To think that most health care professionals are hopeless at advising on weight

[Hellostrawberries]

I had a hospital appointment today and the doctor, as expected, advised me to lose some weight. (My BMI is 39). He then spent around 30 seconds explaining how to do it, basically by eating less processed foods and more fruit and veg, lean protein, whole grains etc.

I couldn't be bothered to say what I was thinking so I just thanked him, assured him I'd try and went on my way. What I was thinking was more along the lines of 'FFS do you honestly think I don't know that! I've spent the last 30 years trying to do just that. I succeed for a few weeks and then the hunger and cravings overwhelm me and I abandon the diet yet again. Each time it happens I hate myself a bit more. I've also got a history of ED and had a year of therapy for bulimia in my teens. My weight and my disordered eating are the biggest struggle of my life. And you reckon you can wipe it all out by trotting out a line about how I should eat more vegetables and less cake! Fuck off!'

So AIBU to think that HCPs are hopeless at advising on weight? I'm happy for it to be mentioned. I'd just like it to come from a place of understanding, of assuming my weight history is long and complex, of crediting me with knowing what healthy eating is.

I hear you 😢. I know all the answers but also struggle constantly with disordered eating - I’m so tired 😢

Yeah it's patronising, right? I wonder how many patients have been living under a rock and go in and are genuinely like, "WOW I did NOT know that!"

Not many I would think.

What would you like to have happened differently? Weight is a hugely complex multifactorial issue, what works for one person won't work for another. It would need a huge in depth conversation really to give it justice. Do you think that this NHS doctor has the time, resources or expertise to go deeply into this with you?

Well to be fair to him, he doesn't know that, does he? Most doctors will start with generic advice and it's up to you to then explain anything else they need to know so it can be adjusted for you.

I think they might not empathise with the complexities but they do appreciate it's not as simple as more veg/ less cake. I wonder if there is a prompt and tick box in the record keeping system that they have to complete for anyone with a BMI above a certain level.

BMI 30, healthy eating advice given ✅

Unfortunately the NHS is massively under resourced. To do this well would take time the doctor just doesn’t have. So in one sense I agree with you, his approach was patronising and insufficient, but on the other hand, by your own admission (and I can say the same about my own weight too) your weight history is long and complex and to explore it well would take much longer than this doctor was given.

HCP's are not experts on weight loss. It's not a taught subject. However they do have a professional duty to provide health promotion and signpost to services that can help wether it's weight loss or smoking, drinking etc
Why is it the doctors downfall that he cannot tell you exactly how you should lose the weight you want to lose? We have a responsibility to ourselves to figure that out surely? They have enough to deal with.

Well he should know! Because it's the statistical likelihood. That's the point, chances are you've never met an obese person who a) doesn't know how to eat healthily and lose weight, b) desperately wants to do it and c) hasn't tried countless times over the years.

YANBU. We don't really get much training it it, dietician is a whole other specialty. I am a HCP and as part of my job am expected to advise on diet and exercise. For most people, I caveat that advice by acknowledging that they probably know it all already and that most of us do, it's just doing it that's the hard part. I then tell them that there are many different diets that work, the one that works for them it the one they can stick to.

For some people, there are obvious changes they could make that they hadn't considered (like the older gentleman I had with high blood sugars and a 'healthy diet' but was drinking a litre of orange juice a day!) or they may genuinely have never tried to diet before (older generations usually, often men) and actually ask me for specific advice. For things like pre-diabetes I have a diet advice sheet I give out and signpost them to online resources and offer a referral to a course/weight loss programme (which all basically say the same 'eat better, move more') while again acknowledging that it likely will be telling most of them what they already know.

Weight and diet are about so much more than food, we all have our own complex reasons for being overweight and our own barriers to healthy diet and exercise. I am not qualified to counsel people about this. Ideally we could offer referrals for personalised support with therapy, but I think the best we can hope for is being able to prescribe weight loss drugs in future!

So in the (30 seconds? 1 minute?) he had to discuss your weight, what should he have said? What would have been helpful?

Fair point. If there is relevant research that shows that, then they should be made aware of it in their training. A question along the lines of 'do you feel you need any support to reduce weight' might be better. Although if people say yes, I don't suppose there is any. So maybe not.

What do you want them.to say?

Those are the facts

He knows you won't listen to him, but yes, he has to mention it.

A BMI of 39 is relevant to your health and your appointment. He needs to make sure you understand that. There is also some evidence that a HCP mentioning it can make a difference.

He knows you know. You know he knows you know.

At least he mentioned avoiding UPF which is better than recommending low calorie chemistry experiments. If and when you are in the right headspace, I recommend Andrew Jenkinson's why we eat to much. Amongst other things It explains why diets don't work.

What could he really have said though?! What did you want him to say? If he had the magic answer that would stop your years of disordered eating I’m sure he would have given it to you!

I find that a lot of health care professionals are overweight themselves. It’s the blind leading the blind.

Agree completely OP.

I’m obese (very obese) for a variety of complicated reasons. If losing weight actually was straightforward there’d be no fucking fat people.

I have gained weight due to medication I have to take. I kept asking for help with my weight and was referred to a 'health coach'. She was dreadful. Had no idea about the medication I was taking. So vague. Told me to eat more and 'healthy' food and that was it really.

However, I then managed to get a referral to a dietician. He was great as he really looked at my case on an individual level and gave me some specific things to try, then at my second appointment really listened to what worked and what didn't and made changes. Unfortunately, I'm only going to see him once more as he has no capacity to provide ongoing support.

I have found our local services useless. At my request, I was referred to a weight loss service only to find that it only operated Mon-Fri 9-4 (so not something you can access regularly if you work). A year later, again at my request, I was offered an online appointment which my GP inferred was with a dietician. The person definitely had not had any in depth training and the advice offered over the two 30 minute. appointments was eat fewer snacks. She was a complete waste of my time and of NHS resources. I have now requested a referral to the specialist weight loss service. I wasn't referred and instead have been sent for a blood test. This seems to be a thyroid check (I have hashimotos) and doesn't include a check for diabetes. I am trying to help myself and have had a PT for 2 hours a week since December. I am definitely fitter but have only lost 4kg in weight.

At a certain point in a nation's overstretched health system, you have to take responsibility for yourself. We are at that point. Not the HCPs fault.

No one is saying it’s their fault.

Yes, we are just saying they need to be clairvoyant.

This is a fair point but it is likely to be cheaper to provide effective support than to deal with the health costs associated with obesity

You could say that about anything. You have any health condition whatsoever - you have to take responsibility yourself. But if you need the professional advice of a dietician, 'taking responsibility for yourself' isn't going to cut it.

And the other reason your advice is crazy is being overweight means you will need more help from the 'overstretched health system' so what we really can't afford to do is not help those who are overweight.

It rather depends on what the speciality of the doctor was...so if you'd been referred to bariatric service id expect a bit more as it's their speciality, however if you were seeing an orthopaedic surgeon about your dodgy knee for example, NO it's not reasonable to expect them to have a deeper understanding of disordered eating and obesity and weight loss...
As said up thread at some point self responsibility needs to kick in and we cannot expect our HCPs to omnipotently knowledgeable in everything. If you think you need tier three help ask your GP to refer you to the appropriate doctor/team..

No, you can't say it about anything.

You can't take your own appendix out, CT your own brain, fix your own broken leg.

You CAN eat and drink less crap, move your body more

Even after 2.5 years of waiting for tier 3 support I’ve been told there’s actually nothing they can really offer me as the local icb won’t fund certain medications and I don’t want a gastric band 🙃