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Healthy living: practise what you preach?

Research suggests that patients are less likely to accept weight-loss advice from an overweight or obese health practitioner. So should we be taking more of our own advice as a profession, or is it more complex than that?

In the spring of 2013, alarming reports appeared in the press of a health crisis in the NHS. ‘Half of the NHS workforce is obese,’ claimed the Royal College of Physicians (RCP, 2013). Soul-searching opinion pieces followed on the state of our health service and the nation’s health.

Dig a little deeper and the picture is not so simple. The RCP was quoting from a Department of Health report which concluded that of 1.2 million NHS workers, about 300,000 were likely to be obese and a further 400,000 overweight, meaning about 58% of the workforce are either overweight or obese (Cross-Government Obesity Unit, 2009). Unsurprisingly, this reflects the weight of the UK population: in England, nearly 62% of adults are overweight or obese, in Scotland 65%, 59% in Wales and 60% in Northern Ireland (Department of Health, 2016; NHS Digital, 2015; Scottish Government, 2015; Welsh Government, 2015).

So all we’ve learned is that the healthcare workforce reflects the general population. And that working in healthcare settings isn’t always conducive to a healthy lifestyle. As Tam Fry, chairman and spokesperson for the National Obesity Forum, says: ‘Healthcare professionals are often required to work ridiculous hours. They snack and they are unconscious of the number of calories they’re eating. That doesn’t absolve them, but it’s a fact of life for them.’


On the front line

A member of a Nottinghamshire health visiting team gives her view:

‘I have a colleague in the school health team who presents as obese. She is also the lead on the healthy eating project. One parent said she had left the session because she felt patronised by a larger person telling her how to manage her daughter’s weight when “she clearly can’t manage her own”.

‘I could do with losing a stone or two! I generally use the excuse of being the wrong side of 40 and having two children under the age of five. I’m often exhausted by the time I get home so reach for convenience over healthy food. Working in the community, lunch breaks often get missed, and long hours mean grabbing food when you can. Long periods are spent typing up records, and there is always a tin of biscuits or a box of chocolates at work, which doesn’t help.

‘I think the overall appearance of health professionals is important – not just weight but hair, clothing and cleanliness. It’s important to look like you have made an effort yourself, before you help people to change their own approach to life.’


Difficult dynamic

From a public health perspective, however, this gives rise to a potentially tricky dynamic between health workers and patients, notably when overweight and obese health workers try to help patients struggling with weight issues. ‘Patients might assume, rightly or wrongly, that health professionals would know enough about the problems to keep themselves in check,’ Tam says.

Fiona McQueen, Scotland’s chief nursing officer, agrees: ‘[People think] “How can a nurse who’s very overweight advise me to lose weight?”’

This is the crux of the issue. Are patients less likely to heed the advice of an overweight health professional? There’s evidence to suggest that they are.

In 2014, a Royal Society for Public Health (RSPH) survey of 2100 people found that 41% would be reluctant to take advice on diet and exercise from an overweight or obese healthcare professional, compared with 17% who would. 

In another study, former mental health nurse and psychology student Helen McDowall found that people are less likely to believe or act on healthy lifestyle advice from an overweight health professional (Stephenson, 2017).

Research suggests that healthcare professionals are aware of the issue. The RSPH also surveyed 103 people working in public health: more than 80% said they believe that practising what you preach is particularly important for the public to trust you on maintaining a healthy weight.

A US study showed that doctors felt overweight or obese patients were less likely to trust weight-loss advice from overweight or obese GPs. Overweight or obese doctors were also less likely to engage their patient in weight loss discussion in the first place (Bleich et al, 2012). 

So how does this affect health workers’ interactions with patients? Fiona Sim, a GP who has designed training for healthcare professionals on talking about healthy weight to patients at Imperial College London, says: ‘It’s not in anybody’s interest to start stigmatising people. The most important thing is to ensure health professionals are trained and comfortable raising the subject of healthy weight.’

She adds: ‘Obviously there’s the issue of “What gives an overweight or obese health professional the right to preach to me?” But the other side of the coin is that health workers who find the subject of weight difficult can very often empathise with people who are also struggling.’

 

Changing lives

Fiona reports that, anecdotally, training in raising weight issues with patients has a positive impact on health workers’ own lifestyle. ‘A lot of people that have gone through our training say it’s made a difference to their own eating and lifestyle, and to that of their families,’ she says.

Others believe that employers should make it easier for practitioners to stay healthy. The RCP, for example, said in its Action on obesity report (2013): ‘Workplace health and wellbeing should be placed high on the agendas of NHS trusts’ and ‘Staff wellbeing and health should become embedded within the culture of the NHS’.

There are various healthy weight initiatives to help people working in the NHS. For instance, clinical commissioning groups in England are empowered to commission staff health and wellbeing services under the Commissioning for Quality and Innovation payments framework. NHS Wales has a charter outlining the expectation that all its employers will plan services and staffing to take account of staff’s health and wellbeing. NHS Scotland’s Safe and Well at Work framework sets out how health boards should approach occupational health and safety. And in Northern Ireland, each of the six health trusts has its own policy for staff health and wellbeing.

These initiatives and frameworks are no doubt changing the lives of individual NHS workers across the country. How effective in the long term these initiatives will be while the UK’s obesity epidemic worsens, however, has yet to be seen. Healthcare professionals are themselves part of the country’s health landscape – they are human, after all. 

 

Resources


References

Bleich SN, Bennett WL, Gudzune KA, Cooper LA. (2012) Impact of physician BMI on obesity care and beliefs. Obesity 20(5): 999-1005.  

Cross-Government Obesity Unit. (2009) Healthy weight, healthy lives: one year on. See: http://webarchive.nationalarchives.gov.uk/20100408082112/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_097623.pdf 
(accessed 22 September 2017).

Department of Health, Northern Ireland. (2016) Health survey (NI) first results 2015/16. See: health-ni.gov.uk/sites/default/files/publications/health/hsni-first-results-15-16.pdf (accessed 22 September 2017).

Royal College of Physicians. (2013) Action on obesity: comprehensive care for all. See: rcplondon.ac.uk/sites/default/files/action-on-obesity.pdf (accessed 22 September 2017).

Royal Society for Public Health. (2014) Public less trusting of diet and exercise advice from overweight doctors and nurses. See: rsph.org.uk/about-us/news/public-less-trusting-of-diet-and-exercise-advice-from-overweight-doctors-and-nurses.html (accessed 22 September 2017).

NHS Digital. (2015) Health survey for England, 2015: adult overweight and obesity. See: content.digital.nhs.uk/catalogue/PUB22610/HSE2015-Adult-obe-tab.xlsx (accessed 22 September 2017).

Scottish Government. (2015) Health of Scotland’s population: obesity. See: gov.scot/Topics/Statistics/Browse/Health/TrendObesity (accessed 22 September 2017).

Stephenson J. (2017) Nursing needs to confront its weight problem, says researcher. See: nursingtimes.net/news/research-and-innovation/exclusive-nursing-needs- to-confront- its-weight- problem/7020706.article (accessed 22 September 2017).

Welsh Government. (2015) Welsh health survey 2015: initial headline results, statistics for Wales. See: gov.wales/docs/statistics/2016/160601-welsh-health-survey-2015-initial-headline-results-en.pdf (accessed 22 September 2017).

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