Health and weight

Treatments through GPs, dietitians, counselling and surgery

GPs
Young people and their parents were often unsure whether they should talk to their GP about the weight problem, either because they hoped that the problem would go away on its own, or because they didn’t believe that there was anything the doctor could do. When the topic of weight came up in discussion with the GP, parents were sometimes told not to worry and that their child would grow out of their excess weight.
 
Emily thought that her GP was unhelpful and just said whatever he thought would keep them happy. Steevie’s GP told her that she was overweight but also said that it was probably because she was ‘hitting puberty’. Her mother joked about it afterwards and said the GP didn’t understand that their family were all on the large side.
Looking back, some people were amazed that their doctor, health visitor, or practice nurse had not spotted the problem earlier. Shannon said that when she was a small child her mother thought she was overweight but the clinic staff said it was just ‘puppy fat’. Then, when she was 5 years old, they suddenly said, “What have you done wrong? She’s too obese”.
GPs who raised the subject of weight gain were sometimes not very tactful: Holly’s GP said “I don’t mean to be blunt but, you know, there is a lot of you”. Holly didn’t think that this was the best way to broach the subject. But she also wondered if she would have taken it seriously if her doctor had been less direct. Steevie also suggested that clinicians need to be ‘nicely blunt’ if they are going to have any impact.
 
Sometimes a GP drew attention to weight while they were consulting for something else, such as the oral contraceptive pill or even something quite unconnected. This could be a bit embarrassing, especially if they had a friend with them.

Dietitians
If the GP thought there was a weight problem they usually suggested seeing a dietitian. The first step was often to complete a food diary and then the dietitian would suggest changes, provide ideas for recipes or give leaflets about healthy eating. Although some young people liked the dietitian they had seen, others said that it was a waste of time and they had not been told anything they did not already know.
When Reg was 10 years old she saw a dietitian who upset her a bit by suggesting that her friends might only enjoy being with her because she made them feel  good and slim. She knew this wasn’t true because she’d been friends with several of her group for many years, but she thought it was a strange thing to say and it dented her confidence for a while.
 
Parents sometimes thought that it was helpful to see a dietician, even if they didn’t hear anything new; they thought it could be useful for their child to hear someone else say what they had been telling them about healthy eating.
 
Counselling
Several young people believed that weight problems are often caused by (or complicated by) emotional issues. Becca pointed out that being overweight and anorexia are both connected to emotional problems that cause physical damage and should be approached in the same way. She feels that people are blamed for being overweight and viewed more negatively. Others compared weight problems with addictions such as taking illegal drugs, or smoking.
 
Sami went for counselling after she broke down in tears in class and her teachers became concerned. She didn’t tell her parents for nearly a year, worried that they would be ashamed of her for needing counselling. Mary said that her daughter didn’t want any of her school mates to know that she was having therapy for her weight problems.
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Family therapy and individual counselling helped Alex with coping strategies and improved relationships in the family, but the counsellor wasn’t really able to deal with her eating issues. Jezzie saw a counsellor for six months and found that it helped a bit. She found the interaction with the counsellor too formal.
Those who attended community based weight loss programmes often really liked being able to talk to someone who listened sympathetically and informally.
See also 'Low moods & depressionand 'Eating disorders -talking therapies'
 
Weight loss medication
If the weight problem continues despite diet and lifestyle change, some GPs may prescribe a drug (orlistat) that stops the gut from absorbing fat in the diet into the body. In 2009 a health researcher Dr Russell Viner found out that doctors had been prescribing this drug to young people, even though it’s not licensed for under 18s. The same research study found that 45% of young people who took orlistat stopped taking it after one month (possibly because of side effects that include diarrhoea)*. 
Some of the people we talked to were wary of taking any weight loss drugs – Rachael was concerned that she might get addicted or end up “crazily thin on these tablets, like one for lunch, dinner and tea”.
 
Daniel’s father told us that his son had been taking the drug to ‘kick start’ his weight loss and so far it seemed ‘fairly promising’. But Gemma, who later had gastric banding (see below) had a bad reaction to the medicine and ended up in hospital.
 
Surgery
Until recently, surgery was not recommended for children under the age of 18 years but The National Institute for Clinical Excellence (NICE) guidelines now say that it may be considered for young people, in exceptional circumstances, if they have been through puberty.
 
Some of the young people we talked to said that they couldn't imagine they would ever consider surgery for weight loss– it seemed too extreme, or they could not believe their problem could ever be that severe.
 
Gemma had a gastric band, a surgical procedure that involves fitting a band around the upper part of the stomach. The band divides the stomach in two, creating a smaller pouch at the top. Having this small stomach pouch means that it takes a lot less food to feel full. Gemma’s father had complications after the same surgery 7 years before, which added to her concerns about undergoing surgery. Ten weeks after the surgery she was very pleased to have lost over 4 stone and was feeling much better and more active.
Charles was a bit surprised to discover that clinicians disagreed over what is the best treatment for his son, Daniel. One suggested a hospital stay where food and exercise would be controlled while another was convinced this would be a bad idea and referred Daniel to the SHINE (Self Help Independent Nutrition and Exercise) programme (see Community-based weight management programmes).

​*This research was carried out by Dr Russell Viner and colleagues from the UCL Institute of Child Health and the University of London. The study was funded from various sources including the Higher Education Funding Council, the NHS, the National Institute of Medical Research and the School of Pharmacy at University College London. The study was peer-reviewed and approved for publication in the British Journal of Clinical Pharmacology.

Last reviewed July 2017.

Last updated July 2017.
 

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