Starting a dialogue about weight with patients who are overweight or obese is not easy. Many health care professionals are hesitant, even when it’s a motivating factor in a patient’s decision to make an office visit in the first place. However, with more than two-thirds of adults in the United States considered to be overweight or obese—many of whom have related conditions (eg, diabetes, cardiovascular disease)—the stakes are too high not to.
Many factors may prevent health care professionals from initiating these conversations, says Scott Kahan, MD, director of the National Center for Weight and Wellness and medical director of the STOP Obesity Alliance, a coalition of consumer, provider, business, and government organizations. “Mostly, this is tied to a lack of comfort in obesity counseling or insecurity about knowledge and ability,” he says.
Kahan and the STOP Obesity Alliance offer providers several useful tips to initiate these conversations.
Weight is a sensitive topic for many patients, says Kahan. You can start simply by asking your patient whether it’s okay to discuss weight. Then listen. “This puts the patient in control and lets him feel like you understand,” he explains. “It’s an easy way to break the ice.”
Choose Your Words Wisely
Avoid stigmatizing language. Words like fat and diet may have negative connotations for your patients. Instead, use terms such as unhealthy weight and eating habits. Kahan explains: “Neutral terms and ‘people-first’ language are going to be more productive.”
Some patients want to avoid developing diabetes, whereas others are concerned about physical or lifestyle limitations. Motivational interviewing can help you identify and appeal to your patient’s motivation for change.
Environment, genetics, and physiology can affect whether a person is overweight or obese. Talk to patients about their home and work environments, understand that genetics can predispose people to weight gain, and recognize that physiologic changes such as a slowed metabolism can wreck the best of intentions.
Do not expect to solve the problem in a single encounter, Kahan says. Keep the interactions short, think of each as an opportunity to build a long-term relationship, and collaborate on developing a treatment framework.