An interesting question that arose from a shift a few nights ago – how do we approach the topic of weight with our patients? It is one of the most sensitive issues in medical practice, particularly as it is associated with so much social stigma, bullying, isolation and taunts. It is blasted by the media, and monetised by so-called “health” magazines that broadcast “fad” diets and revere the idea of losing weight fast.

In medical school, we are taught to approach such emotionally-charged topics with empathy, patience and understanding. We are advised that we should be non-judgemental and encouraged to be proactive by taking every opportunity to emphasise the importance of prevention to our patients. Preventative medicine is all about driving towards positive health outcomes before illness occurs, rather than after. Obesity, smoking, alcohol, diet, exercise and mental health are all very important keywords in this specialty of medicine. Obesity continues to top the list as the single most important contributant to poor cardiovascular health outcomes.

Recently, I came across a well-meaning lady that presented to my Emergency Department after sustaining a joint injury. After a comprehensive clinical history and examination, it became apparent that the most significant contributer to her presenting complaint was her weight. I trod lightly and aproached the topic with all the tools taught in medical school to be an empathetic doctor. I took a thorough social history, and sought information about current lifestyle choices, weight loss goals and strategies. I suggested the usual prescription for exercise of 30-minutes a day at least 5 times a week, going on to state that for a person at specific risk from obesity, 45-60 minutes a day for at least 5 days in a week is recommended. I also suggested that if this goal is unachievable, even a little exercise is better than none. I also suggested diet strategies and advised her that weight loss is a collaborative effort, and that some of my patients have benefited greatly from input from a primary physician, dietician and exercise physiologist. Above all, I emphasised the potential consequences of not doing anything about her weight, and why immediate steps were so important.

I took all the steps that I thought were necessary for my patient to achieve the best health outcomes, and I felt that she had understood and was prepared to take action. However as she received the discharge summary from me and I left to write her a medical certificate, I came back to see that she had opened the envelope in which the discharge summary was enclosed and appeared quite distraught that I had mentioned everything we had discussed in the letter. Then the derogatives commenced, and I was told that she would prefer to see a “real doctor”. As a doctor, you learn to appreciate that you will be sometimes appreciated, and often abused – so the comments didn’t affect me as much as the idea that my patient would not be taking any action to control her weight despite my efforts. She of course stormed off outside the Emergency Department door, and our consultation ended there.

What could I have done differently? Would I have done anything differently? I don’t know, and I can’t really see that I could have done much more than I had. It was my responsibility as a caring, concerned doctor to approach the topic, and that’s what I did. Regardless, I do not feel that it is good enough that no positives would come out of my consultation, and I seek your opinions as to what you would have done had you been in my shoes.

How do you approach such emotionally charged topics in your practice? What recommendations do you make to your patients? And how do you approach the topic of preventative medicine? I would love to know your responses!