Primary Care Doctors: Raising Weight Concerns with Patients

By Nancy Wurtzel

The U.S. is in the middle of a health crisis with roughly two-thirds of adults considered overweight or obese.  While these numbers are increasing, the actual percentage of primary care doctors willing to tackle the issue is on the decline.

“The vast majority of doctors have little or no training in weight management and nutrition and, they say, they’re not likely to have anyone else in their practice who can be of help,” wrote Roni Caryn Rabin in The New York Times “Well” Section.

Surprisingly, even new residents coming out of medical school often lack the basic facts of obesity and do not have the skills to provide patients with a proactive plan of treatment.  Their training may have been simply, “Eat Less, Exercise More.”  As a result, physicians avoid the topic altogether.

However, this silence on the part of the physician is not helping patients.  After all, a doctor would not be silent about heart disease, skin cancer or other diseases that can often be treated through positive behaviors.

Granted, tackling highly-sensitive issues such as weight is not easy.  Weight management is not a topic that can be comprehensively discussed in just a few minutes.

Since patients are not apt to bring up the topic on their own, the burden is usually on the health care professional to take the lead.

A good place to begin is to tell the patient you are concerned about their weight.  Next, demonstrate respect by asking if it is okay to have a conversation about their weight as it relates to their health.  If tests have not already been completed, mention you would like to rule out any medical problems, such as hypothyroidism and other conditions.

The vast majority of patients already know they are overweight, so this will not be news.  However, a small number of patients may be in denial, even expressing surprise when the topic is broached.

Either way, language choices are important during this conversation.  Physicians can use more neutral terms and still get their point across.  Words and phrases such as, “excess weight” and “above ideal body weight” are better choices than “morbidly obese” or “very fat.”

When it comes to weight, the approach, attitude, and words all matter to the patient.  If the patients senses you are using shame, it will be a turn-off.  Empathy reduces defensiveness and will get better results.

How doctors talk about weight was the focus of a 2013 Johns Hopkins internet survey  of 600 adults.  Researchers revealed overweight and obese people who feel their physicians are disapproving of their size are more likely to attempt to shed pounds but are less likely to succeed.  In other words, doctors can spur a patient into making a short-term weight loss, but it doesn’t translate into long-term success.

“Ideally, we need to talk about weight loss without making patients feel they are being judged,” said John Hopkins study leader Kimberly A. Gudzune, M.D., M.P.H.  “It’s a fine line to walk, but if we can do it with sensitivity, a lot of patients would benefit.”

One way to have a non-judgmental conversation with patients is to ask open-ended questions such as:

• “What are your thoughts about your weight?”
• “Are you interested in learning more about weight management?”
• “What are your weight and health goals?”
• “What tools do you need to reduce your weight?”
• “What other kinds of help do you think you need to be successful?”

During the conversation, emphasize the positive aspects of getting healthy, such as more energy, better sleep and living longer.  Explain terms such as BMI, and don’t assume the patient knows everything you know.  Discuss goals and obstacles in realistic terms and stress that weight management is an ongoing process.

Offer proactive options and suggestions at the ready, such as brochures, online tools, food diary, patient health-insurance programs, dietician recommendations, buddy programs, exercise ideas, and improved eating choices.  Seek out dieticians and other weight management professionals for a referral.

Another excellent resource is an online program The STOP Obesity Alliance which offers a free 22-page “Why Weight” program.  The free, downloadable program is chockfull of tips and ideas for weight management.

Begin and end all conversations about weight with an emphasis on health, rather than a number on a scale.  The ultimate goal is to motivate and empower the patient to take charge and improve their health.