Obesity podcourse with Dr Patrick Holmes, part 1: metabolic vulnerability

Right, so that was Sophie at 28, newly pregnant with obesity and pre-diabetes.

What are the main priorities in this case?

The big issue is she's already showing metabolic vulnerability at a very young age.

Not only has she obesity, but irregular periods, pre-diabetes and the social pressures.

All of that puts her at a very high risk of gestational diabetes and future type 2 diabetes.

So in the short term, the priority is healthy pregnancy.

But in the longer term, there is a major prevention opportunity.

So do we know whether Sophie has tried to address her weight? She's been given leaflets, but she's sort of saying...

They didn't really help.

I mean, what would be the main barriers for somebody in her situation?

From the consultation, you can hear she's dealing with shift work, fatigue, transport issues.

She's got another child and has limited time and money.

These are all real barriers.

When you're exhausted and financially stretched, advice about cooking from scratch and exercising more, just... isn't very realistic.

So this isn't about motivation.

A lot of it's about circumstances.

Also, one observation, the GP really should have asked for permission before talking about weight.

There remains significant stigma around the word obesity and weight in general.

And although Sophie wasn't too defensive, this can be a major obstacle too.

Okay, so that's a really important point to raise.

One of the aims of our campaign, Confidence in Obesity Care, is to support healthcare professionals to treat patients with obesity more confidently.

And that part of that is encouraging this idea that we should be treating the patient, not the BMI.

Anyway.