Medical Matters: Obesity: a sin or a disease? "Jaysus have you ever had this thing serviced, it can't be right."
I am well used to adverse comments about my weighing scales positioned at the entrance to my consulting room. I bought it for ante-natal care but patients use it as a service.
On their way out many people, always large, step on to it and utter a sigh or a complaint. By and large, fat people know they are fat and find it hard to shed weight.
Some ask for medication and most do not find it works. Weight watchers seems to be the best bet in my neck of the woods.
Recent studies in the British Journal of General Practice show that even moderately obese people receive many more prescriptions from the doctor when compared with thinnish people.
The statins or cholesterol-lowering drugs are 20 times more likely to be prescribed followed by anti-diabetic and blood pressure lowering agents.
Poly pharmacy or multiple drugs are also much more common in obese patients. The more drugs, the more likely the side effects. Interestingly, in the study the obese were not more likely to be prescribed antidepressants.
Being obese leads to a host of medical problems. Every self-respecting government in the western world has a policy or a taskforce on obesity, all saying the same things.
Predictable reality television gets involved in what is the modern day circus of reporting on a morbidly obese person undergoing radical surgery and consequent weight loss.
When GPs were asked about their approach to obesity they seemed not to have heard the governments' recommendations. They didn't want to offend the patient by bringing it up.
How do you bring it up? Say an obese person is coming in for treatment of a chest infection, does the GP say "listen we need to talk about your weight"?
It gets worse. GPs actually don't think anything works for obesity. The pharmaceutical industry is rubbing its corporate hands in glee at the opportunities presented by obesity. If only they could get the GPs to believe in their products.
Dieticians, in general, don't want clinics of overweight people as they attend once or twice and give up. GPs don't refer obese people to psychology or counselling as they don't believe they work well either.
When the researchers dug deeper they came up with what is perhaps the real reason for GPs' resistance to managing obesity. It is because they see it as they patient's responsibility and not theirs. "He was looking at what I was going to do about his weight rather than what he was going to have to do about it," said one GP.
GPs described a lack of insight: "What I feel is almost a classic response from women who want to lose weight, but are big, is the sort of 'but I only eat a lettuce leaf' approach."
When they dug deeper, GPs tried to locate the problem in the context of patients' lives - "they've got problems of housing, marriage, children, money, so they've got other sorts of problems". Giving a weight-reducing tablet for such problems is a bit naive and misleading.
GPs manage eating disorders and gross obesity differently and appropriately, but the run-of-the-mill obesity that affects nearly one-third of the population is a different matter. If we take on such obesity we have made another disease for ourselves when we struggle to cope with the diseases we already know such as asthma, diabetes and hypertension.
The food industry has been inventive in getting us all to eat more than is good for us. It has effectively removed the association of cooking from eating for many people. It is ironic that kitchens sell houses and that people spend fortunes on kitchens they will hardly use.
Eating is loaded with all kinds of symbolism. I feel sorriest for children who are given access to all kinds of obesogenic foods as a sign of parental care and love. Other kids taunt their resulting obesity and they may avoid sporting activities that aggravates their weight.
The reality for us doctors is that patients seem to opt for the pleasures of food and alcohol and seem willing to forgo the sensible diet and longer healthier lives. The other reality is that we cannot be judgmental when they come along asking to be repaired from the excesses of such a pleasurable life. Sin does lead to disease after all.
• Tom O'Dowd is professor of primary care and public health at Trinity College Dublin and a practising GP.