October Focus

[摘要] There is a growing view that obesity is the most serious and pressing health problem affecting the western world. The report from a large study on page 743 emphasises some of the health consequences, confirming an association with increased drug prescribing in the drug groups that one would expect, namely those to treat hypertension, diabetes, arthritis, but also in other more surprising groups, such as skin conditions, infections and gastrointestinal complaints. In a recent issue Mike Fitzpatrick argued very strongly that GPs should not let themselves be manoeuvred into feeling that dealing with the nation's obesity was their responsibility. The qualitative study on page 750 gives an insight where this might lead. The picture it presents is of a group of doctors frustrated by the problem and, thinking of it as the patients' responsibility rather than a medical problem. Oddly, none discussed the bigger picture that includes the influences of the food industry and its interest in encouraging us all to eat more than we need, and the increasingly sedentary nature of our lives … Then there is the vexed question of encouraging patients to change long-established patterns of eating, when eating is associated with all kinds of symbolism, and occupying such a central area of family life. Finally, this is one of those topics where nobody seems to have spotted the potential conflict with promoting patients' choice. Policy statements tend to imply that we should all eat a less calorific diet for the long term benefit of weight loss and the accompanying reduction in cardiovascular risks. But I have always thought that many would opt for the pleasures of an unchanged diet (and do) rather than eating much less in order to live a bit longer. We have had moderate success encouraging patients to stop smoking. The message is simple (all tobacco is harmful) and the culture in the UK has, over a long period, become gradually more averse to smoking. Improving the national diet is likely to be much more complex and take much longer to succeed.

[学科分类] 卫生学