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Nutrition matters

BMJ 2014; 349 doi: (Published 27 November 2014) Cite this as: BMJ 2014;349:g7255

Rapid Response:

Re obesity and our ‘role as doctors in the fight against obesity: understanding and acting on the causes’. I have two proposals to make.
Proposal 1: Rebranding Lifestyle advice as a ‘Meta-intervention’
This has two advantages, firstly it sounds so much more significant and sexy. We all prefer to be involved in important work after all. Secondly it summarises the point that lifestyle interventions may help solve a patients problems at a more fundamental level
An Example: on obese diabetic with arthritic knees presents with an umbilical infection.
• Level one intervention, antibiotics for the infection.
• Level two intervention, metformin to improve diabetic control.
• Level three intervention, weight loss. This improves diabetic control, BP, lessens the knee pain, could improve general wellbeing and self-esteem. Surely a meta-intervention?

Part of how the public have come to believe blood pressure is very important is that doctors check it so often. They assume that doctors do ‘important' things to them. Until a few years ago I didn't even have a decent pair of scales in my consulting room, but realised that patients might take action on weight if I signalled its importance by just weighing them myself. I have been amazed how this very simple change has affected my practice, particularly if patients know I will re- weigh them at our next meeting.
Proposal 2: We all start weighing patients ourselves. If we do it rather than health care assistants, patients will get the idea it's an important thing medically - which it is. We could even do waist measurements too (ref 1) Possibly we could do a few less blood pressure assessments to make time for this!

From a patient perspective concern over weight has one great advantage over blood pressure -it's in their control. How much better if we worry them about something that is important and that they can take action on!

David Unwin

Ref 1. World Health Organization. Obesity: Preventing and managing the global epidemic. Report of a WHO consultation, Geneva 2000
‘Risk of metabolic complications substantially increased’
• in men with a waist measurement > 102cms
• in women with a waist measurement > 88 cms

Competing interests: No competing interests

30 November 2014
David J Unwin
GP Partner and Trainer
The Norwood Surgery, Southport