Obesity podcourse with Dr Patrick Holmes, part 2: established metabolic disease

Okay, so things have progressed since we last saw Sophie.

Given she has type 2 diabetes, dyslipidemia and hypertension, she must be on some form of medication?

Yes, at this stage, she should be on standard cardio metabolic prevention.

So typically that would be metformin, an SGLT2 inhibitor, statin and an ACE inhibitor for that blood pressure, all assuming she's not trying to conceive.

So she may need to be on contraception as well.

From a guideline point of view, that's appropriate treatment, but it's treating those consequences rather than the underlying driver, which is in this case, excess adiposity.

So in terms of the obesity, Sophie seems a little bit nervous about it.

She feels like she might be told off about her weight.

We discussed this in the first episode, but Should her GP keep trying to address it if Sophie doesn't want to talk about it? And how can we do this sensitively?

It's a really important point, I think this.

We've got some fabulous tools to help manage excess adiposity and situations like this, but the language really does matter.

So yes, it's really important how it is raised.

What you hear is frustration, probably burnout.

She's been told the same things for years and nothing's changed.

So we need to be asking permission before even discussing weight.

If clinicians come across as blaming, people are disengaged.

If we frame weight as a shared medical problem rather than a personal failure, patients are much more likely to be engaged.