Why Weight? Guide
A guide to discussing obesity & health with your patients
Created by the Strategies to Overcome and Prevent (STOP) Obesity Alliance, the Why Weight? tool is a guide for health care professionals to initiate effective conversations about weight and health with their patients.
Weight is a complex and sensitive issue, and conversations about weight can be challenging. Many factors are at play, not least of which may include feelings of failure, shame, and concerns about being judged by health care providers. Many providers have concerns about how to begin conversations about weight, what words to use, and how to communicate about weight while supporting their patients in ways that are empowering and nonjudgemental. Providers report minimal, if any, training on obesity, inadequate resources for effective conversations, and insufficient clinical time to devote to conversations about weight.
Why talk about weight?
Many patients want and expect weight loss guidance from health care providers. Weight-related discussions with providers can influence patient engagement in weight loss efforts. Having the conversation and formally diagnosing and documenting overweight or obesity strongly predicts having a treatment plan in place and subsequent weight loss success.
The United States Preventive Services Task Force (USPSTF) guidelines recommend intensive, multicomponent behavioral interventions for patients with BMI of 30/kg/m2. The recommendation is largely based on a 2012 systematic review that showed intensive counseling led to an average 6% body weight loss, along with improved comorbidities and cardiovascular disease risk factors.
Why isn't addressing obesity about eating less and exercising more?
Understanding the complexity of obesity is an important prerequisite for productive conversations about weight. Provider misperceptions about causes of and contributors to weight gain and obesity can lead to blaming and shaming patients for their weight difficulties, undermining productive conversations, and provider-patient relationships.
While providers cannot manipulate a patient’s genome or his/her environment, knowing that these factors can contribute to difficulties managing weight is essential to building an informed and empathic approach to talking with patients. It is also important for providers to recognize the biology opposing weight loss. In our obesogenic environment, weight gain is common and sustained weight loss is difficult.
What are the barriers to talking about weight?
Lack of time, reimbursement, training, and effective tools and treatments are among them. The first and perhaps most important barrier is not knowing effective ways to initiate and continue productive conversations about weight management.
Why don't patients with obesity seek help?
Many patients avoid or delay medical treatment due to concerns that their providers will not treat them with compassion and respect, or that their struggles will be dismissed as “not trying hard enough.” In other cases, patients are concerned that their provider’s office will lack the equipment to properly accommodate them. Patients also may avoid seeking help from providers because they feel that their providers don’t have insight on their condition or can’t provide sufficient counsel.
What is holding a patient back from addressing their excess weight?
Most patients with obesity have tried – often repeatedly – to lose weight and improve their health. At any given time, patients may be in one of five stages of behavior change: pre-contemplation, contemplation, preparation, action, or maintenance. Assessing patients’ stage of change can help determine how to assist them in moving forward. Repeated weight loss and weight regain emphasizes the need to focus on sustaining weight loss from the outset of therapy.
Why should I attempt to undertake a disease as broad and challenging as obesity?
Obesity treatment may feel like a futile undertaking. Yet, there is a range of effective and evidence-based treatments available. With excess weight affecting more than two-thirds of U.S. adults, providers are in a position to create a positive impact. Moderate, sustainable weight loss, such as 5-10% sustained weight loss, can have a positive effect on health improvements.
What can I learn about my patient to help us engage in a productive discussion?
Health behavior decisions are heavily influenced by our environments and social norms. Taking some time to learn about your patients’ everyday lives, including their home and work environments and families, can lead to better understanding of the challenges they face and inform conversations about weight.
What are some important considerations I need to know before I talk to my patients about weight?
Recognize that weight is about health, not appearance. Be aware that weight is a personal and often sensitive topic and tailor your interactions and words in ways that are productive, not stigmatizing. Be aware of your own attitudes toward weight and obesity, so that you can compassionately interact with patients on matters of weight.