15. Referrals for morbidly obese people?
Suffolk Branch
(MFD) This meeting of RCN Congress discusses whether morbidly obese people presenting to a clinician should be routinely referred to mental health or addiction services
Debate report
“Morbid obesity is not simply a lifestyle choice; it has many causes and significant psychological and social repercussions”, said Andrea Williams who opened this highly emotive debate.
“Being overweight increases the risk of depression, so should we not consider the two morbidities together as part of a robust assessment?” she asked. Andrea cited multiple conditions associated with morbid obesity and said that psychological treatments that have been shown to be effective are called for.
The majority of subsequent speakers raised issues about the terminology of the resolution, taking particular issue with the notion that referrals should be made routinely. Fiona Taylor of the Mid Yorkshire branch pointed out that “if there are multiple causes of obesity, then there should be multiple treatments – one size does not fit all”.
Student Nurse Mary Johnes bravely took to the stage to share her own personal and professional experience of eating disorder and post bariatric surgery services. “I struggle to see how when treatments such as CBT are offered to patients suffering from anorexia or bulimia, why they are not offered to the morbidly obese”.
Some members were incensed by the wording of the resolution and took great offence. Chair of Council Rod Thompson pointed out, however, that the matter for discussion had stimulated a lively debate and reminded him how important MFDs at Congress are.
Background
UK rates of obesity are on the rise, with nearly 25 per cent of adults currently defined as obese (with a Body Mass Index (BMI) of more than 30) and between one and two per cent as morbidly obese (with a BMI of more than 40).
It is now widely recognised that the causes of obesity are manifold and that society plays a significant role in its proliferation, with increasingly easy access to foods that are high in sugars and fats. Decreased emphasis on regular meal times and exercise and changes in work patterns, all contribute to unhealthier lifestyles.
Obesity has major adverse consequences for health, wellbeing, work output and life expectation. The cost implications of obesity and its co-morbidities are currently estimated at £5 billion per year and predicted to double by 2050 (Royal College of Physicians, 2013).
Across the UK, various strategies for the treatment and prevention of obesity are being developed. Scotland, according to the national strategy on obesity (Scottish Government, 2010), has one of the highest obesity levels in the world. In 2010, almost two thirds of men aged 18 to 64 and more than half of women were classed as overweight, obese or morbidly obese. There is increasing understanding in Scotland that obesity is not just a health issue. However, there is no reference in the strategy to routine referrals to mental health or addiction services.
The RCN response to the Government’s public health white paper in 2010, supports the acknowledgement that more integrated and innovative methods are required to help people make healthier choices. The RCN is clear that nursing plays a significant role in preventing unhealthy lifestyles by, for example, providing advice on healthy eating and weight management.
A recent report by the Royal College of Physicians (2013), Action on obesity: Comprehensive care for all, states that despite the high prevalence of obesity in the UK, the multidisciplinary treatment necessary to manage this problem is inadequate.
The report makes clear links between obesity and mental health issues, such as anxiety and depression. It recommends that this link should be recognised in provision of treatment in order for patients to achieve meaningful lifestyle change, weight loss and improvement in co-morbidities.
Motivational interviewing, or directive patient-centred counselling, has been shown as an effective therapeutic approach within the addictions field. Some research shows that it enhances weight loss in overweight and obese patients. This is an area the RCN is keen to develop and has planned workshops to support developing such techniques.
However, while research indicates that the behavioural approach has a place in treatment of obesity, it should be recognised that obesity is a complex problem and treatment and management of obesity is equally challenging.
References and further reading
Department of Health (2011) Health lives, healthy people: a call to action on obesity in England, London: DH. Available at: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_130487.pdf (accessed 14/03/13) (Web).
Royal College of Physicians (2013) Action on obesity: comprehensive care for all: report of a working party, London: RCP. Available at: www.rcplondon.ac.uk/sites/default/files/action-on-obesity.pdf (accessed 14/03/13) (Web).
Scottish Government (2010) Preventing overweight and obesity in Scotland: a route map towards healthy weight, Edinburgh: SG. Available at: www.scotland.gov.uk/Resource/Doc/302783/0094795.pdf (accessed 14/03/13) (Web).
