Confession, they say, is good for the soul. True or not, I’ll leave that to the theologians and places of worship. I don’t think it has any place in the medical appointment.  We have to be very clear here that tell me in a factual way what has been going well – and not so well – is really important.  I definitely want to know how things are going  – but we don’t need to assign guilt, blame, shame, or moral failing to this.

When it comes to blame, guilt, and internalised stigma, I find too often that patients bring it with them into an appointment. Patients shouldn’t feel they need permission or absolution if they haven’t made the healthy choices they need to. It’s my job to figure out the Why: “Why isn’t the plan we put in place working?” and the How. “How to we make this easier to do?”

These are really important discussion to have, especially as we mark World Obesity Day this week.   Patient blaming and patient shaming – something too often experienced by those living with obesity – does nothing to promote health, or to build that important Doctor-Patient relationship 

As we approach March weekends full of celebration –   Mother’s Day brunches, 6 Nations matches, St. Patrick’s weekend nights out, Easter  lucnhes – the flip side of this is that we need to have a better understanding that, as understanding as I may be next month in clinic, your liver is unlikely to grant you the same absolution later after binge drinking. Going dry for the next month after or an ill-advised and pointless “detox” is not the penance your liver is looking for.

Likewise, I encourage my patients to make their own informed choices.  I advised a patient recently that their medications would react poorly with certain foods and alcohol.  They contacted me a few weeks later, making an excellent case for why they deserved to indulge at an upcoming event.  It was a moving and emotional argument.  However,   I simply pointed out that their medication, however, did not have an appeals process and that they are quite likely to be in for a rough morning-after if they choose to indulge anyway. My role here is merely to advise and inform – I can’t grant absolution from the rules of simple biochemistry anymore than I can from gravity.

If you’re looking forward to indulgences in the coming weekends, best advice is:

• There are no “bad” foods.  Food does not have a moral value.  However, if you have a food that you have been advised not to eat for any number health reasons – from irritable bowel to diabetes to reflux to triggering migraines  –  it’s best to come up with an alternative. You’ll feel better. It’s not “good” – just sensible.

• Regardless, just keep it in moderation. Honestly.  

• If you are having family or friends over, ask about any dietary needs.  If you are someone who has dietary needs, be empowered to say no thank you to something you know will cause problems. You are never obligated to explain your health condition to anyone. (if pressured try:  “I’d rather not get into my health today, if that’s okay.  It’s nothing to worry about but my doctor recommended I avoid certain foods/alcohol.”)  And, if you are offering someone food, remember they are not obligated to explain their health condition  — or reasons for not drinking –  to you, either.

• Stick to low-risk drinking limits.  Know them, stick to them.  That’s what you liver can handle.  Women: Less than 11 standard drinks (110g pure alcohol) spread out over the week, with at least two alcohol-free days. Men: Less than 17 standard drinks (170g pure alcohol) spread out over the week, with at least two alcohol-free days.  Common examples include a half pint of 4.5% lager, 100ml glass of 12.5% wine and pub measure of 40% spirits, but it is always well-worth doing your calcuations of your favourite tipples over at Drink Aware.

• There is no magic hangover cure.  Read More on Mythbusting Hangover Cures

• No time for your work-out because of festivities?  Ate take-aways every weekend in March?  Exceeded your recommended safe drinking limits for the entire month?  You weren’t “bad“.  These things happen.  Ditch the guilt — but do engage with your doc to get support making a plan going forward.