Why are there so many overweight GPs? December 2010

[Paul Murphy]

Why are there so many overweight GPs?

26 Nov 10

GPs may constantly tell patients the benefits of diet and exercise, says Pulse's GP registrar blogger Dr Syed Arfeen - but they don't all practice what they preach

Click here to read more the GPs to be

I don’t suppose I will make many friends with this. But just as sometimes in medicine - both clinical practice and research - we have to be
straight and say what we think even if it is disliked or not to our
listener’s ears' approval, I will do so anyway. So, with that
disclaimer out of the way, I will say just how disappointed I was when
attending a recent study day for GPs in paediatrics to see so many of
them being overweight.

The existence of it in the current milieu of general practice, when we've moved beyond simply tackling life-threatening conditions such as infections to a health promotion
role, while acutely aware of the obesity epidemic in the UK, is
eyebrow-raising.

GPs are the frontline medics (alongside A&E, although their role usually involves little health promotion) and the first ones to consider primary prevention for any condition
(alongside public health doctors, though they unfortunately don’t
consult patients individually). And no condition at this present moment
requires as much primary prevention as obesity.

Professor Harold Ellis, the Emeritus Professor of Surgery at the University of London who began practice in 1947, often recalls that they never used to have obese
patients but that when they began to see them they would think to
themselves ‘What is this?’ We certainly do not give it a second thought
anymore, and Pulse readers will be well aware that the rising incidence
of obesity is mirrored by the rising incidence of diabetes and cancers.

All of us consulting will have every week many times over given the health promotion talk. Yes, you know the mantra of ‘diet and exercise, 30
minutes five times weekly and cut down the fats and salts’ - and often
with a statin
on top. So how then can we face patients in a state of corpulence? It’s
the old ‘do as I say, not as I do’ maxim of medicine shining through
again.

Indeed, I’m surprised that amongst all the negative press about doctors, this issue has not made its way onto a letters page from a dissatisfied if observant patient. Perhaps patients are
still so overwhelmed by the consultation itself or the advice, or are
so fond of their GP, that they see in them no faults. But to a more
discerning eye it would be a difficult position to hold.

[Paul Murphy]

* Hazel Drury | 26 Nov 10

OK, well as someone who has suffered with her weight all of her life I find your article slightly offensive and condescending. Clearly you are one of those lucky people who don't gain weight easily. Alas I am not, and tyypically have been obsessed with dieting for as long as I can remember. I keep active, have done fun runs and last year won the national 6 hr endurance motorcycle racing championship (knackering) and consider myself to be cardiovascularly fit. Alas my BMI remains "obese".

It's doctors (to be) like you that alienate patients who genuinely struggle to lose weight and thus don't come to see us anymore for fear of a lecture.

It's my job to advise patients not live their lives for them. I suggest you use a step ladder to get down from your high horse there.
* Thomas Caldwell | 26 Nov 10

Dr Arfeen seems to have perhaps strayed away from the aims of this blog with his second entry. I thought this blog was designed as a voice box for the concerns and interests of registrars as they proceed through there registrar year. Perhaps my experience was very unusual but, as a registrar, high on my list of concerns was not my collegues waistlines. The more pressing concerns of the AKT, CSA, getting to 10 minute consultations, completing my OOH comitments, balancing my family life with 3 children and my wife working as a GP locum all were things that would have been higher on this list. Perhaps this blog would be better advised to ask what registrars concerns are nationally rather than give a sounding box to a small group of London-based registrars. I think this blog could be a very useful resource for a large number of registrars. I hope the bloggers are able to rise to this challenge. I apologise unreservedly if I have misunderstood the aims of this blog.
* manmohan singh | 27 Nov 10

We GPs don't get time to look after ourselves. It's donkey work. I joined the gym recently after working in the NHS for eight yrs. We should learn from our patients who come to our surgery everyday for nothing. if their life is important, ours too.
* jimmy paul | 27 Nov 10

