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The health benefits of sustained weight loss for persons with obesity could be a valuable topic when a discussion is opened.
Weight and health is a fraught subject for primary care providers. It’s intensely personal for the patient. On top of that, popular culture bombards a person living with obesity on this subject almost endlessly. Well-meaning friends and family offer unsolicited advice and non-verbal cues about their weight status. Though Al Roker lost more than 100 pounds after gastric bypass surgery in 2002, he advises people that offering unsolicited advice about weight is a really bad idea:
"Look, here's the deal. If someone asks you, then that's fair game. People who are overweight don't want unsolicited advice. Guess what? We know we're fat. We live in homes with mirrors."
Ask first, then listen
So the best place to start a conversation with a patient about weight and health is to ask and listen first. Is this something they want to talk about? If not, a conversation is likely to do more harm than good for the patient-provider relationship. But if so, the provider can start on solid ground with a patient who may be ready to address an important health risk.
This approach is grounded in the framework of 5 A’s for obesity care, which evolved from guidance for patient counseling on smoking cessation: Ask -> Assess -> Advise -> Agree -> Assist.
Evidence for heatlh benefits
New research continues to support the health benefits to people with obesity when they achieve and maintain at least a modest reduction in body weight. Depending on a patient's health status and receptivity to this type of information, it could help support the decision process.
Recently, a team of health researchers examined more than half a million UK patient records. These were all records of people living with various degrees of obesity. Also, they had evidence in their records that they were trying to lose weight. After 4 years, roughly 10% of these patients had indeed lost weight and maintained a weight that was 10% to 25% lower than their initial weight.
The results are not surprising. The biggest risk reductions came in type 2 diabetes, blood pressure, and cholesterol. For sleep apnea, the data suggested some reductions, but some risks remained. The story was similar for osteoarthritis. In the case of unstable angina and heart attacks, these data provided no evidence for a benefit.
These data, presented in September at the European and International Congress on Obesity (ECOICO 2020), confirm other research that supports the health benefits of sound obesity care. Even conservative approaches with behavioral support can reduce the risks of type 2 diabetes. More aggressive treatment with bariatric surgery may prevent premature death, major cardiovascular events, and serious complications such as cancer.
The benefits of managing the risks of obesity can be important. But remember that any clinical conversation about the subject must begin with respect for a patient’s needs and preferences. To do otherwise can eliminate the possibility of any real benefit to the patient and increase the harm they experience from obesity.