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Weight change & associated health problems

Messages to healthcare professionals interested in helping people with weight control

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 asked them what messages they had for health professionals who want to help people control their weight. There were many suggestions, which we summarise below under ‘services that should be offered’ and ‘in the consultation’. However, two overarching themes arose, namely:
  • Healthcare professionals should raise the subject of weight with patients more readily
  • Every patient is different
People felt that healthcare professionals were often reluctant to mention weight, or to have a frank discussion about it, for a variety of reasons including lack of time, other priorities and embarrassment [see Weight management - 'Experiences with GPs and practice nurses’ and ‘Experience of weight management support within specialist health care’]. Among the suggestions from the people we spoke with were that healthcare professionals should:
  • Be more vocal with patients about their weight
  • Mention weight routinely
  • Discuss weight in a more direct way
 

Paul Y suggests that healthcare professionals should communicate more frankly about weight.

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Age at interview: 55
Sex: Male
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I mean I think what you said earlier about, you know, sort of medical professionals sometimes being quite sensitive as to the subject of weight, you know, I’m not, I’m happy for somebody to say, “No, no, you really need to be five kilos lighter, ten kilos lighter. This is, but this is the way you’re going to get there and next time I see you, you’re going to have done this, else we’re going to have to change the regime. You’re going to have to work harder or we’re going to look at a different way of helping you get there.” Okay, but let’s not just say, “Oh it’s crept up a bit or it’s fallen.” Let’s just say, “let’s link it to your activity or your diet.”

The second overarching theme that was mentioned was that “everyone’s different” and therefore dealing with weight issues requires a personalised approach. Shirley: “We’re all different, we’re all built differently. So what might work for one person doesn’t work for another”. Rather than giving out general advice, meal plans or rules to follow, it was suggested that healthcare professionals view the person holistically and tailor their advice accordingly.
 

Paul X would like healthcare professionals to listen, treat people with respect and “not just go through the motions”.

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Age at interview: 57
Sex: Male
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What would you like from them? What would you advise them to do?

Listen

For people like you?

Yeah, listen. Listen without prejudice. Listen without anything really going on between your ears. We can, we can label people. We can put them into pigeon holes. The fact that this hospital or this surgery, GP surgery cannot tailor make a solution for an individual is not that individual’s fault. So, don’t treat it like he’s a, he or she is just that. He’s a, he wants too much. He’s a nuisance. Listen to what he’s got to say, and I mean listen. It’s not his fault that you don’t have the resources. It’s not their fault that you, and I mean you in the meaning of XXX, that you don’t have the resources is not my fault, you know, people work hard, they pay their taxes, part of your taxes you pay to the NHS.

What governments do with the NHS is up to them. But don’t treat people like, and you might, if you treat people with respect, and that’s with working with disabled people that’s one of the first things that I learnt as well as choices and, you know, you treat people with respect and that goes all the way down the line, down the line when you’re talking, I, I really have felt like a naughty boy sometimes. And I’ve done something wrong and I’ve been called to the Headmaster’s office. I’ve been treated like a ten-year-old and I’m not a ten-year-old. I’m a fifty-seven-year-old struggling with his health and health and weight is part of that.

So, yes, health professionals, you listen and you, you don’t just go through the motions with somebody because you’re doing more harm than good. If you can’t help them, don’t give them false hope. “We’ll do this, and we’ll do that and in x months’ time you’ll be this,” because you set people up, you know.

 

Rather than offering general diet lists, Julie thinks healthcare professionals should tailor weight management advice to the person’s preferences and family circumstances.

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Age at interview: 73
Sex: Female
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Okay and do you have any messages for health care professionals…

[Laughs] Oh, oh, oh.

…who want to help people with weight control?

Well, I think that they, they need to, it needs to be more personal rather than rules and, and regulations. I think you need to really sort of understand the person’s problems and lifestyle and because what will fit suit one, won’t fit the other. I live alone, what suits me won’t suit somebody who’s got three small children and they’re busy, and goes to work full time. So, I think that health professionals need to tailor their advice to the person involved and not have general rules.

I mean, the thing that annoys me is you go, you go to your health professional and they give you a diet sheet or they give you a list of foods and they say, “You can eat those, but you can’t eat those. You can’t….” It’s kind of, then you go away with this sheet and you think, ‘Oh, well, I don’t like that, you know, I’m not sure I like that,’ or ‘how am I going to cook this?’ or, or ‘how am I going to have that for myself and what shall I have for my children?’ I just think that it’s too generalized. I think that people need to be dealt with on an individual basis.
 

