DEB ATE: OBESI T Y 2
Do we doctors underestimate our patients’ interest in lifestyle change and willingness to collaborate to improve health? David Unwin GP; RCGP National Champion for Collaborative Care and Support Planning in Obesity & Diabetes RCGP clinical expert in diabetes
So much chronic disease is partly a result of the lifestyle choices we make. The drugs we doctors prescribe for these conditions may control things like type 2 diabetes or hypertension but can also lead to other problems and don't lead to a cure. For most of my career I thought patients were not interested in changing their lifestyle. I was wrong and find now that very few of my patients actually choose lifelong drugs if lifestyle alternatives are explored in a supportive way.
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A GP partner in Southport for 30 years, I have witnessed first-hand the twin epidemics of sugar (type 2) diabetes and obesity developing in my community. Also I noticed I was spending more and more time signing prescriptions, monitoring blood tests and checking blood pressure. Deep down there was a nagging doubt about this being the best use of my time and energy to help my patients find good health. The results just didn’t seem that good. I began to have success in getting patients to give up sugar completely and the rest is history!
Yesterday I asked a patient how she felt about being on long-term medication for her blood pressure. ‘It’s a worry as I’m only 40 and it’s taking three different meds to keep my BP down, also how many can you keep adding and be safe?’ This presented the ideal opportunity to explore lifestyle improvements as an adjunct to her care. She said it was a ‘relief ’ to feel she might be able to ‘take control’. To my embarrassment she had not been weighed for some years, so we agreed to get a baseline weight measurements (96kg) and added in a waist circumference (118 cm); she was surprised to hear weight loss would really help her case and may even give her the chance of reducing medication. For the past four years I have been experimenting with a lower carbohydrate diet to help interested patients like this one. I keep an Excel spreadsheet of anonymised (and consented) patients as a rather lowbrow basis to my practice-based research (Unwin and Unwin 2014; Unwin and Tobin 2015; Unwin 2014a; Unwin et al 2015). So I can tell you I now have a case series of 91 patients on the diet for an average of 15 months who have lost an average of 8.8 kilos. Over 40 of my patients
weigh less now than at any time since the year 2000! In my case series the systolic BP drops by an average of 7.5mmHg, the diastolic by 5.5mmHg, giving me hope for the lady from yesterday. But quite unlike most drugs which only target a single surrogate marker she may experience a whole host of other improvements. The average cholesterol drops by 0.36, and the cholesterol ratio by 0.47. Of the 91 low-carb cases, 60 have diabetes and the average HbA1c dropped by an amazing 12.1 mmol/mol taking many into the pre-diabetes category and avoiding metformin. Added to this are reported improvements that cannot be measured; self-esteem, knee and back pain, more energy and feeling younger. Results I was quite unable to achieve in the first 25 years in practice. I wonder why? I suspect it’s a question of belief. At medical school we spent months learning pharmacology as ‘the most important tool of our trade’ alongside surgery. Lifestyle medicine and even disease prevention was hardly given a mention, it just wasn’t sexy. Also medicine was something ‘done to patients’ whose part was to get better and be grateful! This situation was compounded by ‘evidence based
© Journal of holistic healthcare
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Volume 13 Issue 2 Summer/Autumn 2016