Dear Dr Afreen May I detail the chronology of public health hazards since the days of professor of surgery(1947) 1) introduction of oral contraceptives based on steroid hormones in the sixties 2) widespread use of chemicals/plastics in everyday life 3) artificial feeding of animals and thereby introduction of ' chemicals' in our foot chain 4) longer GP hours and stress with forever changing modern medicine 5) we overweight and obese GPs admit that we may not leave long after our retirement, but we will not be burdening the next generation with dementia and social care costs. We are happy. leave us alone. Just like our patients will try to control our destiny. We don't need a lecture from tabloids and their cronies!!
* Bapi Biswas | 28 Nov 10

I'm not sure what you base this on? I suspect the BMIs of GPs will have a normal distribution, like the rest of the population. Is a BMI of 28 really that unhealthy? I'm afraid, this own't change. To take this too it's logical conclusion GPs would all have to fit the following; 1. BMI of 19-26 2. Non smokers 3. Non drinkers 4. White (remember some ethnic minorities have ahigher rate of CV disease) 5. A JBS rink of 10% or less 6. Eat 5 protions of fruit and veg a day I'd better resign soon.
* susanne stevens | 28 Nov 10

Well said Hazel! Of course Sayed has a point but does he really think people do not comment on overweight healthworkers! It is not a case of being 'so fond' of them (he wishes) but of being too polite and more worldlywise perhaps. We all know healthworkers are the same as everybody else, some fat some thin and all inbetween. Those with all too human foibles are often liked more than the obssessives with their never ending lectures and critical eyes. Plenty of healthworkers can be seen having a fag break outside the premises by the way (horrors) !! They attract the same kind of comments as overweight ones, usually good humoured, understanding of human differences.
* Rosie Posy | 28 Nov 10

Surely stress adds to the problem of obesity and I am sure many GPs are stressed out. It is sedentary. I think it makes it harder for GPs to advise about weight loss if they themselves are obese as patients are less inclined to take their advice.
* Kev | 28 Nov 10

Pies are better than patients!!!!
* anon - london | 28 Nov 10

thats because in gp your sitting at office and computer all day long- or driving around, its mostly a sedentary based job with long working hours. but as you've chosen a career in gp enjoy your growing waistline.
* Karl Bennett - Blackwater | 29 Nov 10

Was your observation based on a representative sample? Or do a greater proportion of GPs with an interest in paediatrics have a soft spot for chocolate cakes covered in Smarties?
* Simon Ruffle - Twyford | 29 Nov 10

'I don’t suppose I will make many friends with this' Therefore - shut up!

Insight is a wonderful thing, most of us experienced GPs have it in abundance just like our waistlines - or coastline in my case! As an overweight GP I have empathy for my fat patients and huge enormous insight into the irony of the 'do as I say' process that I have to go through with them. Struggling to lose weight is the right wording for most of us gut-buckets. Dr Arfeen a word of advice from the adipose world - WE KNOW - don't be dissappointed on our behalf, live with it, stay slim and sanctimonious but I would hazard a lipomatous guess that my lardies feel better and more comforted by my consultation, empathy and encouragement than by a 20 BMI'er whose never had a weight issue.
* Sue Martin - uppermill | 29 Nov 10

It's because (as I've said many times before) it's not ignorance that causes obesity, but other psychological/c or other factors working at a chemical level. I am overweight because I like food and I feel like eating all the time. If I could control it I would be slim. Speak to anyone involved in weight loss and they will tell you that 3 months of dieting is usually the sticking point - then old habits tend to start returning and that is because they are often not easily controlled by the conscious mind.
* simon gilbert | 29 Nov 10

I think Dr Arfeen's post and the various responses are useful as they illustrate how difficult it is for some people to lose and maintain a healthy weight, even if they are fully aware of diet, exercise etc.

I suspect I'm not the only GP who feels impotent when an obese patient asks for help having gained weight on dietary modification / excercise / orlistat. Weight loss surgery is certainly a better option than in the past but there is a pressing need to develop effective non surgical interventions for obese individuals who truly wish to lose weight.
* Louisa Shillito | 29 Nov 10

I have a normal BMI, and I actually find it quite hard to advise patients on weight management. I get a lot of 'you have no idea how hard it is' looks. It's easy for me to demonstrate that if you don't eat too much and move a bit, and you happen to have OK genes, you stay thin. It's harder to advise how to lose weight once it's gained.
* naseer nuaman - Dartford | 29 Nov 10

