How To Discuss Weight With Your Patient

Over the next little while, I will be taking a few days off and so I will be reposting some of my favourite past posts. The following article was first posted on Sep 16, 2011:

One of the reasons that many health professionals do not bring up the issue or weight, is simply because they feel uncomfortable doing it.

So what is the best strategy and what does the research on this issue actually show?

This topic is a significant part of a new Scientific Statement From the American Heart Association, endorsed by the Society of Behavioral Medicine, published in the latest issue of Circulation.

Based on a systematic search of the literature on this topic (published between 2002 and 201), it is clear that patients describe a need for empathy, nonjudgmental interactions, and specific personalized recommendations.

As regular readers will recall, this is actually rule 1 of my 10 tips for family docs, and if nothing else, this is the only rule that all health professionals should adhere to – always!

While some patients associate even the word “obese” with discrimination, patients rate “‘weight” as the most desirable term, and “fatness” as the most undesirable term.

In my practice, I often also use the terms ‘large’, ‘size’, or ‘big’ and have never had a negative response – much of how you use the language is determined by the general ‘non-judgemental’ manner in which the words are used. When I do use the term ‘obese’, I generally explain that I am using this ‘clinically’ as the ‘medical’ definition.

“Patients also express a preference for clinicians taking time to deliver weight loss counseling, rather than offering weight loss advice as an afterthought as they leave the room.”

“The importance of verbally recognizing patients’ small weight losses as well as their unsuccessful weight management efforts was also noted, because nonrecognition by providers was seen as a judgment that the patient did not care or was not making an effort toward weight loss.”

I generally do acknowledge changes in weight, but do not make them the topic of discussion unless I am specifically asked. Any comment would always be objective, non-judgemental and generally encouraging, no matter what – even a small weight gain could be worse!

When the patient brings up and insists on discussing the weight – this is always a good opportunity to explain (once again) that obesity management is not about weight loss and what is really important are the behaviours (weight loss is NOT a behaviour).

“Patients expressed an interest in hearing about how their weight was affecting their specific medical conditions (or risk for conditions) and an interest in receiving specific recommendations from the individual provider on how to lose weight rather than just broad statements about the need to lose weight.”

“Finally, physician recommendations related to diet and physical activity were more effective (ie, associated with greater likelihood of patient behavior change) if patients were given the chance to reflect on causes of their overweight during counseling visits and their own perceptions about weight management were incorporated into the recommendations.”

Yup, it never hurts to ask and listen to your patient.

“Beginning a conversation about weight is challenging and may be especially difficult if there are no readily available and affordable resources for patients genuinely interested in losing weight.”

This is definitely a problem, as most resources are either generically useless (focussing almost exclusively on “eat-less-move-more” platitudes) or consist of BMI charts and other material that is hardly useful. Of course, the fact that the ‘weight-loss’ industry is in the business of selling ‘weight-loss’ and is not in the business of providing obesity treatments, is a fine point that many patients (and professionals) find difficult to understand.

Overall, this is certainly an issue that will continue to prove challenging simply because most health professionals do have significant weight bias, tend to stereotype their obese patients, and too often have little more than a lay man’s knowledge of obesity themselves.

I am sure that readers will readily recall instances where communication on this topic could have been better.

London, UK

Rao G, Burke LE, Spring BJ, Ewing LJ, Turk M, Lichtenstein AH, Cornier MA, Spence JD, Coons M, & on behalf of the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Clinical Cardiology, Council on Cardiovascular Nursing, Council on the Kidney in Cardiovascular Disease, and Stroke Cou (2011). New and Emerging Weight Management Strategies for Busy Ambulatory Settings: A Scientific Statement From the American Heart Association * Endorsed by the Society of Behavioral Medicine. Circulation, 124 (10), 1182-1203 PMID: 21824925