Weight, in the waiting room
Tompson et al’s recent article on blood pressure (BP) self-screening raises the issue of other opportunities to self-screen in GP waiting rooms.1 In addition to BP, some GPs also encourage patients to measure their height and weight with weighing scales and stadiometers in the surgery.
This might be important as we know from studies using electronic health records that weight data are commonly missing and that weight it is not measured routinely.2 Weight measurement is prompted by registration, clinical events, and chronic disease reviews, and BMI data are more complete in females and older age-groups.3 Despite this, the proportion of patients with a BMI recorded within the last 3 years has increased from 37% in 1990–1994 to 77% in 2005–2011.3 This is partly in line with QoF, which encourages GPs to weigh people to support action on obesity. In a recent trial of a behaviourally informed opportunistic brief intervention for obesity, patients were weighed before their consultation, handing the results to the GP.4 GPs reported this made it to be easier to discuss weight, and the trial showed the brief intervention was effective in motivating and supporting weight loss.
Weight recording, especially if it identified weight loss, might also help us to detect serious disease. Current NICE guidance on “suspected cancer” includes no recommendation on how much weight loss, over how long, should trigger a cancer referral.5 Only one study informing that guidance used weight measurements to define weight loss.6 It did so by comparing the last recorded weight with the highest recorded weight in the preceding two years,6 a method that underestimates weight loss.3
Self-weighing in the waiting room might help but may not be straightforward. There may be issues of acceptability to be overcome for self-weighing to become routine, but it seems to be a health screening opportunity worth assessing. Instead of waiting to weigh our patients, shouldn’t we find ways to make it acceptable to patients to weigh themselves while waiting and routinely capture such measurements in the clinical record?
References
1. Tompson AC, Grant S, Greenfield SM, et al. Patient use of blood pressure self-screening facilities in general practice waiting rooms: a qualitative study in the UK. Br J Gen Pract 2017; May 8. doi: 10.3399/bjgp17X690881
2. Marston L, Carpenter JR, Walters KR, Morris RW, Nazareth I, Petersen I. Issues in multiple imputation of missing data for large general practice clinical databases. Pharmacoepidemiol Drug Saf 2010;19(6):618-26.
3. Bhaskaran K, Forbes HJ, Douglas I, Leon DA, Smeeth L. Representativeness and optimal use of body mass index (BMI) in the UK Clinical Practice Research Datalink (CPRD). BMJ Open 2013; 3(9):e003389.
4. Aveyard P, Lewis A, Tearne S, et al. Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. Lancet 2016;388(10059):2492-500.
5. NICE. Suspected cancer: recognition and referral (NG12). National Institute for Health and Care Excellence 2015.
6. Hamilton W, Lancashire R, Sharp D, Peters TJ, Cheng K, Marshall T. The risk of colorectal cancer with symptoms at different ages and between the sexes: a case-control study. BMC Medicine 2009;7:17.
Competing Interests: None declared.