For those patients who meet the criteria for obesity or overweight, intensive therapeutic counselling on behavioural changes can be an effective part of weight management. Empathetic and supportive counselling can help patients to address the challenges of weight management.1
Click on the sections below to explore talking points and resources to help shape your discussions with your patients.
Studies have shown that productive conversations between healthcare professionals and patients help people living with obesity to be successful with their weight loss goals.3
Studies have also shown that when physicians advised patients living with excess weight or obesity to lose weight, to change their eating habits, or become more active, they were more likely to do so than if not.3 While frequent discussions about weight management are helpful with patients, it is the quality of the discussions that actually leads to behavioural changes.4
The complex and sensitive nature of obesity can make it difficult to discuss with patients. Taking an empathetic approach, and obtaining the patient’s permission and buy in throughout the conversation can be effective.2 Research has shown that when healthcare professionals employed such an approach, patients were more likely to implement lifestyle modifications for weight loss. It is important to first ask patients for permission to begin the conversation about excess weight.
Start with a general opening question, such as:2
Tell me more about why you've come here today.
Do you have any other health concerns that you'd like to talk about?
Tie it to symptoms or other problems that the patient stated:
Carrying excess weight can be a cause of some of your health concerns. Do you mind if we talk about how weight management could help with this problem?
Do you think your weight might be contributing to the problem that you're having?
Refer to other clinical measures:1,5
I notice that your body mass index, or BMI, is high, which means you are carrying excess weight for a person of your height. This can affect your health. Is it okay if we talk about your weight?
If we can review your previous test results for a moment, I think it may be beneficial to discuss how weight management would help to improve some of these results in the future.
Regardless of a patient’s readiness to take action to address his or her weight, it is recommended that you assess for the health risks associated with excess weight.1
Advise your patient on how even a weight loss of 5% to 10% can improve his or her health by improving glycemic control, blood pressure and lipid levels.1
Talking points and questions:
Do you have any questions about what it means to have a high BMI?
"BMI is a measurement that helps determine if a person is carrying excess weight for his or her height.5 BMI isn't a complete measure of health, so we look at other measures like waist circumference, blood pressure, and cholesterol levels that indicate what should be addressed about your health.1"
"Because of your weight, you are also at risk of developing several weight-related complications including diabetes, high blood pressure, and dyslipidemia.1"
"Weight loss of as little as 5% of your body weight can help to improve your health by improving blood pressure and lipid levels.1,6"
"Achieving 5% weight loss is a process that begins with making a few specific behavioural changes to your eating habits and increasing the amount of physical activity. We can reassess in 3 to 6 months and discuss other treatment options at that time.1"
"I can support you in your efforts to improve your health and lose weight. Is that something you would like?"
After initiating a discussion about weight and the risks of excess weight, explain that the next step could be to take a weight history in order to set goals for individual weight management.
A weight history discussion is intended to complement a full clinical and physical assessment to identify metabolic, genetic and hormonal factors as well as medications that may be the reasons for weight gain. A successful weight history discussion can result in:1
Assessment of root causes that influence eating and activity behaviours7
Understanding of past efforts, challenges and successes with their weight management journey7
A basis for individual behavioural goal setting
Main components and goals of a weight history discussion
The following talking points and questions may be helpful to achieve a successful weight history discussion:
Changes in weight over time
Each patient will have gained weight differently. Understanding how and why their weight has changed can provide insight into their weight gain triggers.7
Factors in weight changes
This discussion involves eliciting your patient's perceptions of causes as well as connecting any past medical causes to changes in weight.7
Descriptions of past weight loss efforts
Discuss and understand your patient's past efforts with weight loss, including specific programs or plans, duration, and results.7
A discussion about your patient's current eating and activity habits and how they might feel about changing their current habits.8
It may be helpful for patients to chart their own history of weight changes over time. This can help facilitate a discussion of appropriate treatment options for the present and future. People gain weight differently over time. Have your patients chart their history with weight changes and the events that were related to those changes on a piece of paper.
