sit down and, and go through....” The NHS hasn’t got time for that anymore. It’s a totally different NHS today than it was.

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”.
 

Because appointments are so short, Carole finds that weight is always left until the end and then there is no time to discuss it. She thinks doctors find it easier to discuss other issues, but weight is “a sort of taboo subject”.

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Age at interview: 59
Sex: Female
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And, as I say, when I’ve when I’ve tried to go, I often, I hate going to the doctors because you go with these little, when you’ve got lots of different things you always go with a couple of things and then they’ll say, “Oh we’ve not got time to talk about that next one.” Or I’ll say what I’ve got, this this and this that I want to talk about. “Okay. We’ll talk about the physical, you know, we’ll talk about your thumb is poorly or we’ll talk about, you know, get that fixed. We’ll talk about.” And the weight is always left until the end. “Oh sorry, we’ve run out of time now. So, you know, we can’t talk about that.”
 
Have you tried to make an appointment just to talk about your weight?
 
Yeah, but then they don’t do it. They’ll say. [buzzing sound]
 
It’s okay.
 
Oh right. That’s when they sent me to the dietician and then and then the follow-up, even though I’ve tried. And you see a different doctor every time and you have to go through everything about yourself and then and then they’ll help.
 
This is in your GP surgery.
 
Yeah. [buzzing sound] There’s so many different doctors there now and the ones that, they they go to like all these different practices and you can’t get to see the same one each time, even though you would go round to see, you know, to the other places but [sighs] and they keep changing like a new one, a young one will come and everyone will be good at the other things but not about the weight. It feels like a sort of taboo subject somehow.

 

Paul X says it’s usual to see a different doctor each time he has an appointment. The allotted time is not enough to go through all his issues and he feels it’s a case of “get them in get them out”.

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Age at interview: 57
Sex: Male
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I’ve been in and out of doctors and hospitals and we don’t have, up in our doctor’s surgery you don’t have one particular doctor, so you might see a doctor one day. You go again the next week and you see a totally different doctor. He might even not be from that practice. He might be a locum. So, you never get that kind of care where you sit down, and they go, “Oh hello Paul.”

Because then, you have nine minutes with a doctor. They’ll never admit it, but they want you in and out because it’s, a doctor’s surgery’s a number crunch just the same a big hospital is. Get them in get them out. Get them in get them out. The days of sitting down with a doctor and going, “Now tell me all about it. Tell me all your worries.” Again, gone. Get in tell me what’s it’s like and go.

So, if you’ve got to see somebody that you’ve never seen before, you have to sort of recap and there’s four or five minutes of your time gone. I once went in and I said, “I’ve got three things.” I trapped my finger in the door, in that door when we moved here. It flattened the finger. I said, “I’m here about my heart and oh by the way...” She said, “No, no, no, one thing.” I said, “But oh...” “No, no, no, one thing. Yeah, yeah that looks okay.” She said, “You can’t have two. You, you have one. You have one issue and you go” [sighs].

 

Ellie thinks that GPs find it hard to make connections between different health issues when they don’t have time to listen to more than one issue per appointment.

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Age at interview: 69
Sex: Female
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I don’t think, I don’t think GPs make connections. I think they treat you for the thing you go in with and they’re not really interested, [sighs] not because they don’t want to be interested, because they don’t have the time. I once went in with a list and it wasn’t a big list, it was maybe three or four things and she says, “Now, what can I do for you today.” “I went, “I’ve got this list.” She went, “I don’t want a list. Tell me one thing, make another appointment.” And it was things like, I’ve got a freckle there which I thought, ‘Does that need to be looked at?’ Nothing huge but she wouldn’t deal with anything other than one thing and I thought you could have, it would have taken, I don’t go to the doctors unless I have to and she could have spent the time just saying, “Okay, right.” So, one of the things was my blood pressure, not my blood pressure, the blood sugars, but I can’t remember, oh I had polyps removed, she only wanted to speak about that and I just felt that you can never go into the doctor again with a list. You had to go with one specific complaint, so I don’t think they have time to connect things, like you do research, they don’t. They just process people, don’t they? And if somebody would make the connections maybe it would be better for everybody all the way round.

