What is your baggage allowance?
My eldest son and his wife are scheduled to fly to New Zealand tonight. They are moving there for work and to make a new life together out there for themselves. Although most of their possessions are being shipped out there by sea, they are taking quite a lot of baggage on the aeroplane with them, so have been using bathroom scales to check that they are not over their baggage allowance (30kg each).....
Years ago, I was nervous about talking about weight with my patients, and as a result I did not have any weighing scales in my consultation room. I made the excuse to myself that ‘people who are overweight know it, and do not need me to point it out’. But as the years progressed, and as I myself put on weight, it became increasingly evident to me that I should give my patients an opportunity to discuss their weight and their diet with me. Furthermore, I felt that it was part of my job to help my patients to reduce their cancer, diabetes and heart disease risk (1) (2) (3). By not weighing my patients, I felt that I was doing them a disservice. I had to find a way to address it in a manner that was positive and non-judgemental. So to start with, I bought a set of scales and kept them in the treatment room.
Now, when I do a patient’s annual review, I get them to stand on the scales, and I record their weight in the annual review record. I can compare it with last year's figure, of course. I don't want to be judgemental, so I never tell a patient what I think their weight ‘should’ be. I use Socratic questioning techniques derived from CBT (4). I ask them what they think their weight should be. They nearly always volunteer a specific (lower) number. I then ask them how they will get to that weight, to which they might respond: ‘drink less and eat fewer sweets’. ‘Is that a goal’? I ask them, and then help them make it a SMART goal (Specific, Measurable, Achievable, Realistic, Time-bound). This is part of their health agenda for the following twelve months.
There are numerous benefits to talking about weight in this way with patients:
I can see if there is any correlation between their weight and other health issues such as an increase in blood pressure, or knee pain.
Improving their diet might help to stabilise blood glucose levels, preventing or even reversing diabetes (5).
It opens up the opportunity to discuss nutrition generally.
An unexplained loss of weight might stimulate the implementation of more medical investigations.
It reminds me that I should always be assessing the patient as a whole, and not just as a symptom that has walked through the door.
It has been demonstrated that weight-loss management intervention delivered in primary care is effective (6).
We have just heard that the airline cancelled tonight's flight! They have been shifted to another airline. Is their baggage allowance the same? Will there be an excess fee to pay? Right now, talking about weight feels stressful! Where is Socrates when you need him?
Questions to think about:
Do you think that we should talk about weight and nutrition in our chiropractic consultations?
Do you weigh your patients?
What symptoms might prompt an undiagnosed diabetic patient to consult a chiropractor?
Do you refer to weight in metric units (kilos), or imperial (stone)?
I am a chiropractor and sonographer. I also mentor colleagues to help them become the clinicians that they want to become. Find out more here.