In 1947 no TV , you would use your legs for transport,and eat Less Chocolate ! Obesity is an world wide epidemic, as result of comfort society & life style ! I agree we should look after ourselves better !
* Burntout GP | 30 Nov 10

Ever thought that putting your head above the parapet can be dangerous. Dont forget even GPs can have big bones and gland problems..................
* Anonymous | 30 Nov 10

I think Dr Arfeen makes a very valid point in his artilcle. You must practice what you preach.
* C M | 30 Nov 10

Clearly mixed views on this article. I don't think I'm alone in doing a working of 12-13 hour days four days of the week and one 9 hour day. This does leave little time for all important exercise and taking care of oneself. Perhaps Dr Arfeen's article would have been better written if it focussed on how GPs should be looking after themselves.
* Not a GP but work in the NHS | 01 Dec 10

In response CM on health professionals looking after ourselves - I agree - we're often not so good at this... I have found the articles and books of Susan Kersley, retired doctor writing about change for doctors to be a really interesting and thought-provoking read (She had some columns in the BMJ some years ago). After all, we need to look after the people who look after the people...
* Rob Findlay | 01 Dec 10

If eating less and exercising more was the answer, then losing weight would be easy! Perhaps the "mantra" is not all it's cracked up to be, as argued here: (warning: it's a heavy read) http://www.amazon.co.uk/Diet-Delusion-Gary-Taubes/dp/0091924286/ref...
* Anon | 01 Dec 10

Well done Dr Arfeen for bringing this topic up, hopefully it will make us doctors think twice when we're dishing out the usual healthy lifestyle advice.

That's not to say that there's a lot more to losing weight than the old input>output theory.
* David Grieve - Tiverton | 01 Dec 10

I agree well said Dr Arfeen. You have courage. For years I advised my patients to go to Slimming World. Best way to lose weight I believe. This year I followed my own advice and have lost 2½ stones plus. BMI down from 30 to 25. Feel a lot better. Have been walking much more. Golf several times a week. Yes you've guessed it. I retired last year.
* cheeta - liverpool | 01 Dec 10

I found the article and the discussion interesting. I think Arfeen has a point. We have a duty to maintain good health in spite of a busy lifestyle - just as we advise our patients to do so.
* Michele Cameron | 02 Dec 10

This is actually a serious problem and it seems to me that none of us really understand all the issues as even the active fit can be fat as described above but the comments of 'burntout GP' made me chuckle.
* Dr Ben Sinclair- York | 02 Dec 10

This has hit a nerve. Dr Arfeen may be insensitive, have a lucky slim bodytype and may have not yet experienced the watershed of metabolic slowdown at 30. He still has more time as a registrar and less responsibility than a GP.

However he is correct to challenge us on our example. It's not hard to diagnose obesity.

None of us like to face up to the challenge of maintaining our weight alongside pressures of an intense work schedule with little time for self care and endless patient demands.

We are victims of the lifestyle we have chosen and is thrust upon us; but also victims of our own lack of discipline with extra calories from back room biscuits and cakes and hidden calories in alcohol.

It's hard for doctors to see themselves as needing maintenance but we are no different from all hardworking humans and need to allow for our own needs - if we are obese we are likely not to see retirement let alone retire with the way pension ages are going!
* Jennifer Corbridge - Bradford | 02 Dec 10

When I started in practise, many moons ago, we did morning surgery and visits, then went home for 4 hours to walk the dog, do the garden etc. then went back to do evening surgery until 7pm. Post Kenneth Clarke and his clinics, targets etc, we now all work through the day and no longer get this precious time in the afternoon to exercise in. Add in all the stress and you get fat doctors. Having said this, as a fairly thin GP I get the 'it's allright for you' response from the patients who I advise about weight control.
* D Wilkins - Eastleigh | 02 Dec 10

As an active cardiovascularly fit but overweight GP I actually have a much better success rate amongst my weight loss patients than my slim colleagues. The empathy and 'we're all in it together' approach works well for me. I worry that sanctimonious, judgmental and dictatorial views on any aspect of human nature/medical care - obesity, smoking, alcohol, abortion for example, will alienate patients and do more harm to the cause than good... Has Dr Arfeen considered a surgical career... he seems more suited.
* Nigel Dickson | 03 Dec 10