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.
 

Feeling under stress at the GP’s surgery can make it hard for Meeka to get her words out in the allotted ten minutes she has with the doctor.

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Age at interview: 66
Sex: Female
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This is another thing I find as we’re getting older. A ten-minute appointment, it takes us that long sometimes to think. I also have, suffer from tremors sometimes and dithers, what we laughing call ‘the dithers,’ and sometimes it’s hard to get my speech out, thinking from brain to mouth and I can sit there in a doctor’s surgery and if I’m feeling under stress or intimated, it will often take me five to ten minutes just to try and get out what I’m thinking and, and it, it’s hard and then I feel embarrassed, which adds to the stress, so it’s not a successful interview. It’s not like you and I sitting here now where I feel perfectly comfortable, you know, we’re not time poor and I can relax and, and talk about things and that’s how it should be. I know there isn’t the money for the doctors to that. I appreciate that, but perhaps if we took the emphasis away from curing illnesses to prevention, that in the long run this would be money well spent because people would be healthier in the long run. Seniors would be healthier.

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”.
 

Kate would have welcomed the opportunity to discuss her weight with the GP but didn’t want to waste the doctor’s time with “trivial” concerns.

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Age at interview: 58
Sex: Female
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Would you have welcomed the opportunity to discuss your concerns, your worries about weight and your sugar addiction and?
 
Yeah I would have, absolutely have done but I wouldn’t have been. I never fear. I don’t want to waste the doctor’s time, you know. I’m healthy overall. I wouldn’t have wanted to go and talk about my concerns with the doctor because I would have felt that was really trivial.
 
Ok.
 
Really trivial.
 
So it was you more?
 
Yeah
 
Ok.
 
Yeah but I did ask Dr [Name]. I said, “If I lose weight does that mean I don’t have to take statins?” And he said, “It could do. It could mean that.” So he
 
And that was all?
 
That was all. He’s a marvellous doctor and I’m quite sure if I’d had the courage to ask him more about it, you know, it would have, he would have gone deeper. But, you know, they only get 10 minutes. They can’t, they can’t
 
Ok so you were sort of, kind of conscious, too conscious about the time?
 
Yes.
 
About…
 
Definitely wasting his time. My questions being very trivial because I knew I was hovering on the, and I knew my family was obese, I know I could tip easily into obesity and I was well on the way to, to you know. I was going, I was on the trend but I didn’t feel it was something that he could help me with.

 

Paul Y describes how time pressures affect the type of conversation it’s possible to have with the GP.

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Age at interview: 55
Sex: Male
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I do feel that doctors and health professionals are busy people and they, you’re just going, you’re in and out and they, you know, they haven’t necessarily, you know, it’s ten minutes per appointment and by the time they’ve taken your blood and you’ve had a quick chat about the weather, you’re out the door again. I don’t think health professionals are always good at saying, at starting what might be meatier, more lengthy interviews.

Okay and what…?

There is, it sometimes feels that it’s a bit of a turnstile operation and they, they’re under pressure to, you know, to see an awful lot of people in quite a short time and, you know, yeah if you’re at the end, certainly if you’re at the end of the day and you’ve already, you know, it’s a typical situation isn’t it that you know, that doctor, you know, you’ll have an appointment. Your appointment will be twenty minutes late, twenty-five minutes late and you’re just thinking, ‘Well, that means that they’re pushed. They don’t want to have this long conversation about looking at, you know, how I was eight years ago or six years ago or four years ago. Yeah, they just want to, you know, the next person is waiting behind you and they’re appointment is twenty minutes late as well.’
 

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.”
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