Should doctors have to practise what they preach At 22 stone, this GP was hardly a role model for patients. She took action – but others don't
Dr Arabella Onslow has lost an incredible 10st – seven in 14 months
Whenever her patients visited GP Lady Arabella Onslow for advice about weight or healthy lifestyle issues, she began the conversation with the same few words.
‘I know how hard this is. But this isn’t about me,’ she would say as she explained the need for regular exercise and smaller portions. ‘This is about you.’
For as she was handing out this lifestyle advice, Dr Onslow was grossly, even dangerously, overweight.
At her heaviest, the 41-year-old weighed 22st.
5ft 8in, this gave her a BMI of 46.2 (officially morbidly obese) and
put her at high risk of a host of weight-related conditions, including
diabetes, high blood pressure, cardiovascular disease and osteoarthritis
— the very same enemies she warned her overweight patients about each
day in her NHS surgery in Dalton-in-Furness, Cumbria.
a GP you listen to patients with all sorts of problems, and while not
all of them are connected with weight, a lot can be — such as
breathlessness, bad joints and diabetes,’ says Dr Onslow, whose father
was the Earl of Onslow.
when I had to tell a patient they would benefit from losing weight, I
felt they were judging me. You could hardly ignore the fact I was obese.
knew that at the very least I was giving tacit approval to someone who
was overweight. If their own doctor, the person they went to for health
advice, could be that fat, then surely it was OK for them to be fat,
Indeed, it was the
thought of the potential harm she might be doing indirectly to her
patients that spurred her on when she finally decided to lose weight.
seems to have been a real motivation, for Dr Onslow has lost an
incredible 10st — seven in 14 months.
‘I began to put on weight during my late teens, and from my early 20s onwards the weight just piled on,’ says Dr Onslow, who is single.
'When I had to tell a patient they would benefit from losing weight, I felt they were judging me. You could hardly ignore the fact I was obese,' said Dr Onslow
‘I come from a family of bon viveurs and didn’t want to give that up.
'My portion sizes were enormous and unhealthy, doused in fat. An example would be a pasta dish on to which I would pile cream and maybe cheese, and then eat enough for four.
‘I loved to cook, but I would eat while I was cooking — chunks of cheese or crisps — and then have my main meal.
‘Another issue was that I really hated exercise. I was sent to a mainly boys’ school when I was 11. I never, ever got picked for teams, and when I did sport I would feel humiliated and left behind.
'As I got older, this metamorphosed into a loathing of all types of exercise.’
Over the past few years, Dr Onslow’s weight gain was starting to have an effect on her health.
'I come from a family of bon viveurs and didn't want to give that up. My portion sizes were enormous and unhealthy, doused in fat,' said Dr Onslow
‘My knees were hurting and I got breathless when I walked,’ she says.
‘My world began to shrink, too. For example, I worried about getting on a plane because I had to ask for a second seat belt, and when I walked into a restaurant I had to think about whether I would fit on to the chair.
‘My family were worried about me, but I rebuffed any attempts to discuss the matter.
'However, in 2006 my younger sister Charlotte plucked up the courage.
'She said I was very overweight and it wasn’t good for me, and she kept on telling me until I got the message.
‘At the back of my mind was the knowledge that I wasn’t providing the best example that I could to my patients. I really care about them and I wanted to be the best doctor I could for them.’
How a doctor’s lifestyle choices affect patient care is an issue that has only recently begun to be explored by the medical profession.
‘In the past, people accepted what doctors said without question,’ says Michael Wilks, of the British Medical Association and chairman of the Sick Doctors Trust, which helps medics suffering from addictions.
However, this dynamic is breaking down — which is a good thing — and people are more likely to look at their doctor with questioning eyes.’
Indeed, a survey carried out by the Department of Health two years ago found that fewer than half of those questioned would readily accept health advice from a health professional who appeared to have an unhealthy lifestyle. A third would actively not accept that advice.
‘Like it or not, doctors are role models,’ says Dr Wilks.
‘Obesity is a visible condition, but equally, if a patient knew their doctor smoked or drank heavily, then it could weaken their authority if they were giving advice on these matters.’
'It wasn't until I joined a Rosemary Conley slimming class in 2010 that I realised where I was going wrong,' said Dr Onslow
Not all the experts are convinced doctors’ own lifestyles matter.
‘Doctors must be trustworthy, competent and professional, but this does not mean they must lead healthy lifestyles or be thin or good-looking,’ says Dr Daniel Sokol, a medical ethicist at Imperial College, London.
According to the Royal College of General Practitioners, as long as the doctor acts professionally, there is no dilemma.
‘When the patient leaves the consulting room, they must feel that the doctor has listened to them, addressed their needs and was kind,’ said a spokesman.
‘This is the best way to ensure that the next time they visit their GP, they can trust them enough to talk about their eating, drinking or any other personal concerns.’
However, a GP’s lifestyle can affect their ability to do their job, as a survey published in the journal Obesity suggested.
This found that doctors who were overweight or obese were far less likely to diagnose obese patients than doctors who were a more normal weight.
Thirty per cent of doctors with a normal BMI were likely to talk to their obese patients about weight loss, while only 18 per cent of the heavier doctors would.
It took 14 months of cutting back drastically on portion size, cutting out fats and exercising, but Dr Onslow is down to a size 12, with a BMI of 24.9
The normal weight doctors were also more likely to give advice on diet (53 per cent versus 37 per cent of the heavier doctors) and exercise (56 per cent versus 38 per cent).
This is something with which Dr Onslow identifies.
‘I can see in hindsight that my idea of what constituted normal weight was massively skewed,’ she says.
‘For example, when I weighed 22st, if I saw a patient who weighed 18st I found myself thinking they weren’t that overweight — while, of course, they were.
‘Luckily, however, my professionalism and training took over and I gave them the correct advice according to weight guidelines.’
Dr Onslow managed to lose the first three stone in 2006 by cutting down on portion sizes, but then her weight loss stalled.
‘It wasn’t until I joined a Rosemary Conley slimming class in 2010 that I realised where I was going wrong.
‘I started to look at thin people and see how they ate and behaved.
'Invariably they ate small portions, regular meals, never snacked and took exercise.’
It took 14 months of cutting back drastically on portion size, cutting out fats and exercising, but Dr Onslow is down to a size 12, with a BMI of 24.9.
‘Looking back, I was plagued by myriad niggling ailments that restricted my life and prevented me from doing fun things such as going to the theatre or travelling.
‘I don’t think I am a better doctor because I am no longer obese. But I do think I am a better role model for my patients.’