Content area
Full Text
Conversations about obesity need to be realistic and informed
In response to the Ewald et al article 'Quantifying the benefits and harms of various preventive health activities' (AJGP December 2018),1 we would like to comment on the benefits and harms attributed to weight loss. Tools to aid discussion about preventive health activities are welcome. But while the article provides useful information for health service prioritisation, it is of limited assistance for discussing individual risk with patients as risk is presented as a population-based statistic.
It is always important to set realistic goals with patients. While 40.9% of the eligible population participated in bowel screening in 2015-2016,2 the annual probability of 5% weight loss (approximately 2 kg/m2) is 12.5% for people with a body mass index (BMI) 35-39.9 kg/m2.3 This weight loss is far less than the five-point BMI reduction that is mentioned in Table 1. The article is potentially advocating for unrealistic weight outcomes for patients living with obesity.
The article also does not discuss the differences in treatment burden for the proposed preventive activities. For example, attending to bowel cancer screening is much less burdensome for patients than weight loss treatments.
Table 1 does not provide any examples of harm from weight loss despite a large body of literature describing the experience of harm in family interventions, workplace interventions,4 and post-bariatric surgery.5 Harms can be related to stigmatisation,4 side effects from medications,6 through to life-threatening harms including suicidality and selfharm.5 No treatment is without potential side effects or adverse events and patients must be informed of these when making decisions about care. And these harms are likely to be mediated in positive and negative ways as a consequence of the patient's particular life circumstances.
We advocate for obesity risk to be kept in perspective with other harms, for realistic and context-orientated goals to be set with patients,7 and for potential harms from weight loss management to be always visible.
Elizabeth Sturgiss
Senior Lecturer, Department of General Practice,...