Johanna Finkle, MD, on Approaching Weight Loss Discussions with Reproductive-Aged Patients

In an interview at the 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical & Scientific Meeting, May 16-18, 2025, in Minneapolis, MN, Johanna Finkle, MD, offered actionable guidance for clinicians on initiating weight-related discussions with reproductive-aged patients. Speaking with Patient Care, Dr Finkle emphasized the importance of asking patients if they are open to talking about weight, framing the topic around health outcomes rather than numbers alone. She also addresses common barriers clinicians face, including discomfort with sensitive conversations and lack of training in nutrition, lifestyle medicine, and pharmacologic treatment. Her insights aim to empower physicians to engage with empathy, clarity, and evidence-based tools.

The following transcript has been edited for clarity, style, and length.

Patient Care: How do you approach weight loss discussions with reproductive-aged patients?

Johanna Finkle, MD: That’s a great question. The way I described it in my session is that you need to ask patients if they want to talk about their weight—on their terms—and whether they want to have that discussion during the current visit. Annual appointments often come with time constraints and a lot to cover, but weight should be one of the topics addressed.

Just asking the question—“Would you like to talk about your weight today?”—can be powerful. Research shows that this simple inquiry can help patients decide if they're ready to address it. Often, they say yes, and then we frame the conversation in medical terms. Why do we care about weight? Because it has real health implications—it increases the risk of cardiovascular disease, breast cancer, and uterine cancer, among others. Providing that context and some brief education helps. Even a 5% to 10% weight loss can significantly reduce these risks.

Patient Care: What can clinicians learn from that approach?

Dr Finkle: I think a lot of physicians avoid the topic. They worry about stigmatizing patients or simply don’t know how to begin the conversation. Often, they start with, “Your BMI is high,” but many patients don’t even know what BMI means or why it matters.

We need to help clinicians become more comfortable with the language and the why behind the conversation. Asking something like, “Would you be open to talking about this today?” gives the patient a choice and opens the door for future discussions. Even if they say no, it plants a seed—they may come back ready to talk later.

In my practice, many patients do want to talk about their weight. They want to understand how factors like menopause or pregnancy contribute to weight gain. I hear stories about postpartum weight retention or struggles that have persisted for years. These conversations can be emotional, and that’s another reason some physicians shy away—they feel unequipped to manage the complexity.

Also, many of us weren’t trained in nutrition, lifestyle counseling, or the use of anti-obesity medications. I teach newer generations of clinicians who are being trained in these areas, but for many of us, the knowledge gap is real. What nutritional advice should I offer as an OB/GYN? What kind of exercise counseling? What do I need to know about weight loss medications—their contraindications, side effects, and whether I should be prescribing them?

That’s why I gave this talk: to help clinicians feel more comfortable having these conversations and more confident in the tools available to support patients.