‘So, are we going to talk about it?” was how our family GP raised it with my brother – as he sat in the consulting room, overweight. It was asked gently, and came after a practical discussion had settled the problem he’d come in to talk to her about, but it stayed with him as a negative mark against her, and against GPs in general. He became reluctant to go to see her again, and that had consequences later on.
Fear that “it” will be brought up by a doctor is a given for people who are visibly obese. It’s well within the realm of the probable that someone who has trained to safeguard the health of fellow human beings is going to want to talk to you about it. So the actuality of the “30-second interventions” for weight-loss study published in the Lancet isn’t ground-breaking – little interventions for big problems was not invented for the trial. Yet hearing about it will probably be no less worrying for those who’d hoped they were just being paranoid when they feared their GP would answer a “I’m concerned about this mole on my face” visit with a “I noticed when you walked in that you’re very fat” non sequitur.
Avoiding your doctor ... now there’s a problem as big as that which GPs have in not wishing to offend their chubby patients. Maybe a bigger problem. Chubby patients, The Boyd Family, have been running a parallel study for a lifetime, as I’m sure many others have: we’ve all been impacted by fear of “interventions” in different ways.
The automatic linking of any health problem to obesity provides enough motivation to skip a GP visit.
“Hi doc, I get that I’m fat, but I just got run over outside and my head came off … ”
“OK, but have you considered losing weight.”
“I just did. I just lost 11lb worth of human head.”
“Good job, off you go then.”
Ludicrous, but not so far as to be unrecognisable as real experience. I’d been struggling with stabbing pains through my throat and chest for weeks – I couldn’t lie down without feeling as though something was digging through my neck from the inside. Having to sleep face-down with a pillow rolled up and punched into place to take the slump of my neck, I was very scared. I went to a GP who could see me quickly. He silently stared at me, then asked if I’d thought about losing weight. Was my weight hurting my neck and chest, I asked? “Perhaps.” Would losing weight stop it hurting? “Losing weight would help a lot of things.” Could he help to stop this specific thing hurting me now? He seemed to have decided he didn’t need to consider it further: I was just fat. He sent me away to stop eating so much.
Surprise, I didn’t stop eating so much. The pain was stopped by something else, something small. My regular GP figured out the long waits on cold train platforms on my way to work that winter meant that I was tensing my shoulder and neck muscles for long periods in an effort to warm up. Instead of just looking at me and seeing the extra weight that needed to go and nothing else, she listened and recommended a warm scarf and heat pads.
Focusing on weight because it’s easier to diagnose than a recurring health problem – there’s a potential problem. My sister had been a chubby kid, but lost the weight as an adult. A size eight with a healthy diet and regular exercise, during her GP visit for angular cheilitis, a skin condition of the lips and the mouth, she was put on the scales and told to lose a stone and a half. It shocked and upset her. Listening to her berate herself during the effort to lose that weight upset us all. But my sister respects the weight intervention. She’s a more generous spirit than I am. Albeit one who still gets splitting skin in the corners of her mouth. That didn’t leave her along with the stone and a half.
And to the last Boyd case study: dangerous avoidance. A while after the gentle intervention from the family GP, my brother was burned very seriously across his leg. He didn’t want to see a doctor in case of a repeat of that question from before. The over-the-counter burn creams he tried didn’t work – his foot got infected. After an enforced trip to A&E (and layers of necrotising and pus-ridden epidermis and dermis being painfully scraped away over the course of a few hours), he was told he’d nearly lost his leg because he didn’t get help for the burn earlier.
Avoiding a doctor’s visit because of fear they’ll focus on weight; past eating disorders being triggered because of a question assigned to GPs industry-wide; and specific problems being ignored because they’re wrapped up in extra flesh aren’t unique to my family. Many, many people are going to be worried about the consequences of this trial, because they were worried already. GPs: don’t be afraid to cause offence by asking that gentle question and intervening. But more importantly, listen to us. Don’t just look, judge, and blurt out the question – that’s what worries us.
