The Doctor’s Essential Role in Weight Loss

The doctor plays a crucial and multifaceted role in addressing weight loss, drawing on various skills and knowledge.

Key aspects of the doctor’s essential role in weight loss include:

• Identification of patients at risk and assessment: Doctors are essential in identifying individuals who are overweight or obese and are at risk of associated health problems. This often involves calculating Body Mass Index (BMI), as mentioned in the context of bariatric surgery and orlistat use, and using screening tools like the Malnutrition Universal Screening Tool (MUST) to identify malnutrition risk, which can coexist with overweight or obesity. A thorough history, including dietary patterns, exercise habits, and family history, is crucial. They also need to assess for any underlying metabolic stress or micronutrient deficiencies.
• Providing guidance on lifestyle modifications: Doctors play a key role in recommending and encouraging lifestyle changes as the first-line therapy for most overweight and obese individuals. This includes advice on reducing calorie intake, adopting a balanced diet rich in fruits, vegetables, and whole grains, and increasing physical activity. They should help patients understand the principles of energy intake and expenditure. Doctors should also counsel patients on reducing salt and fat intake and advise against using tobacco.
• Setting realistic goals and providing support: Doctors should establish realistic weight loss aims with their patients, such as a 10% reduction in weight. Constant supervision and encouragement, either directly or through referrals to support groups like slimming clubs, can help with compliance. They should also explore the patient’s motivation and potential barriers to making healthy lifestyle changes and consider referrals to other healthcare professionals like social workers or psychologists to overcome these hurdles.
• Considering pharmacological interventions: Doctors can consider drug therapy as an adjunct to dietary regimens in the short term for weight loss. Orlistat, a pancreatic lipase inhibitor, is a licensed drug for weight loss in the UK for individuals with a BMI over 30 kg/m². However, doctors need to monitor for potential side effects and vitamin deficiencies. They must also be aware that anti-obesity drugs have had limited long-term success and that lifestyle modification remains paramount.
• Evaluating the role of bariatric surgery: For morbid obesity, doctors need to be aware of bariatric surgical procedures as a potential intervention. They should understand the different types of procedures, their effectiveness in achieving and maintaining weight loss, and the associated improvements in comorbidities. Referral to specialist obesity services is important, and this should involve a multidisciplinary approach, not solely focusing on surgery. Doctors also need to advise women to delay pregnancy for at least a year after significant weight loss following bariatric surgery.
• Referring to other healthcare professionals: Doctors often work as part of a multidisciplinary team to support weight loss. They play a crucial role in referring patients to dietitians for thorough nutritional assessments and personalized dietary recommendations. Referral to psychologists or other mental health professionals may be necessary to address psychological factors that contribute to or are affected by weight issues. Exercise physiologists can also provide guidance on physical activity.
• Addressing the broader context: Doctors should consider the social determinants of health that can influence weight, such as access to healthy food and opportunities for physical activity. They also need to be sensitive to individual and cultural preferences when recommending dietary changes.
• Long-term management and prevention: Doctors have a role in long-term monitoring of patients’ weight and related health conditions. They should also emphasize the importance of preventing overweight and obesity, especially in children and adolescents, through public health campaigns, education, and promoting healthy lifestyles.

Considering underlying medical conditions: Doctors must consider if weight loss or gain is related to other underlying medical conditions, such as thyroid disease, or the metabolic syndrome. They also need to be aware that certain medications can affect weight. In cases of unexplained weight loss, doctors should conduct appropriate investigations to rule out serious conditions like malignancy.