Confessions of a GP

Obesity register

Jemma is 28 and has come to see me about an infected insect bite on her ankle. She is nice enough but not very confident and admits to feeling a bit nervous around doctors. We have a bit of a chat and I like to think that I put her at ease. Her bite needs some antibiotics and all is straightforward until my computer butts in. Flashing up on my screen is ‘WEIGH PATIENT AND CONSIDER INCLUSION ON OBESITY REGISTER.’ Yet another target in our target-based world. The computer wants me to weigh Jemma and if she is above a certain weight, I would be obliged to put her on a special register along with our other overweight patients. Hmm, how can I put this tactfully to Jemma?

‘Oh Jemma, before you go, I’ve noticed you’re a bit of a porker. Jump on the scales; mind not to break them now, cupcake. That’s it…16 stone. Bloody hell, you are a big girl! We’re going to have to put you on our special fatties list. That’s it, have a good cry. Maybe it will burn off a few calories. See you again soon for another weigh-in. Won’t that be fun?’

Okay, so I am a little more subtle than that, but I do object to having to put my overweight patients on an obesity register. Perhaps I’m wrong here, but I imagine that a young woman would not want a young slim male doctor, whom she doesn’t know, pointing out that she is overweight (something she is probably already aware of). Especially when she has come to see him about something completely unrelated.

Of course I recognise that obesity is a large problem with social and medical consequences. I sometimes have patients who come in to ask me specifically about their size and to seek advice and support about losing weight. When this happens, I’m happy to listen and try to offer some encouragement. I explain about eating less and exercising more, but generally the world is already oversaturated with information about losing weight. I don’t really have that much more to add other than a sympathetic ear and a few supportive words.

Currently, we reach our target and get our points (and money, of course) by simply having patients on the register. We don’t do anything with the register. There aren’t teams of dieticians waiting to give advice and support to our overweight patients. There are no good slimming medicines that have been shown to significantly reduce weight in the long term. All in all, the list is currently fairly devoid of function other than successfully alienating a significant percentage of our patients. Perhaps we should make our obese patients wear a little yellow cake logo on their clothes so we can differentiate them from our ‘normal’ patients? Of course, I’m overemphasising the point here, but I just feel that weight is a very sensitive subject and although encouraging healthy lifestyles is vital, are an enforced obesity register and regular weigh-ins the answer?