Some conversations are always difficult. Explaining to Megan, a 38-year-old woman with severe heart failure, that she couldn’t go on the heart transplant waiting list because she is obese was one of them. Megan is a single parent to an eight-year-old girl, has a history of depression and anxiety, and until recently was in full-time employment. By the time I saw her, she weighed 135kg and had a body mass index of 50kg/m² (obese being greater than 25kg/m²), which placed her in the highest level of obesity.
She calmly explained that I’m not the first doctor to inform her that her obesity is causing her harm. The first time she was told this was by another well-meaning cardiologist, who bluntly told her that her chest pain was a result of obesity (it wasn’t) and that she simply had to lose weight by eating less and moving more.
She felt humiliated and patronised, and subsequently found it difficult to trust medical professionals as she felt blamed for her illness. Certain health conditions lend themselves to more compassion than others, and obesity is not one of them.
The cause of her obesity was, by her own admission, complex. She explained that she had always been overweight but was active and played sport at national level at school. She was diagnosed with polycystic ovary syndrome in her early twenties, and this condition predisposes women to becoming overweight and obese.
She binged on carbohydrates and fat-heavy meals when she felt depressed or anxious, she felt ashamed of her body and stopped exercising and, despite trying several diets, could not maintain the initial weight loss she incurred and was always heavier than before.
Megan is not alone. More than 60 per cent of adults are overweight or obese in the UK. Every week there is a sensational headline in the news about how the “obesity epidemic” is creating a huge financial burden on the NHS. However, the effects of obesity on health are often unappreciated: apart from joint problems, diabetes and cardiovascular disease, obesity is the biggest cause of cancer after smoking.
The Royal College of Physicians has called for obesity to be classed as a disease in order for it to be taken more seriously and to develop clear targets for its prevention as well as treatment. It calls for a shift away from the view that obese people are to be blamed and instead, to see obesity as a result of health inequalities, genetics and social factors.
This is excellent in theory, but substantial funding of public health measures is required to educate people about healthy diets and exercise and – for those who need it – provide multidisciplinary weight management programmes on the NHS. In the era of cuts to public health, it will be hugely challenging to put these proposals into practice.
I referred Megan to a heart failure specialist nurse who saw her in the community. She attended cardiac rehabilitation classes where she was able to exercise under medical supervision, and began an NHS weight management programme. She also saw a cardiac psychotherapist for several months. This intensive multidisciplinary approach is not routinely available in all NHS trusts and is something I fear could soon be cut because of staff shortages.
She returned to my clinic six months after I initially gave her the news that her obesity was stopping her from going on the transplant waiting list. To her delight – and to my amazement – Megan had managed to lose 20kg. She was exercising and was no longer depressed. Her heart failure has improved to such an extent that she no longer needs a heart transplant.
I asked Megan how she would like doctors to help overweight and obese people and she emphasised the need for empathy and a non-judgemental approach. She said, “Patients don’t care about how much you know until they know that you care.”
Nishat Siddiqi is a cardiologist based in south Wales
This article appears in the 09 Jan 2019 issue of the New Statesman, The Brexit Showdown