GPs too embarrassed to tell overweight patients: slim or risk cancer

Professor Annie Anderson's team found reluctance to talk
Professor Annie Anderson's team found reluctance to talk
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DOCTORS and other healthcare workers are failing to give patients crucial information about the links between obesity and cancer which could reduce their risks of disease, Scottish research shows.

A team from Dundee University said not enough was being done to prevent cancers linked to obesity, such as bowel and pancreatic cancer, or to reduce the risk of cancers returning after treatment for the disease.

Speaking at a conference in Liverpool, they said this was despite obesity being the largest preventable cause of cancer after smoking.

Health campaigners warned that, in some cases, NHS staff were reluctant or embarrassed to raise the issue of weight with patients because they were obese themselves.

It is estimated that about 43 per cent of bowel cancers and 42 per cent of breast cancers could be avoided through better diet, increased physical activity and maintaining a healthy weight.

Researchers in Dundee, led by Professor Annie Anderson, conducted a series of interviews and questionnaires with both patients and health staff to assess what advice was given about the links between cancer and weight, and what guidance would be welcomed by the public.

In one study, they spoke to four focus groups of patients in Scotland who had been treated for pre-cancerous polyps – the removal of which can stop cancer developing – found through bowel cancer screening programmes.

The researchers were surprised to find that even though these patients had been through screening, nobody had said to them that diet and lifestyle might play a role in cancer or the return of more polyps.

Prof Anderson said: “They said they would be interested if someone had said diet and exercise was a worthwhile thing to do, but nobody had ever said that.”

In another study, researchers spoke to six focus groups of bowel cancer patients across the UK aged from 27 to 84 to find out if cancer patients would welcome advice on weight issues.

“The best phrase a patient used was that advice would be useful ‘Because I want to stack the odds in my favour’ against the cancer coming back,” Prof Anderson said.

“That’s about as good as it gets. We can’t say that if you get really physically active and lose weight you won’t get recurrence, but you will reduce the risk of recurrence and other diet- related diseases.”

The focus groups indicated that patients would welcome advice specific to them on how much exercise and what level and dieting was appropriate for them, rather than relying on guidance from family or the internet.

Finally, the researchers conducted a survey of more than 300 colorectal cancer clinicians from across the UK.

It found that 89 per cent recognised that weight reduction was important for people who were overweight or obese.

But when they interviewed some of the respondents in more depth they found many were worried about weight loss in their patients as it could be a sign of the disease returning.

“I think this clouds the issue of intentional weight loss and that does not come to the fore,” Prof Anderson said.

“When we asked why clinicians don’t give advice they had responses such as ‘The evidence isn’t that good, you can’t put your hand on your heart and say if you lose weight you won’t get cancer’ so they feel embarrassed as a clinician bringing it into the conversation.”

Some said that it was a difficult area to discuss with patients and it was not their main area of business, and primary care staff rather than those in hospitals were better placed to deal with lifestyle factors.

Others said in an ideal world if they had more time it would be a subject they would cover with patients.

“But on the positive side, we had 50 per cent saying they would like training on weight management,” Prof Anderson said.

“They recognise that they are not very good at giving it, are unclear how to raise the sensitive topic, but might benefit from some training.”

Prof Anderson said the NHS was missing key opportunities to provide crucial information to people who needed it most.

“Obesity is having a huge impact on cancer incidence worldwide. If we are to tackle the rising cancer incidence, we must do all we can to combat obesity,” she said.

“The hospital environments must also be improved. It gives the wrong message to see fast food outlets in hospitals.”

Prof Anderson said as well as health workers, governments and the public also has a role to play in tackling obesity.

Tam Fry, from the National Obesity Forum, said medical staff needed to find time to talk to patients about the risks from obesity where cancer was concerned.

“One of the real problems I find is that doctors and nurses are reluctant to talk about weight because they can often be pretty heavy themselves, and that’s a good reason not to bring the subject up,” he said.