Abstract:
Introduction: Obesity is a common, chronic condition, its prevalence rapidly rising, which carries significant morbidity and mortality as well as health economic burdens (1). Hospital admission provides an opportunistic occasion to discuss benefits of losing weight to our growing proportion of obese patients. During the COVID-19 pandemic, this is an even more urgent part of clinical practice given its links with greater risks of severe consequences from COVID-19 (2). As clinicians, it is necessary to focus our attention on tackling obesity and to empower our patients to impact their future health.
In 2020, physicians both in training, and consultants (attending physicians) at an NHS District General Hospital in Manchester, United Kingdom, demonstrated considerable variability in clinicians’ confidence and awareness regarding obesity assessments, and efforts to improve this are discussed.
Method: A questionnaire was sent to physicians of both training and consultant grades, on a variety of issues surrounding tackling the obesity epidemic on ward round in acute medical presentations to hospital in morbidly obese patients, including current practice of addressing obesity, barriers perceived, and knowledge of local referral pathways for weight management. Following this, an educational programme was developed including teaching seminars, posters, and a pathway introduced to directly refer in-patients to weight management services in the community. The questionnaire was repeated in 2021.
Results: Fifty and twenty-eight clinicians responded in 2020 and 2021 respectively, the latter of whom eight (28.6%) were consultants and the remainder (71.4%) were junior doctors (training grades). Most junior doctors had rotated on their training programme to new hospitals, while there was minimal turnover amongst consultants. Figure 1 shows three questions with responses in 2020 compared to 2021, showing that confidence in addressing obesity on ward round increased after training in consultants, but decreased in training grades.
On being offered seven barriers to addressing obesity on ward round, the top two major perceived barriers in both 2020 and 2021 were a lack of clinical time and fear of causing upset to the patient.
Across both years, the majority of clinicians believed that a patient information leaflet with advice and weight loss services would be very useful.
Discussion and Conclusion: Amongst consultant physicians, by highlighting the issue of obesity, having an educational focus and installing a referral pathway, this led to increased confidence in discussing and documenting obesity with obese patients. Work on smoking cessation has proved that acute hospital admission can be an effective teachable moment in empowering patients to make lifestyle changes (3). Undoubtedly, the effect of the COVID-19 pandemic and increased awareness of the risks associated with obesity are likely to have contributed to increased awareness in consultants. Continued efforts are needed to educate healthcare professionals on identifying morbid obesity as a comorbidity, embracing ward round as an opportunity to discuss lifestyle factors and educating on available weight management services. Doctors in training who rotate regularly require this in core undergraduate and postgraduate training across the board, in order to make an impact to an obesity epidemic that is of grave global concern.
