Addressing weight issues with patients can be tricky, but these 8 tips can help make that awkward conversation a little easier.
1. Ask permission. The NIDDK guide to talking with patients about their weight suggests asking the patient’s permission before opening the subject of weight. “May I talk with you about your weight today?” or “How do you feel about your weight?” can be respectful ways to initiate the conversation. If the patient is unwilling to go there, William Dietz, MD, PhD, Professor and Director of the STOP Obesity Alliance at The George Washington University, suggests saying something like, “I understand this might not be the best time, but I want to be sure you understand the risks.” Unless the patient’s health requires immediate intervention, you may have to go slowly.
2. Make time. Lack of time can also be an obstacle to having this conversation. “In primary care setting, you have limited time with patients, and there are lots of things to talk about,” says Prianka Chawla, MD, primary care physician at Tufts Medical Center. “Often these are related to the weight problem: diabetes, hypertension, joint pain, even infertility.” It’s important to talk about these issues first-and separately-even if excess weight does contribute to them. But this doesn’t leave much time to talk about the weight problem. “It is ideal,” Chawla says, “if you can set aside an entire visit to talk about weight.”
3. Create a safe space. Prianka Chawla, MD, advises creating a safe space where patients can feel comfortable discussing their weight. How to do that? “Allow the patient to bring up their own concerns first,” she says. “Ask about their job, where they live, who’s in their home.” When you do get around to the subject of weight, it will be easier to do this “without assigning any judgement,” Chawla stated.
4. Earn the patient’s trust. “Sometimes patients aren’t ready to open up,” says Dietz. “The advantage of a primary care provider is that they will see the patient repeatedly over time.” This continuity gives you a chance to earn the patient’s trust, and that, says Dietz, is an essential part of the doctor-patient relationship.
5. Don't use "heavy" words. For physicians, the word "obese" has a specific clinical meaning, but for most patients, it’s an insult. “Unfortunately,” says Chawla, “we really don’t have a gentler word. But it is important to explain to patients what the words ‘overweight’ and ‘obese’ mean clinically.” By defining your terms, you can avoid sounding as if you’re insulting or disrespecting the patient. “These terms are also useful in part because certain levels qualify patients for different interventions, such as certain medications or surgery,” Chawla adds.
6. Share the decision making. Giving the patient agency over this problem, rather than simply issuing commands or even offering advice, is much more likely to be effective. “Jointly work with the patient to figure out what to do,” says Dietz. “Don’t say ‘You need to eat better or you need to exercise more.’ Instead ask the patient: ‘What do you see as the things that can be changed?’ Keep bringing it back to the patient. The key thing is shared decision making.”
7. Call in the team. Weight issues are often too much for one doctor to manage; however, there are many resources available to help patients with weight problems. “You can refer patients to a nutritionist or a weight management program,” says Chawla. “You should also refer patients to other specialists, such as an endocrinologist or a bariatric physician, when appropriate.”
8. Get schooled. “Providers themselves have relatively poor training in nutrition,” says Dietz. Use continuing education to get more training in nutrition. If you want to go all in, Dietz recommends the licensing program from the American Board of Obesity Medicine. The more you know about obesity and how to treat it, the more help you can be to your patients.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), ~70% of US adults are overweight. The associated health risks include diabetes, cardiovascular disease, kidney disease, and some cancers.Every physician knows the importance of addressing weight issues with their patients, yet providers often neglect to help patients with weight problems because they don’t know how to initiate the conversation.Â Patient CareÂ® OnlineÂ asked 2 physicians for suggestions on how to make thatÂ awkward conversation a little bit easier. Scroll through the slideshow below for their top tips.