Below we summarise the other messages that people had for healthcare professionals.

Services that should be offered

The following suggestions were made for improvements, or new services that would help people control their weight:
  • Specialised weight-related services attached to the GP, such as nutritionists, nurse-led clinics, or weight management classes run by the NHS
  • Specialised weight services for particular groups e.g. cardiac patients, older people, men or women
  • Regular drop-in clinics offering a weigh-in and advice
  • More readily-accessible counselling
  • Residential rehab for overeaters
  • Routine weight monitoring and charting for all patients at the GPs
  • Provision and integration of self-monitoring devices such as fitbits
  • Follow-up for people after they have lost weight
 

If Kate was running a General Practice, she would weigh every patient and chart their weight so that they could see what’s going on.

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Age at interview: 58
Sex: Female
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If I was running a surgery I would make everybody weigh and measure themselves and have a graph for each person so they can visually see what’s going on. Because and it would be easy to do because we could say, “We do this for everybody.” And you can refuse to do it. That’s fine. And people can opt out but if I was running a surgery that’s what I would do.
 
Ok. So to visually present?
 
Yes, you know because people go to the doctor at different periods obviously but if they could see unhealthy because, and that’s often related to, you know, overweight, it can be, you know, diabetes. Lots of lots of things diabetes - You know, making people aware of what’s going on and facing up to what’s going on is, I would have thought would be the first thing that I would do.
 
Ok. And
 
In talking about it you could then talk about it if there’s, if it’s obvious on there but you can do a lot. You could do it electronically.

 

Meeka would like there to be specialists for seniors as well as for men and women.

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Age at interview: 66
Sex: Female
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Okay and do you have any messages for health care professionals who want to help people with weight control?

Yeah, be more active with it. Try and lobby the government to give you more money, so that you can, there can be more of you that reach more of us. And also if possible, could we have a specialist in certain areas. I know that’s difficult when money’s tight. But I’ve talked during this interview about having a senior, you know, having someone that just deals with seniors, so if we could, even make it a little bit more specialist again. A senior that deals with, sorry, a senior specialist for women as opposed to a senior specialist that deals with men. You could have another one that deal with men, so that men could feel comfortable and go down and talk about what’s going on with their bodies at their times of life where they can feel relaxed and comfortable. So, I know that in this very politically sensitive time we shouldn’t be splitting the genders or things, but I think there are occasions where, particularly for seniors, we feel more comfortable talking to a female about female issues. That’s my perception. So, I would be gender-specific.

 

Lesley describes how people with heart conditions can be scared to exercise. She suggests having specialised exercise and peer support classes for cardiac patients.

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Age at interview: 60
Sex: Female
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In term of intervention and services, what do you think would be a good idea? What do you think it would help you?

Oh, that’s difficult. I think, I, I do believe it’s, sort of, more exercise classes for people who, you know, aren’t completely mad at the gym but aren’t, just don’t want to do a little bit of, like, light walking or anything. It’s, I think having someone who understands that you’re slightly worried about doing anything too thing because if your heart rate goes up you will think, ‘Is this going to fire up or am I going to have..?’ But I want to push myself. It’s knowing how much to push yourself. I think that’s…

Okay.

That’s the for me, for probably a lot of people I spoken with cardiac conditions, you know, you’re frightened to push yourself but if you don’t push yourself, what’s the point in doing it in a way. You know, it’s like going for a walk. But I, I know that they’re, they’re basis, the cardiac rehab team, ‘Go ‘till your pink and puffy.’ That’s, you know, you’re pushing, but which I, which I probably do every day, nearly, walking to work because I’m always late. But it’s not enough, but I think if you had more specialised exercise classes. Again, talking to people from the cardiac thing, they just need, I suppose in a way, I’m talking around about having a slimming group and I’m talking about having cardiac group. It’s exactly the same thing, yet I’m reluctant to go to one because I don’t feel a part of it yet but I’m happy to go to another. So perhaps in a way, I’m, I’m talking myself round to say that peer support and that group work is probably, you know, the most beneficial thing you can have.