See below for an example
A discussion about goal setting is a way to help your patients connect their goals with the behavioural changes they can make for better weight management. Align with your patients on realistic and individualized goals as a first step towards creating sustainable long-term changes in behaviour.1,2 Try setting goals that are connected to your patients’ values and objectives. For example, connect the goal of engaging in more physical activity to activities they can do with their children or family, such as going for a walk once a day.
It can be helpful to refer to the responses for the talking points and questions above, about how weight may affect your patients’ medical, physical, emotional, and day-to-day well-being, and their lifestyle goals and plans.2
There are several things you can do, such as working with your patients to help them set lifestyle goals. To begin the process, here are some questions to consider asking:
Focus on sustainable behavioural changes rather than on specific weight targets. Behavioural goals should be SMART: Specific, Measurable, Achievable, Rewarding, Timely. When you are finished discussing the goals, consider establishing a follow-up plan for future appointments.
Guide patients to set specific goals for changes to behaviours or habits for healthy eating, or activity levels.
Ask how they will measure their progress toward achievement or know when they have achieved their goals.
Discuss how confident they feel about achieving their goal. This is a chance for a reality check to revise the goal if patients don't feel confident that the goal is achievable.
Ask about how initial goals are rewarding to your patient.
Place a relatively short time frame on the initial goals and revisit whether they are achievable in that time frame.
When discussing treatment for weight management with your patients, incorporating healthy eating and activity habits should be included along with other options available, such as medication and/or surgery.1 Patients who have struggled with excess weight may take some time to adopt new healthy habits. As you approach the topic of healthy eating and physical activity with your patients, focus on achievable steps that patients can take toward sustainable lifestyle changes.
Patients could also keep a food and physical activity journal to help them stay on track with these behavioural changes. They can record things like:
By recording the situations and feelings in which people living with obesity make decisions about food, you and your patients may be able to identify areas for change. Patients can bring their journal to each appointment to discuss general patterns. Healthcare professionals are encouraged to provide positive feedback and celebrate any progress made with the patient’s lifestyle changes.
Consider which options might best serve your patients and explore the decision-making process with them. A discussion about clinical weight management should help patients to understand:
The Canadian obesity treatment guidelines provide recommendations for patients living with obesity or overweight. After reviewing the guidelines, consider which options might best serve your patients and explore the decision-making process with them.
Patients who indicate a higher level of motivation or readiness may be more open to discussing specific treatment options and follow-up plans. Consider each patient's weight history and current situation to determine a follow-up plan for treatment. Follow-up plans should include:1
Assistance in identifying additional drivers and barriers for weight change
Use of credible educational resources
Referrals to appropriate healthcare professionals
Weight management appointments
Scheduling weight management appointments
Patients with obesity or overweight have a lifelong disease that will need frequent and ongoing appointments to monitor progress and make adjustments to treatment as necessary. Evidence indicates monitoring and supporting patients through follow-up appointments—whether they be in-person, over the phone, or patient support programs associated with pharmacotherapy, can have positive effects on weight management.9
Research indicates that patients with excess weight feel stigmatized in many areas of their life, including healthcare settings.1,2 The language you use and your environment are two key components to successful weight management. To promote successful interactions with your patients, it is important to consider the following:2,5
Studies have shown that effective conversations with healthcare professionals can help patients be more successful with their weight loss goals.1 Research has shown that choice of words plays an important role when discussing weight management.10 Certain words should be avoided and other words can have different implications in a different context:
|Terms to avoid:10|
|Fat or fatness|
|Unhealthy body weight |
Obesity and obese are both clinical terms intended to describe a patient’s condition but can also sound judgmental or labelling in a different context. Referring to a patient as "obese" is something to avoid.
People living with obesity can experience weight bias and stigma in a variety of settings, one of which being in a doctor’s office. You can help to combat this by ensuring your office is appropriately furnished for people with obesity.1,2,5
In order to diagnose obesity, you will be required to measure your patient’s waist circumference and/or weigh them. Below are a few tips on how to do this in a respectful manner.5