Every day, patients come to Dr Michael Apple's surgery to discuss their weight. He explains what your GP can do to help.
"Mostly, patients who come to my surgery to talk about their weight complain that it's affecting their quality of life. Excess weight can make people tired. But it can also cause or worsen more serious health problems, such as arthritis, diabetes, high blood pressure and high cholesterol.
"In women, obesity can cause irregular periods; in men it can cause erectile dysfunction and impotence. In both sexes, it shortens life expectancy.
"I'm always happy to discuss weight issues, and to offer advice on what can be done to lose excess weight.
What is your BMI?
"First I check my patient's height and weight, to calculate their body mass index, or BMI (see BMI calculator below). BMI is not a perfect guide to healthy weight. For instance, it can label some muscular people overweight. But it is generally useful.
"People with a BMI above 25 are overweight, while anyone above 30 is obese. A BMI above 35 signals an even more serious weight problem, in which health implications are likely.
"I check the heart and lungs, and feel the belly: any abnormal growths can cause weight gain and I’ve even detected an unexpected pregnancy. I will also often do blood tests, as liver and kidney problems cause fluid retention and an underactive thyroid gland leads to tiredness and weight gain.
"I’ll review any medication the patient is taking, because some can affect weight or appetite.
Diet and exercise
"In most cases, though, excess weight is caused by too much food and too little physical activity. I’ll talk about lifestyle, because overeating can be a comfort activity for people who are depressed, stressed or just bored.
"The calories in alcohol add up, too. I’ll discuss exercise, which doesn’t have to be a Lycra-clad workout at the gym. It can simply mean walking for 30 minutes a day, getting off the bus one stop earlier or walking up stairs rather than taking the lift.
"I tell people that they don’t have to be greedy to be overweight. Just a couple of hundred unnecessary calories a day over several years will do it: for instance, two chocolate biscuits and a cup of sugared tea combined with a sedentary job. As for fat genes, that seems to affect very few people.
"Lastly, a nurse will work out a target weight for the patient, and a sensible timescale in which to achieve that. If a patient can steadily lose 250-500g (half to one pound) a week, that’s 12½-25kg (two to four stone) in a year.
"I highly recommend dieting groups such as WeightWatchers. There’s something about group weighing that concentrates the mind.
Obesity treatments
"Medication is available for people with a BMI above 30. Xenical (orlistat), combined with a healthy diet, can help with weight loss.
"There is also surgery such as stomach banding, which reduces the amount of food that the stomach can hold, or, infrequently, removing part of the intestines to reduce the absorption of food. Like other GPs, I can refer people to specialist centres for this if their BMI is above 40, or under certain other circumstances.
"Overweight children need specialist help, so I refer them to hospital dietitians. Some parts of the country have exercise programmes to which your GP can refer you."