Hm-mm. But you would like it to be more focused on people with heart conditions?

I think if, yes, I think so…..

Okay.

...because it is different, you know, it is, you know, and to talk about the whole, the whole picture the medication, the reluctance to exercise. Not reluctance, but hesitancy to exercise because you’re just a bit frightened…

You’re scared, yeah.

….. of doing that. So, it’s just being able to talk about that and have a professional say, “Oh, you can do that. Don’t worry about that.” you know.
 

In addition, the following society-wide interventions were proposed:
  • Greater government spending on the NHS and weight-related services
  • Financial help for poorer families to enable them to eat healthily
  • Education in schools about weight and health
  • More research into weight and health
 

June suggests that the NHS should have more control of weight management interventions outsourced to private companies.

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Age at interview: 70
Sex: Female
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Well, I think if the NHS is putting public money into subsidising big companies like Slimming World, I think then maybe they should have a bit more say and control over it really. So, the point I mentioned about the classes being too big, you know, maybe they commission some classes specifically or said, “Well if, if we’d got people that were paid to be in that class, we’d like that class to have no bigger, no more than so many people because that gives people more of a chance of success. More of a chance of asking questions and being listened to and so possibly better outcomes.” Don’t, don’t just throw the money at it and hope it’s going to get the right results, you know, use the public money to do it sensibly.

 

Carole says that residential rehab for overeaters would save money in the long-term, for example on antidepressant prescriptions and weight loss surgery.

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Age at interview: 59
Sex: Female
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Drat. You see, I think I think they should have you know, like rehab, I think they should have a rehab place for overeaters, you know, for obese people, for, especially, if you’re as big as me. If they took, if they had a rehab place where they could teach you how to do it, how to include it in your own life where they live with you or whatever so they can see the problems that you have. And then oh, what’s the word? Guide you through that so everyone is different with how they do it. So if it was structured for me with the issues that I have I know it won’t happen will it, but that’s what I, I think that’s what I, people who find it so hard, like myself. There’s obviously some reason why we’re not doing it and we obviously need help in a different way than other people. So going to a rehab place, I would love it. It would be fantastic and I could come back and put all those strategies in place in my in my life. I’d be in the habit of doing the right things then. Whereas for me to suddenly turn off those things, is too hard, too difficult.
 
Okay.
 
And it shouldn’t be but it is. In my head I know I know what I should do but I just I can’t.
 
Yeah and it would save, I mean all these people who have the weight loss surgery and things, that must cost thousands and thousands, hundreds of thousands of pounds. All these people off work with depression, on antidepressants and stuff, if they could [sighs] it would save, although it would be a lot of money in the, you know, to start, to set it up, I think it would save and it would help people’s quality of life and it would help people get back to their work and help oh, help with so many things. Yeah, I think that would, that’s what someone like myself would need. That’s what I would, that’s what I know would help me. And I can’t afford to do it myself.

In the consultation

As well as suggesting specific services they would appreciate, the people we spoke with also had the following messages for healthcare professionals about interactions in the consulting room:
  • Listen to what patients have to say about their weight history
  • Give people time to talk about their weight
  • Be respectful and non-judgemental
  • Believe what patients are saying
  • Acknowledge that the causes of weight gain can be emotional
  • Treat patients holistically and as individuals
  • Be honest with patients about their weight and its consequences for health
  • Provide evidence-based information
  • Provide empathy, understanding, support and encouragement
  • Don’t stereotype people
 

Rosemary, a retired research nurse, thinks it’s important to bring weight up at every opportunity and not “be shy of bringing it into the conversation”.

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Age at interview: 55
Sex: Female
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Do you have any messages for health professionals, who are overweight - , who want to help people with weight control?

I think it’s really important to incorporate it into, at every opportunity. I think having, having been a health professional, I think we’re very loathe to sometimes bring it up because people, we feel like we’re dictating to people what they should and shouldn’t do. But the, the ramifications of being overweight are so large I think, you know, if we have contact with people we can, I used to bring it in to every -, I was obviously only dealing with breast [cancer] but if a lady came in and she was overweight, I would bring it in to the conversation and say, you know, “I know you’ve got a genetic predisposition, but you do realise that obviously that carrying extra weight does increase your risk.” There’s a nice way of putting it but I think it’s really important, we mustn’t be shy of bringing it in to the conversation.

