How to discuss obesity with your patient

Weight is an extremely important issue in western society with prevalence of obesity ever growing. Being overweight or obese is an important risk factor for conditions including diabetes and hypertension. As a result tackling the weight issue is extremely important from a medical point of view.

However, our views on body image mean that weight is often a very personal and sensitive issue. Because of this, addressing the issue of weight in an overweight or obese patient is often very tricky. The result is that health care professionals are often reluctant to bring up the topic of weight. A recent study of GPs in the UK found that that only a third brought up the issue of weight routinely with their overweight or obese patients.¹ Another study found that only a quarter of overweight or obese patients who went to their GP received dietary or exercise advice.² Sometimes patients will go to their health care professional with the goal of losing weight and will bring up the issue by themselves. This makes it very easy to give such patients good dietary and exercise advice, however, the majority will not bring this up by themselves. On the other hand, this does not mean that patients are afraid to talk about weight or that they do not believe they need to lose weight. A study of overweight and obese patients in the US found that only 24% of overweight (BMI 25-30) and 49% of obese (BMI 30+) had discussed weight with their doctor. However, more then 95% said that they would be comfortable talking about their weight to their doctor. 80% of the overweight and 95% of the obese patients stated that losing weight was very important to them as it would improve their health and or their happiness.³
 
The main reasons that make health care professionals reluctant to raise the issue of weight are:¹

• Fear that the patient will react emotionally or become angry;
• Fear that the patient may be tired of hearing the same message repeatedly;
• That the relationship with the patient may become impaired, resulting in the patient becoming alienated from health care services; or
• Fear of exposing psychological problems. 

As weight is such an important health issue and almost all patients are actually willing to at least discuss their weight it is very important not to avoid raising the topic. For the best results the topic needs to be raised in a sensitive way.
 
One way to raise the issue is outlined below:^4,5

1. Always address the patient’s presenting complaint first, without bringing up weight, even if their current problem is being caused by their excessive weight.
2. Include weight measurement in a standard set of observations (for example start with pulse, blood pressure, listen to the heart, measure height and then weight). Often this is already done by the practice nurse but if not it is a good way to begin.
3. Broach the topic of weight with an open ended question such as ‘we have not talked about your weight for a while, what are your thoughts about your current weight?’ Do not immediately blame all the patient’s health problems on their weight or attempt to use scare tactics such as ‘if you do not lose weight then you will have a heart attack’. Although said with good intentions it may alienate the patient and may be offensive.
4. Set a weight goal. This should be a sensible goal such as a 5-10% reduction in body weight over 6 months. Enquire about any previous weight loss attempts. Also highlight the benefits of weight loss, such as a reduction in blood pressure or better blood sugar level control.
5. Give the patient some education about dieting and exercise. Give the patient some straight forward, easy to follow advice about good diet and the required amounts of exercise. Some patients may benefit from a referral to a dietitian if they have specific dietary requirements.
6. Good follow-up of the patient is very important. At follow-up, ask about the patient about adherence to their diet and exercise plans. Provide plenty of encouragement to patients to further motivate them.  

It is important to set aside enough time when dealing with weight issues as this cannot be done properly as just a side note in a standard consultation.
 
Some patients will not be ready to confront their weight or to do anything to change it. In these patients it is very important not to ignore the issue. For such patients it may be worth starting by just planting the idea in their minds. For example, measuring their weight on a regular basis to get them more comfortable at first and then broaching the issue at a later date when they will be ready to address the issue and to change.⁶
 
Weight can be a very sensitive topic but it is also a very important one. For this reason it is important to raise the issue of weight with all overweight or obese patients. If done in a sensitive manner most patients are willing to discuss their weight and to receive advice about how to help lose weight.
 
References:

1. Michie S. Talking to primary care patients about weight: A study of GPs and practice nurses in the UK. Psychology, Health & Medicine 2007; 12(5): 521 – 25.
2. Klumbiene J, Petkeviciene J, Vaisvalavicius V, Miseviciene I. Advising overweight persons about diet and physical activity in primary health care: Lithuanian health behaviour monitoring study. BMC Public Health 2006; 6: 30-6.
3. Potter M, Vu J, Croughan-Minihane M. Weight Management: What Patients Want from Their Primary Care Physicians. J Fam Prac 2001; 50(6): 513-20.
4. Weight Control Information Network. Talking With Patients About Weight Loss: Tips for Primary Care Professionals. National Institutes of Health. 2007.
5. Wadden T, Stunkard A. handbook of Obesity Treatment. Guilford Press. 2002.
6. Perrina E, Finkleb J, Benjamina J. Obesity prevention and the primary care pediatrician’s office. Curr Opin Pediatr 2007; 19: 354–61.