Sir, the obesity crisis within the UK, particularly in Scotland, has drawn large media coverage over the last decade. The World Health Organisation has identified obesity as a chronic disease.1 Those with an increased Body Mass Index (BMI) often suffer from a range of comorbidities including heart disease, hypertension, diabetes and more recently have been shown to have poorer outcomes following COVID-19.2,3 Dentists are knowledgeable regarding the oral consequences of these conditions, alongside the effects upon general health.

The impact of lockdown upon obesity cannot be ignored. Following a reduction in dental provision many patients have required re-assessment for dental procedures, in particular conscious sedation. Safe sedation within the dental setting is recommended for those with a BMI <35kg/m2. Reassessment has highlighted an increasing number of patients around or above this threshold, who prior to the lockdown period, were assessed suitable for dental-setting sedation. Assessment also identifies other parameters of significance: hypertension or reduced oxygen saturations, alongside anatomical complicating factors, such as airway management.3

An observation within the last year has highlighted an increased number of younger and otherwise healthy patients of an increased BMI who cannot be accommodated by a standard dental chair.3 Although frequently accustomed to discussions offering healthy choices regarding sugar content, practitioners may be less well-versed in the sensitive discussion of weight and implications upon other health conditions. Dental practitioners regularly review patients and as such often gain a level of rapport due to frequency of visit. This poses the question of the dental team being gatekeepers to weight management services. Do we have a duty of care to liaise with and inform our, often less visited, medical colleagues of these findings? Policies, guidance and training, supported by published evidence, need to be put in place to support practitioners in these discussions.