 

Janet felt she was treated differently by doctors when she was bigger. She would like health teams to offer more support for weight loss.

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Age at interview: 62
Sex: Female
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Do you have any messages for health professionals who want to help people with weight control?

I seriously think they should be, especially the health teams, I think they should be more supportive. There’s support out there if you’re drug abusers. There’s support out there if you’re alcoholics. There’s support out there if you’re smokers. The support for people that are fat is not there. I don’t care what anybody says, it’s kind of “You’re eating too much, go home and diet.” It’s, that’s no always the cause. We’re not all alike. Everybody’s different and I think they should take that on board, health care workers.

Okay. So, do you think there was a kind of judgement there?

I, oh, definitely. Definitely and something I’ve never thought, I’ve always been a confident lady and when I were big, I’ve always had loads of friends and, you know, I’ve always been the life and soul. Never bothered me. But somebody once said to me, “If you’re slimmer, people treat you differently,” and I said, “Rubbish.” It’s very true that.

You have found that out?

It’s absolutely. Especially on the health teams, yeah. Doctors like to sit and look me in the face now. I cannot tell you, people will look at you rather than look at you. They’ll look at me, they’ll look at me face and talk to me direct. When I were bigger, and I never thought that could ever possibly be true. So that came as a huge shock to me…..

That’s very interesting.

….and it’s true. You were just like a blob on the face of the earth, weren’t you? People now talk to me, talk to me, to me face.

So, do you think they were embarrassed or…?

I don’t know but I, I, but if you’d have asked me when I was as big as I were, would I think I were treated any different, I would say, “Truthfully, no because the group of friends I had, nobody ever looked at me like I were big.” I mean, these friends that have come in now, we’ve been friends since we were babies, they’ve never looked at me any different. Fat or thin, I’ve always just been Janet haven’t I? So, I never thought that strangers would ever treat me in a different way and yes, they do. Absolutely, one hundred per cent.

 

Heidi highlights the importance of listening to patients, believing them and making sure they don’t “get lost in the system.”

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Age at interview: 50
Sex: Female
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What do you think, in cases like yours, health professionals should do, how could they help. What is needed?

I feel to look at the person holistically, look at the whole history and just to, to listen to them and believe them because they’re were so, so many times that I’ve been to the doctors and I’ve come home crying because I’m not believed. You know, if I’ve got this pain somewhere and that kind of thing. I know there’s something the matter I’m just, they’ve just shrugged it off as a nothing.

And regarding your weight gain and what kind of help would you have liked from, from the doctors or from health professionals in general?

Oh, more attitude towards, towards helping the individual lose weight. I suppose it’s like smoking, they’ll only help you to, the NHS will only help you to a certain extent to give up smoking. If you’re hard person to, say, say the person doesn’t want to give up smoking yet and is finding it really difficult to stop smoking even with all the help around them, they need to be sort of listened to and not disregarded because I’ve had that instance before. But doctors could actually give, offer, I know my doctors offer a walk-in, a walk-in.

Club sort of thing.

Class, yeah where they’ll meet altogether and go walking. But I couldn’t manage that unfortunately. But I think just little things like that will mean so much to someone who’s weight, who’s trying to lose weight, just sort of keep, keeping at them. Not bullying them into losing weight but just being there if they need to talk and make it continuous. Make it on, on a one to one level because otherwise they’ll get lost in the system again and they won’t want to bother, keep trying.

 

Alan would be more likely to follow advice if he was shown the evidence behind it.

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Age at interview: 68
Sex: Male
Age at diagnosis: 56
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Do you have any messages for healthcare professionals who want to help people with weight control?

Yes, give me evidence.

OK

Simple as that, because if you can convince me through evidence then I'm far more likely to follow it up.

OK

But if it's... if there's no evidence involved then I'm not necessarily going to take it seriously.

OK. And do you have any recommendations for improvement to services and intervention; weight management interventions?

If the money was there then they could send us on weight management courses, but the money isn't there. So, you're left to your own devices, aren't you; you're left to... it's your responsibility to maintain your weight or lose weight, and whatever. I'm not sure what they can do to be honest. They could have dieticians who were mid-thirties [laughs].

Or older

Or older, yes [laughs], but just not being, you know, too young to have any life experience; it doesn’t help. You know, it's just ... you need to have been through the mill a bit.

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