“You’re fat and you have to lose the weight, it’s as simple as that.” These were the words of an NHS consultant. I was a medical student and we were on a ward round. There were eight of us around this patient’s bed and I remember feeling mortified that he spoke like that but also upset for the patient; how humiliating.
We, the students, all glanced awkwardly at one another as the patient looked down and remained quiet. I imagined how I would feel if that were me. I’d probably would want the ground to open and swallow me up. No support was offered, no strategies discussed, this individual was to “come back when you’ve lost the weight and we might be able to do your knee”, and with that he moved to the next bed.
Clinically the consultant was right. The risks of complications and mortality in surgery are significantly higher in those who are obese. But I felt he was wrong in his approach. Sadly there have been a few times since where I have witnessed weight-shaming among healthcare professionals. My own patients have also shared with me their experiences of negative comments and attitudes that have only left them distressed and caused them to spiral deeper into their plight.
Thankfully much has changed over the past few years due to more compassionate awareness about weight management. But new research from University College London has found that some doctors and nurses still do shame patients who are overweight or obese, leaving them feeling anxious, depressed and wrongly blaming themselves. It also makes them skip other medical appointments for fear of being humiliated.
In my experience as a GP, stigmatising weight has never helped anyone. It’s always evoked a sense of failure and led people into more self-deprecating behaviours, which have caused further harm physically and mentally.
The unfortunate truth is that obesity is one of the biggest epidemics in the UK where around one in four adults and one in five children aged 10 to 11 are estimated to be affected. It is complex and its cause is multi-layered. Achieving the “ideal body weight” for the majority of people requires work ,which includes focusing attention on good nutrition, engaging in daily physical movement, practising sleep hygiene and keeping stress levels in check. It sounds easy when listed but modern day lifestyles make this challenging. Add in other stressors such as the rising cost of living, ever-widening health inequalities, illness and media pressure, and it’s easy to see how this obesity epidemic is growing.
People with weight management issues need help but instead they seem to face a choice: be exploited by marketing companies or celebrities selling fad diet plans or face humiliation and shame at their medical appointments. Who do they turn to?
Obesity isn’t just an aesthetic issue, it’s a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers. Clinically it is the job of a healthcare professional to address obesity and support their patients to manage their weight. However, it must be done with the utmost respect and compassion.
I often find patients suffer alone and fear speaking about their weight either due to embarrassment or shame. It takes a lot of courage to ask for help and anyone who is struggling with weight knows they have a problem. It’s not new to them, it’s not something they feel proud of, and so when addressing it, we have to all remember to be kind.
As a GP, I always like to explore the history of my patients. What has their health journey been, their lifestyle, their socioeconomic situations? When you find the root cause, addressing that is when change can take effect.
On the NHS we do have many resources and a diverse team of experts who can help with weight management, from doctors, nurses and dieticians to nutritionists, physios and psychologists. We have referral schemes into gyms and support groups as well as more advanced treatments including medicines and even surgery. We need people to feel confident to ask for help but we also need those who provide the care to be more sensitive, welcoming and supportive.
I have seen a change in the way we educate healthcare professionals in the context of weight management. Right from medical students to senior physicians, learning to effectively communicate concerns about weight has become a priority. There are resources, modules and courses as well as discussions around sensitivity and compassion. A key step in the journey to spark change is to ensure our patients feel seen as individuals in order to help them achieve healthier, realistic weight goals and to improve their long term outcomes.
If we can address the obesity crisis today, we can prevent the increasing burden on the NHS in future. It’s not a simple problem to solve but it is one we all need to accept as our problem. We all have a role to play. And it starts with being kind and treating everyone with the respect they deserve.
Dr Punam Krishan is an NHS GP in Glasgow, medical educator and director of the British Society of Lifestyle Medicine