Obesity a complex problem with no simple answers: Expert

Public Health

By Mardi Chapman

9 May 2017

The health system is failing to manage people with obesity and doctors need to re-think their approach and attitude to the problem, an expert says.

Speaking from the Royal Australasian College of Physicians (RACP) Congress in Melbourne, Professor Louise Baur told the limbic there was a systemic failure to provide adequate services for people who were obese.

She said many hospitals wouldn’t even provide access to dietetic support for people with obesity unless they had already developed co-morbidities or complications.

“I do think we have a 21st century problem and a 20th century approach. The rise in obesity happened in the late 1900s but our response has been slow.”

“We underinvest in both training for health professionals and in treatment within our health system. We don’t have referral pathways to dietetics or psychological support.”

“We almost expect people to manage by themselves. It’s analogous to mental health in previous decades.”

Professor Baur, a paediatrician and obesity researcher from The Children’s Hospital at Westmead, said training at both undergraduate and postgraduate level needed to step up.

“Every generalist and all sub-groups need confidence in the initial assessment and management of obesity.” “It’s hard to think of a sub-specialty where doctors don’t have to deal with obesity. Paediatrics, sleep physicians and obstructive sleep apnoea, rheumatologists and osteoarthritis, gastroenterologists and non-alcoholic fatty liver disease, cardiologists and heart disease.”

“Even oncologists – some cancers are more common with obesity but doctors also need to know how to modify doses of drugs to manage bigger people,” she said.

She said she had heard from occupational health physicians of train and truck drivers having workplace accidents because of undiagnosed sleep apnoea associated with obesity.

Professor Baur said there were major issues with weight bias, stigma and negative attitudes, including therapeutic nihilism, towards patients with obesity.

“Obesity is complex and there are no simple answers but we tolerate complexity in the management of people with heart disease, type 2 diabetes or osteoarthritis.”

She said UK research published recently in The Lancet showed that GP referral to a community weight control program for a minimum of 12 weeks could improve weight status in adults.

“There is a great need for specialists and GPs to be focussed and thoughtful about what they can do in their local areas of influence. We need clinical champions to improve services and resources for obesity management.”

She added that the language around obesity was often disparaging and practical issues like having extra large gowns or appropriate seating for bigger people were neglected. “We need ways of doing things that allow for dignity.”

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