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.

Unless it is life-threatening or causing major medical problems, why do people need a “health professional” to point out such things? Especially as we all know that the BMI scale is a very rough, and often inaccurate, measurement of health weight. Lots of people would not welcome the observations on one’s weight, often from a complete stranger!

Some people may not have weighing scales or realise the impact of obesity on health conditions. At 12 stone bmi 30 size 14 I was prediabetic and wasn't aware. I thought a size 14 was average and wouldn't have classed myself as obese.
I also didn't know that due to my ethnicity, bmi scales differ so I had to be under bmi 23 to be classed as low risk for health issues and genetic conditions. Information and education is vital.

Absolutely agree the eat less move more programme is not set up for disabled people. I have a swollen foot, arthritis and one or two other ailments documented in my notes at the doctors. Three times I was phoned by the company running the programme about joining. I did join in the end so they would leave me alone. Quite useless, I'm lucky if I can move 1000 steps a day sometimes, the questions are patronising and over the whole 12 weeks I was bombarded with emails regarding filling in that weeks information.

I realise these programmes are helpful to some people but they must take account of people's individual circumstances.

BMI is not rough or inaccurate. It’s a simple calculation that for the very large majority is an effective approximation of their body fat. My BMI was 50 before I started my private prescription for Mounjaro. Even if BMI was a rough guess, it would have been close enough to spot that I was morbidly obese.

I didn’t need a HCP to point out that I was morbidly obese. It would perhaps have been useful for someone to ask me my weight during my annual BP check, done via text, and then perhaps notice that I was morbidly obese and then maybe suggest that Tier 3 weight loss programmes were available and to ask if I agreed to a referral. Or maybe that’s all a ridiculous thought.

A nurse at my annual health check when I was still BMI 45ish said “I’ll put down I told you about xxxxxxx the online NHS weight pages” after she weighed me. I said, “oh, how do I find them”, she replied “they are online somewhere, not sure where” and that was it.

I think GP’s are not keen to start the conversations as there is little they can do to help really, so they just treat some of the consequences of obesity as they arise. Now GLP1s are available their hands are still tied due to funding.

I went to the gp as I was 17 st and felt awful. Could lose weight but then would regain it. I saw the nurse and put a referral into the weight management team and two years later after jumping through hoops I had weight loss surgery. 10 months on and I’ve lost 86lb and am a healthy weight. Best thing I’ve ever done.

What is on offer support wise?

And what does ‘incentivised’ mean?

Thanks

I’m not a GP but I think GPs get QOF points and the help to stop smoking is NRT and there are NHS stop smoking programs everywhere that have decent evidence of benefits

Our 2nd care Trust has mandatory Stop Smoking training and data is collected on smoking status. So not an individual incentive sorry if that was implied but at an institutional level

But what is the incentive? Is it monetary?

In some very indirect institutional way I think so but I’m hazy on the details. It’s a way above my head what goes on with institutional finances.
As I understand it GP QOF points are tied to how much money the practice gets. They have to hit a certain number of points in each area to get paid. It’s all kinds of stuff like vaccination rates, cancer screening rates, diabetes check ups etc etc
2nd care Trusts have a certain proportion of their income tied to performance targets too although not the majority of it.

My personal incentive is more along the lines of my manager will tell me off if I don’t do it

Thanks for your answer, @Shrinkhole - that’s very good of you.

I hope you understand why I’m interested. I do think it’s a bit shocking that HCPs don’t understand the system, let alone members of the public. It doesn’t feel very transparent about how public money is spent!

I get that it must be difficult talking about weight with patients - if you do bring it up, you can’t actually help! Perhaps when GLPs become more accessible (patents running out, tablet form), the NHS will actually be able to use this incredible medicine. What a strange world we live in, to be sure..

I also think that there's a lot of misunderstanding about obesity. I'm quite a fan of the Hunger Games podcast on radio 4 which talks about the science behind obesity, and of course the hormonal impact. It helped me understand that I am different hormonally from my "naturally slim" friends. I very rarely ever felt full, and if I did it would fade quickly, so I didn't have the same natural stop sign. I also have chatted with friends about the food noise and they genuinely didn't know what it was. So it's much easier for someone with my level of certain hormones to become obese and much harder to lose it. Unfortunately there's not always great understanding of this amongst doctors and certainly very little they could offer.

I have since discovered that I possibly could have got WLI on the NHS if my weight had ever come into conversation.

The main difficulty your GP has is there is no service they can refer you to unless you meet specific criteria. Your GP will give you diet advice if you ask but they don’t offer a weight management service. Their staffing levels are based on fulfilling the requirements laid out by the NHS - they are told what there is funding for and what there is none for. Their HCPs are working flat out and don’t have time to run a weight clinic.
There are some changes coming. I believe they will shortly be able to prescribe Wegovy with a BMI of 37 plus 3 Co-morbidities (don’t quote me on the exact numbers!)

Yes, my haematologist. I have a blood clotting disorder and at an annual review she told me that my weight (then 22 stone BMI 55) was a ticking timebomb. She is someone I respect and we have intelligent conversations.

Shortly afterwards my diabetes nurse asked me about trying mounjaro. I grabbed it with both hands.

I'm now 8 stone down.

The thing I appreciated with both HCPs was that their attitude was that there was a problem and it needed to be solved. No blame, no trite 'eat less, move more' suggestions.

That's wonderful @GnomeDePlume

Hi @MoneyJo, good thread!

The only time my weight was mentioned to me was by a surgeon when I was on the trauma ward after I broke my ankle in 4 places and needed surgery to fix it.

He just said that recovery would be quicker if I lost weight. At that time I was probably roughly the weight I am now, so about 7lbs into the obese range. The interesting think was that I was moderately active at the point I had the injury but the injury made it difficult for me to remain active, I took ages to recover and to regain confidence. So, of course, that is when I gained weight.

I've lost approx a stone and a half since starting MJ in March.

I probably should have listened more to the surgeon.

@MoneyJo thank you.

I think I am exactly the person mounjaro was designed for. I eat healthily, like my vegetables, dont snack a lot, dont eat a lot of takeaways. Mounjaro has just helped me to do it better.

Almost certainly I will be on mounjaro or one of its successors for life. This prospect doesnt frighten me. Compared to daily heparin injections (which I sometimes have to do for my blood disorder), mounjaro is a breeze. I am still diabetic just my diabetes is managed.