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How do I broach obesity with my patients?

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Engaging in conversations about weight with adult patients is an integral aspect of primary care practice. While these discussions can pose challenges, especially with patients who are overweight or obese, using sensitive and effective communication strategies is key. 

Physician discussing weight with patient
Initiating Conversations About Weight

Engaging in conversations about weight with adult patients is an integral aspect of primary care practice. While these discussions can pose challenges, especially with patients who are overweight or obese, using sensitive and effective communication strategies is key.1 

Research indicates that many individuals who are overweight or obese appreciate guidance from healthcare providers regarding weight management to mitigate associated health risks. However, initiating such discussions may be difficult for some patients.1 

Patients who are overweight or obese may benefit from dialogues concerning weight-loss objectives, lifestyle modifications, available weight-management strategies, and potential treatments such as medications or surgical interventions. Collaborating respectfully with patients can facilitate the attainment and maintenance of a healthier weight.1 

IDENTIFYING PATIENTS FOR WEIGHT-LOSS DISCUSSIONS 

Patients who have, or are at risk of developing, health issues related to being overweight or obese are suitable candidates for weight-related discussions. This risk is elevated in adults who: 

  • Are overweight (BMI 25-29.9) or obese (BMI ≥30)
  • Exhibit a waist size exceeding 88cm for women or 102cm for men
  • Experience metabolic syndrome, high blood pressure, unhealthy lipid levels, or elevated blood glucose levels.1

 

However, relying solely on BMI and waist size may not give the full picture of health risks associated with excess body fat. Therefore, considering additional factors such as age, race, ethnicity, sex, health status, medical history, and cardiometabolic disease risk is imperative in determining the appropriateness of weight-loss interventions.1 

ADDRESSING WEIGHT STIGMA 

Individuals who are overweight or obese frequently encounter negative attitudes, prejudice, and discrimination, including from healthcare professionals. Acknowledging that weight can be influenced by various factors beyond lifestyle choices is crucial during weight-related discussions.1 Negative weight-related stigma can adversely impact individuals by diminishing self-esteem, exacerbating mental health issues, promoting unhealthy behaviours, and deterring healthcare-seeking behaviour.1 

CREATING A SUPPORTIVE ENVIRONMENT 

Establishing a welcoming environment in waiting areas and consultation rooms, equipped with furniture and tools suitable for patients of all sizes, is essential. This includes providing stable, accessible scales, sturdy examination tables and furniture, and appropriately sized gowns and blood pressure cuffs.1 

CHOOSING APPROPRIATE LANGUAGE 

To address these challenges, efforts to destigmatize obesity are essential. The Joint International Consensus Statement for Ending Stigma of Obesity emphasises condemning discriminatory language and policies and supporting initiatives to prevent weight-based discrimination.2  

Using nonjudgmental language when discussing weight is essential to avoid inadvertently causing offence. Instead of using terms like "heavy," "fat," "overweight," or "obese," opt for more neutral phrases such as "weight" or "having too much weight for health."1 

Person-first language emphasises individuals' identities beyond their weight, creating a more respectful and inclusive dialogue.1 Using motivational interviewing and person-first language empowers patients to set realistic goals and engage in their healthcare journey.2 

INITIATING WEIGHT-RELATED CONVERSATIONS 

Approaching weight-related discussions with sensitivity and respect is vital. Begin by addressing the patient's primary health concerns before broaching the topic of weight. Seeking permission to discuss weight and respecting the patient's decision sets a tone of collaboration and trust.1 

ASSISTING PATIENTS WITH LIFESTYLE CHANGES 

Many patients, regardless of their desire to lose weight, can benefit from discussions about healthy eating and physical activity habits. Conducting thorough assessments of eating habits, physical activity levels, weight history, and potential eating disorders is essential.1 

Encouraging patients to set specific, measurable, achievable, realistic, and time-based (SMART) goals for lifestyle changes encourages active participation in their care. Providing ongoing support, monitoring progress, and acknowledging achievements, irrespective of changes in weight, are vital for effective care.1 

ADDRESSING CHALLENGES AND SETBACKS 

Recognising that setbacks are normal and refraining from judgment are important when patients encounter obstacles in their weight-management journey. Collaborating with patients to identify barriers, explore alternative strategies, and adjust goals as needed will assist with resilience and progress.1 

DESTIGMATISING OBESITY AND ENCOURAGING PATIENT ENGAGEMENT 

Obesity is burdened with social stigma that can impact individuals from childhood, affecting various aspects of their lives. This stigma, often perpetuated by misconceptions about laziness and lack of self-control, can significantly influence patient care. Recognising and addressing this stigma within the healthcare community is crucial for enhancing the quality of care provided to patients
with obesity.2 

Early experiences of discrimination due to weight can shape lifelong perceptions and behaviours. Despite healthcare professionals being key influencers in patients' lives, studies have shown that many harbour biases against individuals with obesity. These biases can hinder communication, creating a barrier in the delivery of appropriate care.2 

Research from different countries, including France, Australia, Britain, and Israel, highlights negative attitudes among healthcare providers towards patients with obesity. These attitudes often manifest as frustrations regarding patient motivation and compliance, attributing obesity solely to lifestyle choices, or even perceiving overweight individuals as lazy.2 

The consequences of weight stigma on patient health are well-documented, leading to increased risk of binge eating, reduced physical activity, and heightened stress responses. Stigma also contributes to patients’ reluctance to seek medical care, increasing health risks.2 Tools like the Antifat Attitudes Test (AFAT) can help assess healthcare providers' attitudes towards obesity, fostering awareness and discussion to drive positive change.2 Reframing obesity as a chronic disease caused by multifactorial influences can help shift the focus from personal responsibility to a collaborative treatment.2  

CONCLUSION 

Creating a weight-friendly clinical environment with appropriate equipment and respectful language is crucial for ensuring patient comfort and dignity.2 

Implementing zero-tolerance policies against stereotypical language in the practice and promoting perspective-taking exercises can enhance provider empathy and understanding. Educational interventions, such as obesity simulation suits and lectures, can challenge biases and foster a more empathetic approach to patient care.2 

By implementing these strategies and adopting individualised, multidisciplinary treatment plans, healthcare teams can work towards destigmatising obesity and providing equitable care to all patients.2  

REFERENCES 

  1. NIH: National Institute of Diabetes and Digestive and Kidney Diseases. Talking with Your Patients about Weight. https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/weight-management/talking-with-your-patients-about-weight#:~:text=Ask%20for%20your%20patient's%20permission%20to%20start%20a%20conversation%20about%20weight.&text=For%20example%2C%20you%20may%20want,they%20feel%20about%20their%20weight.
  2. Ginsburg BM, Sheer AJ. Destigmatizing Obesity and Overcoming Inherent Barriers to Obtain Improved Patient Engagement. [Updated 2023 Jan 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK578197/

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