Why Weight? Tool Content
A guide to discussing obesity & health with your patients
This page provides a summary of the Why Weight? discussion tool. To view the entire section within the guide, download the PDF.
Why Should Providers Discuss Weight With Patients?
Health care providers are uniquely situated to address overweight and obesity. Many patients want and even expect weight loss guidance from health care providers. Patients seek a trusting relationship with their providers, and many choose providers whom they believe have the confidence to raise difficult issues like obesity. In one survey, 85 percent of patients said they look for information about how to achieve and maintain a healthier weight on their own, and yet 57 percent of those trying to lose weight feel discouraged because of unsuccessful attempts to lose weight in the past.
Overcoming Barriers to Create Opportunities to Have Conversations About Weight
Providers report several challenges and barriers to addressing weight with their patients, as described below. While these are real concerns, many of these barriers are being addressed by structural changes in our health care system and new discoveries in obesity management.
Opportunity: While time limitations are relevant challenges for many clinical goals, including obesity management, productive interactions can be relatively short. Initial discussions will set the stage for ongoing conversation. Further, strategic use of a team-based approach, such as including dietitians or nurses and referral to obesity specialists, internet resources, or commercial programs, can extend providers’ impact.
Considerations for Fostering Effective Communication About Weight and Health
Many patients avoid or delay medical treatment due to concerns that their providers will not have furniture, equipment, or an environment that accommodates their needs. In a typical primary care setting, a significant proportion of patients are too heavy to fit into office furniture and medical equipment. In fact, recent data show that 14 percent of American adults have BMI > 35 kg/m2, the equivalent of carrying 75 lbs or more excess weight.
Beginning the Conversation
Weight and obesity are sensitive and personal topics. Discussing weight can be a difficult experience for the patient, leaving him or her open to feelings of embarrassment, fear, and blame. Start by listening. For patients who have not had experience with weight loss efforts, this may be the first time they have ever discussed their weight.
While many patients with overweight or obesity likely have attempted weight loss previously, there are also those who do not consider their weight to be a problem. For these patients in particular, it may be helpful to assess their readiness for behavioral change in order to inform the conversation.
Many providers express concern about offending patients by bringing up the topic of weight. There are many techniques to help start these conversations. For example, motivational interviewing (MI) is a collaborative, goal-oriented style of communication designed to assist the patient in attaining specific goals within an atmosphere of acceptance and compassion.
The Importance of Managing Expectations and Setting Goals
It’s important to work with patients collaboratively to develop weight and health-related goals. Many patients have unrealistic expectations of how much weight they will be able to lose. One study demonstrated that patients expected to lose nearly one-third of their body weight with diet and exercise, which is more weight than the average patient loses even with bariatric surgery.
Listening to and Understanding a Patient’s Situation and Context
Our choices and decisions are heavily influenced by the environment in which we live. Taking time to learn about patients’ everyday lives, including their home and work environments, interpersonal relationships, family dynamics, stressors, and cultural preferences, can lead to better understanding of the challenges they face and a more informed perspective from which to support them.
The Impact of Trauma and Need for Trauma-Informed Care
Studies largely have confirmed the association between traumatic childhood experiences or abuse and the development of eating disorders and obesity, especially severe obesity. One manifestation of this is binge eating disorder, which is three or four times more common in patients who report a history of childhood sexual abuse.
You may worry about how your own weight or health habits impact the discussion you have with your patient. Body image and concerns about weight affect all of us. Yet it’s important to remember that weight is about health, not appearance.