We, as general practice nurses (GPNs), play an important role in prevention and must make every contact count to educate our patients and help them be healthier. When it comes to weight, people who are obese now outnumber people who smoke two to one in the UK.1
Obesity, like smoking, puts millions of adults at greater risk of cancer. In fact, overweight and obesity is the second biggest preventable cause of cancer in the UK. More than 1 in 20 cancer cases are caused by excess weight.2 Being overweight or obese increases the risk of 13 types of cancer, including two of the most common types of cancer – breast and bowel cancers - and three of the hardest to treat – pancreatic, oesophageal and gallbladder cancers.3 The risk is higher the more weight someone gains and the longer they are overweight for4, 5 however research so far suggests that losing weight can help reduce cancer risk.6, 7
How does obesity cause cancer?
Extra body fat doesn't just sit in the body, it's active, and can affect growth, metabolism and reproductive hormones.
Researchers have identified three main ways obesity is linked to cancer. Extra body fat can lead to greater levels of:
- Growth hormones such as insulin and insulin-like growth factor
- Sex hormones like oestrogen
- Chronic inflammation
And these factors can signal to our cells to divide more often, increasing the chance of cancer cells developing. But because extra body fat can affect so many different biological processes, and affects different people in different ways, untangling all the ways obesity is linked to cancer is an ongoing area of research.2, 8, 9
Weight is not just about the individual
Obesity is a complex issue with many causes10 but one of the biggest influences is the environment we live in, which makes being healthy difficult.11 We may think we're in control of what we eat but we're all being influenced daily. Energy-dense food is easily available, often cheaper, on price promotions and more heavily marketed than healthy options, and there are fewer opportunities to move in our everyday lives than ever before. All these things nudge us towards eating unhealthily, being inactive and make it very hard for most people to keep a healthy weight. There are also many mixed messages in the media about what people should and shouldn't do which leads to confusion and eventually people just ‘give up’ listening.
So, what can we as GPNs do to help?
Targeted support and access to weight management in primary care is part of the NHS Long-term plan on prevention and health inequalities but day-to-day there are opportunities for GPNs and other health care support workers to give advice regarding weight.
The good news is small changes that your patients keep up over time can make a real difference.12 Dann from Solihull shows how much his conversation with a GPN changed his behaviour:
‘At my heaviest of 16st 12lbs, I struggled with my job as an electrician and I'd get home tired and in pain. At a routine new patient health check my nurse told me that I was medically obese and that my size was putting my health at risk. It was a real eye opener. They were understanding and supportive though, and I was referred to a 12-week free weight management programme. In less than a year I lost 5st 2lb. I feel fantastic, more confident at work and have more energy to play with my children.’
Losing weight and keeping it off isn't easy and it can be challenging to talk about with patients, especially if you are worried about upsetting them or feel hypocritical given your own weight status.13 But many patients could benefit from your support and advice. There is emerging evidence that having conversations with your patients about their weight could make a significant impact. A 2016 study found that 8 in 10 people who are overweight or obese thought it was appropriate and helpful for their health professional to suggest that losing weight would be good for their health.14
Talking about weight should be viewed as a normal part of a routine consultation but there are opportunities that can make it easier to initiate the conversation. For example, during new patient checks, when patients come in for a review of conditions relating to weight, such as diabetes and hypertension, and during more sensitive consultations around mental health or fertility and contraception checks. Try using open-ended questions to start a conversation as the patient might be more receptive to your advice and discussing support. Also, as GPNs we know our populations and patients well. Their diet is part of their way of life and often reflects the social and cultural settings in which they live. For example, eating foods higher in fat, salt and sugar, which are often on promotion, can be more cost effective for some families, and food types and portion sizes may also vary with cultural backgrounds. As this can be a sensitive topic, we must try and empower the patient to make healthier choices that work for them as an individual. Patients often find weight conversations that are open and sympathetic most helpful and tend to open up a little more about their diet and previous weight loss attempts. When offering advice about weight loss, it's important to acknowledge that it can be hard, and it might take your body a while to adjust to changes in diet so break it down into manageable actions.
Toolkit
Public Health England have put together a toolkit with the following advice to help your conversations:
- Ask to weigh and measure your patient.‘While you're here, can I check your weight?’‘Do you mind if I weigh you?’ Once you've weighed and measured your patient, determine their weight status.
- Advise your patient on what support and services are available to them, based on their weight status.‘One of the best ways to lose weight is with support. [Insert local weight management service] is available free and I can refer you now if you're keen.’ Signpost to locally run initiatives such as weight loss groups, cooking classes, or local exercise schemes.
- Assist. Once you've discussed options with your patient, you should then assist them by making a referral to the service you've agreed on or offering your continued support.
‘Great, I'll make a referral now. You'll get an appointment through the post. I'd like to see how you get on so next time you come in we can chat some more.’
For patients who don't want to engage in conversation about weight management, show acceptance of their wishes but re-offer support should they change their mind.
‘Okay, that's fine. I understand that maybe now is not the right time. If this is something you want to talk about in the future, I'm keen to support you in doing this.’
Complete our CPD education on our health professional website cruk.org/weightandcancer to help you have more effective conversations about weight.