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Australian of the Year and body positivity advocate Taryn Brumfitt is calling for GPs to avoid discussing a patient’s weight during standard consultations.
“Weight bias is the last remaining legal form of discrimination,” she said.
Australian of the Year Taryn Brumfitt is calling out the impacts of weight bias in healthcare settings.Credit: Alex Ellinghausen
“Many people in larger bodies tell us they have gone to the doctor with something like a sore knee, and come out with a ‘prescription’ for a very restrictive diet, and no ongoing support,” Brumfitt said.
“When people are made to feel this sort of shame about their bodies and their weight, the main behaviour they change is that they stop engaging with healthcare altogether.”
Her comments come after a US-based study released last week found a higher body mass index is not associated with early death in people who were otherwise healthy, adding to the debate that BMI alone is not a reliable indicator of a person’s health.
The study found being overweight, but not obese, did not lead to a significant increase in the risk of death for younger adults, while those aged over 65 faced no increased risk for being overweight or slightly obese.
Obese adults under 65, on the other hand, had a 21 to 108 per cent increased mortality risk attributed to their weight.
The study’s findings have also reignited concerns for body positivity advocates about the pervasiveness of weight stigma in healthcare settings.
Brumfitt said GPs did not have enough training and experience to have complex conversations about food, nutrition, movement and other health behaviours, and a standard consultation wasn’t long enough to support sustainable behaviour change.
“In a 15-minute appointment, there isn’t the time to go into the kind of detail required to support sustainable behaviour change,” she said.
A recent Monash University study that interviewed 30 medical and allied health professionals found 43 per cent of health professionals were sceptical of the body positivity movement.
While more than half agreed social media movements about body image were relevant to practice and patients, two-thirds didn’t discuss these movements in consultations.
Study senior lead Associate Professor Gemma Sharp, who also leads Monash University’s Body Image & Eating Disorders Research Group, said GPs were taught to use “opportunistic intervention” to discuss weight in over and underweight patients.
“Every patient I’ve ever spoken to has had this happen to them at one time or another,” she said.
“If, every time a person comes in, the GP wants to discuss weight issues or body image, that’s likely to be a barrier to communications.”
The issue, she said, is doctors focused on diets and exercise instead of body image, drivers of disordered eating, nutrition and different options for managing weight.
Sharp acknowledged that GPs were increasingly pressed for time, but said the lack of early intervention was putting pressure on metabolic and eating disorder clinics.
“If we upskill GPs on managing some of these disorders themselves, it may not have to be such specialised care [down the line],” she said.
A new study at the university is assessing GP knowledge gaps.
“What we’re trying to do is teach GPs to speak in holistic and sensitive ways such that patients are more receptive to the message.”
Australian healthcare students also hold both implicit and explicit weight bias. A study released in March surveying 900 university healthcare students found they had a “fear of fat”, disliked obese or overweight people and believed obesity was within a person’s control.
Two in three Australian adults are overweight or obese, while 12 per cent live with severe obesity, according to the Australian Institute of Health and Welfare.
Royal Australian College of General Practitioners vice president Dr Bruce Willett said medical professionals had to acknowledge the types of implicit and explicit bias they brought into their jobs, be aware of them and move on.
“If, every time a person comes in, the GP wants to discuss weight issues or body image, then that’s actually likely to be a barrier to communications,” he said.
“If you try and force that discussion, when someone’s not ready to have it, you’ll actually go backwards.”
He said while GPs should approach weight from a medical point of view, he found discussing societal factors useful with patients.
“Being quite overweight is one of the highest levels of discrimination in our society,” he said.
“Acknowledging that with patients because they’ve already experienced it, and getting it out in the open, actually helps the discussion.”
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