It’s a Tuesday afternoon. So far today, you have seen a 42-year-old female patient who is struggling to keep her blood pressure under control. Another patient, male 64, reports that he visited urgent care over the weekend regarding a foot ulcer connected to his diabetes. And you just diagnosed a young man in his 20s with sleep apnea and referred him to specialty care.
All of these patients are living with obesity, and for all of them weight is the central contributing factor to their chronic health challenges. You want to talk to patients about weight, but are not sure how to address the topic in a way that will lead to open, honest, and productive conversations.
Obesity and the role of the healthcare provider
Obesity is one of the top causes of preventable deaths worldwide, killing nearly 2.8 million people globally and approximately 300,000 people in the United States each year. Over 100 million Americans are living with obesity, or 42% of the U.S. population. Obesity is a leading risk factor for many of the chronic conditions that drive people to seek urgent or emergent medical care – the same chronic health conditions that primary care and specialty practitioners are challenged to help patients manage and improve.
Yet, as healthcare providers, we are often unprepared – or admittedly uncomfortable – having critical conversations with our patients about their weight. A general lack of recognition of obesity as a distinct chronic disease, societal pressures, as well as stigmas associated with weight can make conversations about weight awkward for both providers and patients.
How you talk about weight to your patient helps shape their own perceptions of this disease. You have the power to begin breaking down stigmas and myths that are barriers to patient compliance and receptiveness to change. Talking about weight in a factual, objective, and non-judgemental manner is central to promoting positive health outcomes.
How can we make conversations about weight easier?
- Open with empathy and ask for consent to discuss the condition. Phrases like “could you tell me about your weight” or “what are you experiencing with your weight” allow the patient to start and lead the conversation, rather than putting them on the defensive.
- Make it about the disease, not the patient. Say “you have obesity” rather than “you are obese”. Using language that separates the person and the condition is a first step toward removing stigma.
- Use words like “weight” and “BMI” rather that “fat” or “obese”. And do not use “morbid” in describing obesity. We never use this word in describing other health conditions, so do not use it here.
- Recognize that your patient may not understand obesity as a disease. Assess their knowledge and do your part to educate them on factors influencing their weight – beyond calories and exercise.
Understanding and treating obesity as a disease
Causes of Obesity
Obesity as a chronic, relapsing, and multifactorial disease that cannot be minimized to the “calories in/calories out” mantra. Obesity can have many complex and interrelated causes, including hormone imbalances, genetics, behavioral health, and congenital factors. Some patients, despite their best efforts, have their own bodies competing against their attempts to lose weight.
The Impact of Medications on Weight
Additionally, there are over a dozen different drug classifications that cause weight gain. Medications used to treat psychiatric disorders are a common culprit in causing weight gain or making weight loss more difficult. Drugs to treat diabetes can have similar effects. Knowing your patient’s medications, educating them about side-effects, and working in collaboration with the ordering provider about switching to a weight-neutral drug can assist in weight loss.
Working with Patients
Collaborate with the patient on setting realistic goals and achievable lifestyle change. A five to ten percent weight reduction over time is the standard for healthy and sustainable weight loss that leads to clinically significant health outcomes. For the patient, desirable weight and body size are influenced by culture and background, so measures like achieving a “normal BMI” can feel arbitrary and may not be attainable for most. Nutritional counseling should be done in collaboration with a registered dietitian who can introduce incremental diet change that aligns with your patient’s food preference and is sensitive to customs or traditions that are centered around food.
Celebrate accomplishments with your patients. Focus on the impacts to overall health, such as changes you notice in symptoms related to chronic conditions or clinical factors. Recognize weight loss, as well as inches reduced, increased physical activity or mobility, better sleep, less pain, improved wellbeing, and consistency in lifestyle modifications. Encouragement and motivation will help keep them moving towards long term positive change.
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