The reality of the new midlife office health checks (including weigh-ins at work)

A new health screening may mean GPs will be coming to an office near you – armed with a set of scales. Here’s what to expect

Are you too busy to go to the doctor’s, or just don’t see it as a priority? As of next year, thousands of people will no longer have an excuse: the doctor’s will be coming to them, armed with a set of scales.
A free health check to assess the risk of preventable disease in people over 40 already exists at GP surgeries. But the Government recently announced a new health screening, aimed at male-dominated industries such as engineering and construction, where employees have traditionally been less likely to volunteer for the existing programme.
Even GPs were taken by surprise by the announcement last week, and aren’t sure how the checks are going to be rolled out. The probable format is that a medical professional will come to the workplace offering a series of tests that could serve to lower patients’ risk of serious disease later in life. As in a GP surgery, all checks are likely to be done in private – so no risk of having to stand on the scales with your colleagues pointing and laughing. 
Around 130,000 checks are set to be rolled out by 2025. Jaguar Land Rover has already signed up as 4,500 staff from the boardroom to the factory floor are set to receive tests within months at its Solihull base. 
Patients will receive a routine 20-minute examination from medics who will visit on-site. If the tests reveal they are at high risk, staff will be offered lifestyle advice and if necessary, treatment including blood pressure medication, statins to reduce cholesterol, as well as referrals to an NHS weight-loss clinic.
So are we moving to a system like the one in Japan, where employees are checked annually, and incentivised to remain a healthy weight – and punished if they do not?
In Japan, those who have put on weight over the past year may be referred to a company doctor, who will make recommendations about their lifestyle or diet. People don’t lose their jobs because of obesity, but if an employee ignores the doctor’s advice, the matter can escalate.
This draconian scheme seems unlikely. “The over-40s check is essentially an attempt to prevent cardiovascular illness,” says Dr Sarah Levy, a GP from Wigston, Leicestershire. “This new programme will be targeting those who are the highest risk groups, but are the least likely to take it up, notably, middle-aged men.”
This population, says Dr Levy, often has high blood pressure, raised cholesterol, and are diabetic or prediabetic but many of them don’t realise it. 
“They are people like my uncle Trevor who died of a heart attack at the age of 54,” she says. “He smoked, was slightly overweight, and had a bad diet. If my uncle had undergone a routine health check, a GP could have spoken to him about his lifestyle habits or given him some medication, and he might still be with us.”
Dr Eve Wijayanayagam is a GP who practises at the Sarum Road Hospital, Winchester. “Only 40 per cent of people attend their over-40s health checks, so this initiative is an attempt to swing the balance from treatment to preventative health, and to help the patients as well as the NHS,” she says.
Health checks are normally done by a nurse or a health care assistant, and you only then see a GP if a problem is found. Whether a medic comes to your workplace or you go to your surgery as usual, there are clearly great benefits to a health MOT, so what happens there?
These will include your age and your ethnicity. This is important, because some populations are at more risk of certain conditions; for example South Asians have a higher chance of developing diabetes. The medic will also want to know whether any close relatives have had any of the diseases being checked for. 
“Asking someone about their medical history is useful on two levels,” says Dr Wijayanayagam. “It makes a person think about the relevance of their parents’ health for the first time, but it also gives the clinician useful information.
The medical professional will want to know whether you smoke, how much exercise you do and how much alcohol you drink. “The idea is not to hector the patient, but to give them information that will educate them and help them,” she says. “The onus is then on you.”
Most surgeries still use the traditional BMI (body mass index) measure to determine whether you are overweight or not. Healthcare providers calculate BMI by using your weight in kilograms divided by the square of your height in metres. Many doctors are starting to see the BMI as an outdated mechanism and prefer to use your waist/ height ratio instead (your waist should be less than half your height to be healthy: abdominal fat raises the risk of illnesses including diabetes and heart disease).
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“It can be hard to talk to someone about this subject, but most people know if they need to lose weight,” says Dr Wijayanayagam. “I tend to present them with the facts: ‘This is your weight, this is your height. If you would like some advice on how to drop a few pounds, I can help you.’”
Around one in three adults have high blood pressure. Six million people are unaware of it. “High blood pressure raises the risk of so many conditions, from kidney disease to stroke and heart attacks,” says Dr Wijayanayagam.
“I tend to take three blood pressure readings as the first is often high, because of ‘white coat syndrome’, where doctors make people feel anxious,” she says.
A normal blood pressure reading is when the systolic pressure (upper number) is lower than 120mmHg and the diastolic pressure (lower number) is lower than 80mmHg. When these levels climb to 130mmHg or higher for systolic pressure or 80mmHg or higher for diastolic pressure, this is considered high blood pressure, or hypertension.
“High cholesterol raises the risk of heart and circulatory problems, stroke, kidney disease, and dementia,” says Dr Wijayanayagam. “Men have higher risk factors earlier in life because, statistically, they tend to drink more and be heavier smokers.” Some conditions are also hereditary, such as familial hypercholesterolemia, a genetic predisposition to high cholesterol. This may need to be treated with statin medication earlier in life.
“Results can be confusing but the easiest to understand is looking at total cholesterol, which ideally should be less than five.” Your HDL (‘good’ cholesterol) should have a healthy ratio to your LDL (‘bad’ cholesterol).
“If lifestyle changes are ineffective, a patient has a strong family history of cardiovascular disease or has had a heart attack under 55, we will strongly recommend starting on statin medication,” says Dr Wijayanayagam.
At the end of the consultation, you will be given a ‘QRisk’ score, explaining your risk of a cardiac ‘event’ in the next 10 years. This is worked out by a computer algorithm using the above information.
 A low QRisk score of less than 10 per cent means that you have less than a one in 10 chance of having a stroke or heart attack in the next 10 years and a ‘high’ QRisk score of more than 20 per cent means that you have at least a two in 10 chance of having a stroke or heart attack in the next 10 years. Your doctor will then discuss treatment options with you.
You will be told your results and advised on any lifestyle changes you need to take to improve your score – this could include advice on stopping smoking, diet, and increasing your exercise levels. If your results indicate you need medication, you’ll be referred for an appointment with a qualified doctor. Following your first check, you’ll be invited for another check every five years until you’re 74.
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