Would you accept dietary advice from a plump physician or a full-bodied nurse? There are certainly plenty to choose from. According to a Royal College of Physicians’ estimate, 700,000 NHS employees are obese.1 How can patients be expected to eat less and move more if those dishing out the advice are sitting down all day and picking at the crisps? It’s the pot calling the kettle fat.
Those who make a living advising others on how to live their lives are always open to charges of hypocrisy. ‘Do as I say, not as I do’ worked 50 years ago but we’re less likely to swallow it now. Medicine is a stressful job, and doctors have always had high levels of addiction and depression. Mental illness can be hidden behind the shield of professional status, extra-strong mints can mask the whiff of cigarettes and vodka—but obesity is impossible to hide.
Far more important than the size of a doctor, though, is their bedside manner. I’ve met pencil-thin consultants who have been very cruel to overweight patients. One used to tell them, ‘There were no fat people in Belsen.’ Another would poke them in the stomach and say, ‘I can’t operate on you, you’re too fat.’ A gynaecologist tried to operate on a very large woman, failed, and wrote to the GP: ‘I am unable to perform this procedure without the aid of a miner’s lamp and a canary.’
Conversely, I know GPs and nurses who struggle with their weight, and patients love them for it because they can share the experience of how hard it is to lose it. We’re encouraged to tell patients when they’re overweight, but most people know perfectly well already. The manner in which you discuss weight issues is crucial; overweight people can have very low self-esteem, and labelling them as ‘morbidly obese’ hardly helps. I much prefer ‘morbidly voluptuous’.
Perhaps patients can help us by taking a couple of skipping ropes into the next consultation and challenging us to a ‘skip-off’. It’ll be the funniest and healthiest 10 minutes we’ll ever spend together. The secret of exercise is not to do it in occasional half-hour blocks down the gym, but to build it into the everyday. Make doctors and patients fitness buddies, and do 50 squat thrusts together. Far healthier than sitting glumly either side of a computer, playing guess the diagnosis (though you might want to run it past the GMC first).
It’s ironic that the NHS should have such high levels of staff stress and sickness. Some hospitals at least are leading the way on obesity by sourcing healthy, local produce for both patients and staff, cutting down on sugar and saturated fats, and cutting out trans fats. And next time you want to thank the wonderful nurses, don’t buy them chocolates—take them celery sticks instead. This would be a huge culture shift (in my experience, nurses guard their gifted chocolates like Gollum and his ring) but in time, they’ll thank you for it.
I know a trauma surgeon who weighed in at 27 stone. He saved the lives of countless other people but his extraordinary dedication to his job put his own life at risk. He lost 11 stone after gastric-band surgery and is now cycling, kayaking, and competing in triathlons. And working less hard. If you work very long hours in an ‘all-or-nothing’ job that leaves you no time to exercise, and you fill up with comfort food, you can easily end up very large. Far from being lazy, most of the seriously overweight NHS staff I know are compassionate workaholics. Their dedication to the job and lack of a work–life balance is at the heart of their predicament, and the solution is not just about healthy eating and cycle routes round the hospital, but humane and happy working conditions. And happy, healthy staff are vital for happy, healthy patients.
Information on Phil’s new tour, ‘Games to play with your doctor’, is available at: www.drphilhammond.com
- Royal College of Physicians. Action on obesity: comprehensive care for all. Report of a working party. London: RCP, 2013. Available at: www.rcplondon.ac.uk/sites/default/files/action-on-obesity.pdf G