Sensitivity is key to helping women feel empowered rather than shamed. Here’s the skinny on the tricky health topics that are weight and obesity.
The statistics tell the story. At least three in five women in Australia are overweight or obese. With this comes well-known implications for their health – a higher risk of diseases including cancer, hypertension, heart disease, stroke, type 2 diabetes, and chronic kidney disease.
Initiating discussions with patients who are overweight or obese can be difficult. How do you raise the issue of weight in a sensitive and respectful way, avoiding all notions of ‘fat shaming’? How to be candid and not accidentally cause offence?
Jean Hailes GP Tessa King says the key to unlocking the conversation is sensitivity. “The majority of people who are obese know they are,” she argues. “They have a sense that it’s contributing to bad health but may not realise the full extent of it.
“I think it’s helpful to ask them if they want to make lifestyle changes, if weight loss or increasing exercise is something they’ve thought about.”
She concedes the conversation can be tricky, but she favours boldness without judgement. In her experience, patients typically raise the issue of weight with her.
She emphasises the need for health professionals to treat the woman in front of them, and to understand that she might be raising the topic of weight because she has exhausted many other avenues in her quest to address it.
For patients who aren’t obese, but for example 10-15 kg overweight, she often frames the conversation around lifestyle changes. “I think it’s about asking the patient, ‘do you have any specific health goals in relation to diet and exercise?’
“Or, if there is a specific health issue like PCOS [polycystic ovary syndrome], then I think it is okay to say, ‘from a medical perspective, even a small amount of weight loss, like 5%, can help improve your symptoms. Is that something you would be interested in discussing?’
Tackling weight issues in clinic begins with a thorough patient history. What medications is the patient taking? Is there a family history of obesity? Have they used medications for weight loss in the past? What diets have they tried? Do they exercise? What does their daily diet look like?
Dr King believes it’s important to explore whether the patient has any barriers that might be stopping her from losing weight. It could be her habits, disordered eating patterns, or she might have some psychological or emotional barriers that prevent her from dropping the kilos.
She may also have barriers to physical activity or exercise that warrant discussion.
In terms of diagnostic tools, BMI (body mass index) has its shortcomings. Conceived nearly 200 years ago, it doesn’t factor in family history, genetics, lifestyle, or muscle mass.
However, Jean Hailes endocrinologist Dr Nellie Torkamani is satisfied that it is a good marker for people who are overweight or obese.
A body mass index (BMI) of 30 means a person is obese; a BMI over 40 means they are morbidly obese.
Dr Torkamani emphasises that the most important element in weight loss is diet, but it is only one of the elements in a management strategy.
Even after years of treating overweight and obese patients, she is often surprised by the number who say they eat little or are unaware of the hidden calories they are consuming.
“For example, everyone thinks fruit is so healthy but it’s full of sugar,” she says. “Low carb fruits include blueberries and strawberries [and are a better alternative for women seeking to lose weight]. Another issue is the gluten-free trap. The carb content is often higher than the normal stuff!”
While there is a plethora of diets, Dr Torkamani insists few have the scientific backing that VLED (Very Low Energy Diet) – achieved through meal replacement shakes – and a low carbohydrate diet have.
Dr King says that as a GP she talks about various diets with her patients to establish what best fits with their lifestyle. Sometimes the patient can benefit from a multidisciplinary approach – an endocrinologist, an exercise physiologist, dietitian, a diabetes educator and potentially a psychologist – gaining different avenues of support.
Behavioural-based treatment programs like cognitive behavioural therapy (CBT) have been shown to improve weight loss results. It encourages healthier behaviour patterns by making the patients accountable for food intake and exercise, and it teaches them how to recognise triggers.
The treatment of a woman living with obesity is complex. “When a patient says they’re struggling to lose weight despite exercise and diet, we as doctors think that can’t be the case,” says Dr King. “But we need to listen. It’s not as simple as calories in, calories out.
“You need to consider sleep patterns, body composition or amount of lean muscle, previous periods of restrictive dieting, age, hormonal changes, alcohol consumption, genetics, the choice and percentage of carbs, protein and fat being consumed, timing of food in relation to exercise, as well as type and amount of exercise.
“This is why a tailored approach is best. It’s about the person sitting in front of you and how you can support that person in achieving her weight loss goal.”
1. Be sensitive, don't judge, find out the patient's experience, and support them to make change.
2. Consider all the contributing factors to this condition.
3. Patients often know they are overweight or obese but may not be aware of the benefits of even a small amount of weight loss.
4. Treatment is not a one-size-fits-all approach.
Dr Torkamani and Dr King feature on this recent Jean Hailes health professional webinar.