Over the past 24hrs I have been called a disgrace. Deluded. Dangerous. One kind person even reported me to the GMC for endangering the NHS. If only there was a way to demonstrate that fat itself is not as dangerous for our health as people would like to believe...
#obesity #haes

Oh wait. There is. We can use a risk assessment tool called the QRISK3 score to work out a person's chance of developing heart disease over the next 10 years. It is a clinically validated tool used by doctors around the country. We are expected to use it every day.

Let's start off with a 64 year old man with a BMI of 24, a normal blood pressure, a normal cholesterol and no pre-existing health conditions. We'll call him Dave. Dave is the very picture of "health". His risk of having a heart attack or a stroke over the next 10yrs is 9.9%.

That may seem high, but it's actually very low for his age. Now let's take the same man and give him a BMI of 40. We'll call him Steve. Steve's risk is higher, obviously. If you believe the media, Steve could die at any second! But here the thing. His risk is only 10.1%.

Steve weighs 49kg (108lbs) more than Dave. To put it another way, Steve would have to lose 108lbs in order to be classed as "healthy" but would end up with only a 2% decrease in his risk of developing a heart attack or stroke in the next 10 years.

Now you might say 2% is better than nothing. And that's fair. But lets put this into context. Let's make our man Dave an ex-smoker. His risk just went from 9.9% to 11%. Even if he quit smoking 20 years ago, his risk is 5X higher than if he were to suddenly gain 110lbs!

If we give Dave rheumatoid arthritis (a horrible autoimmune condition that has nothing to do with weight) his risk goes up by 20% (10X higher than if he were to gain 110lbs). A history of erectile dysfunction increases Dave's risk by 13%. Migraine by 10%.

So in terms of heart disease, it is better to be fat than to be an ex-smoker, have a history of migraine or RA, or take viagra. If Dave were to start smoking now, he'd be over 25X more likely to have heart attack/stroke within the next 10 years than if he gained over 100lbs.

FYI, taking a daily statin, which costs as little as £2.30 a month, reduces your risk of heart disease by about 25%. So our man Steve can chose to lose over 100lbs and reduce his risk by 2% or take a statin and reduce his risk by 25%. Which would you chose?

Still think I'm wrong?
Look, I'm all for healthy eating and regular exercise. But I think my job is to help patients to make an individualised, informed choice rather than just telling them to lose weight. Is that so wrong? Is that so crazy that I need reporting to the GMC?

If you're interested where I got my facts from then check out my photos or visit the qrisk3 calculator yourself. And I know the sceptics are going to say, yeah but what about [insert illness here]? Well we don't have risk calculators for every disease so tough!