Nature and nurture obviously play a huge role in what we eat but as the late Claire Raynor said that was then this is now. We are what we eat. The exercise thing is controversal - the advocates say you can eat what you like so long as you exercise - but who has the time? Better to eat less. Love the sanctamonious slurs of some of replies - hiding authors' unhappiness - lot of my very overweight folk have sad histories when they eventually share such things. The idea that fat folk are jolly is as much a myth as this diet and that diet - at end of day if you eat less than your body needs you lose weight if you eat more than you need you get fatter - what's emotive about that? -"Firm but Fair" brilliant marketing catchphrase that - do Tories still use the Satchii brothers for these things? Nearly as good as "robbing the poor to pay the rich"
* Sara Caine | 03 Dec 10

I agree wholeheartedly with the views of those who point out that life as a GP has changed dramatically and that we have very little time for exercise. I used to walk my dog two or three times each day and now as a full-time GP can barely manage time to walk to and from my car between jobs. I spend many hours sitting at a desk and many more driving each week. I have just managed to work three sessions of exercise into my week - but only by virtue of not actually going home from work and therefore not seeing my family or eating with my children three evenings a week - which I don't feel sets a very good example, frankly.
* Darwisha Al-kalai Shanks | 03 Dec 10

The bottom line, not enough exercise, too much food and too much drink. no one is born obese. get on your bike and cut down the calories all we need one hour in the gem 3 x a week. most of us can manage it but we choose not to.
* Munkler | 03 Dec 10

I think folk are being a bit harsh on Dr Arfeen. Calling a trainee sanctimonious, go and be an ortho etc is likely to shut them up for good, not a good way to enourage enquiry and debate. Perhaps a useful lesson though as it seems to be prerequisite that GPs must be politically correct or risk upsetting someone.
* Elizabeth Howard | 03 Dec 10

I might have been born obese 9lb 11oz, my brother 10lb 11oz(caesarian).
* Karen Guttridge | 04 Dec 10

Everyone knows that to lose weight you need to eat less and exercise more yet only one in every 100 people who commits to a diet (and exercise programme) succeeds in losing weight permanently. Diets tell us what to eat and when, but they don't take into account that food is a coping mechanism and a calming device used to manage the stresses and strains of life. We don't overeat because we lack willpower, we overeat because we're not willing to let go of the comfort that food provides. The good news is that this is a learned response and thus has the potential to be addressed. Whilst I can appreciate the comfort derived from shared empathy between a patient and an overweight GP or a slimming club leader (for whom having suffered a weight problem is a pre-requisite of acceptance in the position) we have to acknowledge that ultimately this is counterproductive. In all areas of life we naturally learn best from someone who already knows how to do something. In the case of our weight this means learning from someone who knows how to manage weight effectively - year upon year. Learning to model the habits and behaviours of slim people when faced with life's inevitable stresses and challenges is key to weight management.
* M S | 04 Dec 10

Interesting article. As for the old adadge of 'Do as I say, not as I do' works in medicine, in my opinion. My understanding is a GP is a lifestyle coach for patients and as in sports the coach is not usually the fittest or the best player at the time he is coaching. He would have been in the past but as a coach the player are there to do as he says. As for advising patients, me being heavy makes it very easy to advise patients and show an empathy of what they are going through. And losing weight is not as easy as a simple medial advise makes it sound, in my opinion.
* Anita Reddy - Sheffield | 05 Dec 10

I actually don't know that many overweight GPs and think Dr Arfreen has not chosen an appropriately representative sample. Either way the fact remains that GPs are no different from other human beings and some people have more difficulty in managing their weight than others, which is just a fact of life, whatever the reasons may be.
* A.A Chukwunenye | 06 Dec 10

we shouldn't miss the point here - practise what we tell our patients, no matter how hard it is. I myself having been struggling with weight gain, hence i see this as a wake up call from someone who loves his colleagues bearing in mind all the problems associated with weight gain: 'PHYSICIAN HEAL THY SELF'.
* mary rogan | 07 Dec 10

As an overweight GP for years, I have tackled my problem and weigh 3 stone less than I did a year ago. I find it easier now to advise my patients to lose weight, and can say, hand on heart , that I understand how difficult it is. Remember its OKto put your own health first, in fact it's essential.