Tiptoeing around elephant of obesity

Few people like being told they are overweight — and portly patients seeing their doctors are no exception.

Video-recorded medical consultations have been analysed by University of Otago Wellington researchers, and their findings suggest some doctors might tiptoe around the elephant in the room, in case they offend the patient and upset their relationship with them.

As a result, fewer doctors would flat out ask "Have you put on a bit of weight?", with most preferring an indirect question like "What do you think your diet is like?" or "Do you get enough exercise?".

Those questions were often accompanied with qualifiers and hedges such as "Maybe", "I think" and "You know" before the GP got somewhere near the point of the query — the patient’s weight.

"By avoiding a question of statement that directly or explicitly referred to the patient being overweight, GPs opened up a face-saving ‘escape route’ if  the patient proved to be resistant to pursuing the discussion," the article — to be published in the next issue of the Journal of Primary Health Care, said.

"While diet and exercise were often raised in consultations, these interactions could be described as a ‘comfortable dance’ around the topic of weight management."

While references to putting on a bit of beef and the need to change one’s lifestyle might be light-hearted, there was a serious issue to be addressed, researchers said.

Obesity is set to overtake tobacco as New Zealand’s leading potentially modifiable risk to health, and the new study suggests doctors here are following the pattern of colleagues researched in overseas studies in not realising their full potential to tackle their patient’s weight issues.

"However, such discussions are challenging and interactionally delicate," the article said.

"The high frequency of patient contact with GPs provides opportunity to reach and work with people at risk of chronic conditions associated with excess weight."

Researchers will now work on drafting guidelines to provide ways for doctors to feel more confident and culturally competent in how they ask questions about people’s weight.

mike.houlahan@odt.co.nz

 

 

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