Having raised the issue of body weight it is important to work with the patient in a way in which they will feel supported and understood. This requires the practitioner to listen carefully to the patient’s description of what being overweight means to them, what they feel has contributed to their obesity and whether they feel ready to begin a treatment programme. It is likely that many patients will already have had a number of attempts at losing weight and it is important to acknowledge and affirm past efforts.

The patient must be given the opportunity to describe what has led to their weight increase and it is also important to discuss previous weight loss attempts (and their success/failure). Listening to a patient’s account of the factors that have contributed to their weight gain will help to establish their understanding and beliefs about obesity With patients who are convinced that their weight gain is out of their control (e.g. due to perceived genetic or metabolic influences) health professionals should recognise that this needs careful exploration.

Classifying the degree of obesity

An important early step in the assessment procedure is to measure the degree of obesity. While more sophisticated measures exist, in clinical practice the most common measurements are of body mass index (BMI) and waist circumference.

The measurement of waist circumference provides information about the distribution of body fat and is a measure of risk for conditions such as coronary heart disease (CHD). It is now well known that people who carry their excess fat centrally (within the abdominal cavity) are more likely to suffer the consequences of being overweight.^2,3

Factors that will influence the risk from obesity include:

• Advancing age
• The duration of obesity
• Family history of conditions such as CHD and diabetes
• Existing medical complications
• Smoking
• The level of physical activity

Building a clinical picture of those factors will help to define the overall risk to a patient’s health. It may be more constructive to have a questionnaire to gather this type of information. Issues arising from this could then be discussed during the consultation process.

It is well documented that obesity increases the risk of other conditions such as hypertension, hyperlipidaemia, diabetes, skeletal disorders and respiratory disease. In addition, the elimination of other conditions such as hypothyroidism (which can lead to weight gain) is important. A thorough assessment should therefore include the following:

Changes to diet and physical activity are the key to any obesity treatment. The evaluation of current dietary and physical activity patterns will therefore form an important part of the assessment process. Making recommendations for change and formulating a plan of action is difficult without a baseline measure of current practices.

Since changes in a patient’s lifestyle are the mainstay of obesity treatment, care needs to be taken to ensure that the patient has thoroughly considered both the pros and cons of change for them at this time. Potential difficulties to success need to be identified from the outset and steps taken to overcome them. The maintenance of a ‘food and activity’ diary will raise patients’ awareness of their own behaviour with regard to eating and exercise – the first and most important step towards changing things.

The expectations that patients have about achieving weight loss are influenced by their past experience, what they read/see in the media, and others around them including healthcare professionals. Expectations are often greatly inflated beyond what is achievable from a physiological and psychological perspective. In addition to patient expectations, healthcare professionals need to ensure that they do not place unreasonable demands on their patients with regard to achieving weight loss. It is not uncommon to have obese patients report that their place on a surgical waiting list has been suspended until they can lose 4–5 stones in weight, yet they are expected to achieve this without any support being offered?

Following a full assessment of the patient’s health risk, dietary and physical activity habits, as well as expectations, decisions need to be taken about how the primary care team can progress with treatment.

Please click "Read More" to view the references for this section.