Have medical professionals ever commented on your weight or offered treatment?

[MoneyJo]

After reading on another thread that one poster was offered help at a BMI of 30 (I think) but not when it was much higher, it made me wonder if anyone on here was ever spoken to by their doctor or another medical professional about their weight, ever?

My weight has crept up over the last 20 years since having my eldest, and my BMI at its highest was 44. Nobody ever commented. My GP once added into the end of an appointment for something else that people who do 20 mins a day exercise add years to their life, but that was it.

A couple of years ago (when my weight was it its highest) I was invited for a health check - bloods, weight etc. I said to the nurse then that I knew my weight was unhealthy and she just said something like we are all a bit overweight these days.

I'm not sure how much it would have changed anything but it makes me wonder if anyone else has ever been challenged.

I don't know what could have been offered or suggested because it never happened to me.

I don't think anyone has said losing weight is impossible without WLI!

Some people have found other things helpful. Not everyone who has ever lost weight did it through WLI. I lost some myself but ground to a halt. It seems like you've just come on here to find an argument, which is a shame because the WLI board is usually very helpful and supportive.

I’m usually in the overweight category and, whenever this comes up, it’s dismissed as “not really anything to worry about”. Which always annoys me as it will be having an impact on my health. On many occasions, though, the person doing the health assessment has been significantly bigger than me which probably impacts both on what they would say and on what their managers etc are comfortable asking them to say. The exception to this was in my 30s when a GP who was a similar age to me & slim commented on my weight and asked why I was overweight. I spluttered a bit but it really stuck with me, did make me think and did lead to me losing some weight as, rather than just going on another diet, I did think about the behaviours behind my eating for the first time.

Not looking for an argument just a bit triggered I guess because as a HCP we are damned if we do mention it and damned if we don’t it would seem.

It looked to be a ‘debate’ thread not a support or advice thread so assumed contributions to debate from either side would be OK and didn’t feel the need for a particularly supportive tone.

I initially intended just to say that yes it is a health risk being overweight or obese just the same as smoking or excess alcohol and yet there is not the same incentive to do ‘health promotion’ for this issue.

But then it occurred to me that people probably wouldn’t welcome it anyway and that seems borne out by the responses.

I still don’t understand if you (or other posters) would have wanted it mentioned or not? Most people where it was mentioned don’t seem to be saying that they saw it as a positive. But maybe most smokers don’t either and we are still supposed to mention it to them.

But maybe most smokers don’t either and we are still supposed to mention it to them.
I was wondering this. Do smokers get told about the health risks? And if so why no conversation with overweight people?

As I have already said, I would have welcomed a conversation perhaps offering some help or support but not one that said just lose weight and suggested all I had to do was eat less and move more.

All HCPs are incentive to mention smoking to people and there is training available on how to have the conversation that is quite useful. You can offer nicotine replacement as that is evidence based.

I don’t think the same is true of obesity although surely it is a health risk. I think there is an analogy there and there is evidence that for smoking cessation and alcohol a Dr pointing out the health risks does significantly increase the chances of positive change. However with weight loss we would be limited to referring to some kind of weight loss support program which is basically a variation on eat less, move more that people usually deride as patronising. I cannot recommend treatment not available on the NHS so I cannot recommend obtaining private weight loss drugs even though they are obviously effective. So I don’t say anything usually unless people ask because I know it offends people and they don’t want what is on offer NHS support wise.

During my fertile years I was always told to lose weight. As soon as I hit menopause, piled on the weight and now have high blood pressure and cholesterol with other medical conditions , all I'm offered is BP meds and statins, both of which make me too ill to function (tried 8 different bp meds so far). Not a peep about my weight which is around 20stone.

@Shrinkhole I went on that eat less move more programme. Unfortunately it's not set up for physically disabled people and I ended up with hip inflammation problems which meant I moved less! A year later my hip is still painful, GP not interested.

I guess because they’re incentivised to promote smoking cessation programmes/medication to smokers but nothing like that exists for weight loss. Probably because the NHS tacitly recognises that there is nothing out there that is effective at a population level. Until WLI of course. But they’re too expensive and popular, so access to them is extremely tightly rationed.

