Legal duty to ID obesity

3 minute read

Telling a patient they’re overweight is not fat-shaming if it is done sensitively and without blame


Telling a patient they’re overweight is not fat-shaming if it is done sensitively and without blame

As if broaching the topic of weight isn’t sensitive enough, doctors face the threat of medico-legal action if they don’t do enough to help patients lose weight.

The duty of care in managing obese patients was highlighted by the case of a GP who was sued after his morbidly obese patient developed liver cancer, likely caused by non-alcoholic steato-hepatitis.

Initially, the GP was ordered to pay $364,000 in compensation for failing to refer the patient to a bariatric surgeon or an obesity clinic.

Although that decision was eventually overturned on the basis the patient had chosen to ignore the doctor’s advice, the case confirmed that GPs do have a responsibility to identify and counsel their obese patients.

In response to the case, medical defence organisation, Avant, recently published clinical recommendations that emphasise GPs’ duty of care.

GPs had a responsibility to advise and counsel obese patients in “unequivocal terms” that weight loss was necessary for their health, wrote Avant’s head of disciplinary proceedings, Dr Harry McCay, and medical advisor Dr Kelly Nickels. These discussions must also be recorded.

Making weight, height, hip and waist measurements a regular part of the consultation could help GPs initiate discussions and reduced discomfort, they said.

Professor Mark Harris, director of the Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, agreed, saying that active management of obesity was a responsibility and “not just optional”.

Despite fears that raising the topic could be detrimental to the doctor-patient relationship, Professor Harris said there was “not a shred of evidence” for this, if it was done in a non-judgmental and non-blaming way.

“Even if that is really the case and we had a patient who really didn’t want to talk about it, we wouldn’t accept that with tobacco we don’t accept that with high blood sugar, so why would we accept that with obesity?” he said.

But his own research had found only a third of obese patients who visited their GP had discussed weight, diet or physical activity in the previous three months.

“Doctors have an obligation to inform patients about the risks associated with obesity, agree with patients on what action if any to take, provide support, refer if appropriate and follow up,” he said.

“Most obese patients have felt stigmatised and discriminated against in their work and social network. It is important that this is not made worse by health professionals,” said Professor Harris, who said he would avoid terms such as obesity that were stigmatising in the non-medical community.

NHMRC guidelines emphasise the need to refer patients with a BMI of 40 or more, or 35 with comorbidities, for interventions such as weight loss medication or bariatric surgery.

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