I think the onus is on the individual more so now and quite rightly.

When was about 24 the gp said to me “maybe if you were more sylph-like” I was 9 stone

There was a bit of a fashion for a while for referring people to weight loss services but I don’t think the evidence of benefit is very strong and anecdotally it seems pretty unpopular too. Other than that I think it’s only Orlistat that can be offered on the NHS and the side effects tend to be off putting

Yes its pretty standard now as part of long term public health management. As a nation we need to lose weight and get fitter.

NHS lifestyle advice has to be one-size-fits-all, lowest common denominator which is never going to be very effective. It seems to start from the assumption that fat people all think burger and chips are a health food. That’s obviously the case for some, but many overweight and obese people know more about carbs than the average practice nurse. Eat more fruit and veg and go for a brisk walk every day is not going to be very effective for serious weight loss.

Plus dietary advice has changed a lot and the NHS seems slow to keep up. Most innovations on weight loss, from calorie tracking apps to mass availability of GLP-1s seem to take place outside the NHS.

That's tough for those people who can't afford to pay for support.

Apparently the average weight loss on the NHS referral programmes is 5-10lb and most people regain it after the programme is over so basically we don’t really have effective interventions to offer so you’d be offending and annoying people for little positive benefit statistically. Depressing.

The NHS is good at treating and managing sickness. It is not good at promoting health, largely because the factors driving public health outcomes (housing, education, employment, leisure, markets and economics etc) are outside the NHS’s control. This is not news.

Advertising bans, smoking bans, taxation, a more informed public and shifting social attitudes have probably had more to do with smoking cessation at scale than the fact you can get nicotine replacement therapy from your GP.

If GLP-1s were to become widely available on the NHS on the same terms that they are available privately it would be a game changer in the management of obesity at scale. The food industry would respond. It already is.

Many years ago now, a doctor at an appointment to fit an IUD just said, without any preamble, “You are obese. What are you going to do about it?”

I said I was very happy in my skin, thank you.

The same woman started another appointment “How are we getting on giving up cigarettes?” I said that I didn’t know about her, but I didn’t have the slightest intention of giving them up.

After that, I asked not to be assigned an appointment with her again.

Very true. I really hope that there can be changes in this obesogenic society that we live in. You need to actively resist putting on weight these days because all the drivers are towards gaining weight.

That's really sad.

@Shrinkhole is there any availability to refer people to the Oviva Tier 3 programme at all?

Tier 3 has very restricted eligibility I think it’s BMI 40 and above or 35 with comorbidities.

Other than telling me my weight was too high no actual advise or recommendations. I already know how to lose weight. I’m not eligible for WLI as I have type 1 diabetes.

The Oviva website says you can be referred with BMI of over 35 and one comorbidity like high BP. At each of my last high BP reviews, done via automated text and maybe a call with a pharmacist, I would have met those criteria if anyone had asked me my weight.

Some areas of the country contract them for Tier 3 and others don’t so it might be possible in your area or it might not.

@Shrinkhole I'm an nhs worker, had high BP, high cholesterol and was prediabetic as confirmed by my nhs healthy heart check for well over a year before I started WLI myself. Ive also had IBS since I was 27. I didn't know about my test results as at my review because the nurse said all my tests were normal and just to do some regular exercise and eat more fruit and veg.
I found out myself when I changed GP 1.5 years later when I saw it on the app.
If I had been told about all these health issues, I would definitely have done something about it myself much earlier. In fact the reason I started MJ was because my sister was diagnosed prediabetic and my dad was diabetic and I wanted to lose weight so I didn't go the same way, little did I know what was going on with me. I had so many symptoms, caught a lot of respiratory bugs and even ended up in hospital and kept in overnight due to dizziness and extremely high BP. In fact I didn't even know about low carb and the impact on insulin resistance and pcos, so if someone had even told me that years ago, I wouldn't have gotten to the situation I was in.
HCP have a duty of care as well as to inform and educate. There are ways of communicating that are empathic and supportive not offensive.

It’s definitely available in my area. I guess the NHS have saved themselves the cost of the referral and the cost of a Wegovy prescription by not asking me about my weight and then me deciding to get a private prescription for Mounjaro.