Clinicians may feel uncomfortable bringing up the topic of weight with patients who have obesity, assuming their patients do not want to talk about it. However, at least one study found that patients often do want their primary care providers to address their weight concerns (Kirk et al., 2014). A look at what patients having obesity say they want to discuss might help clinicians focus these discussions to meet patient needs.

A study of the perspectives of obese patients revealed information about what role they think their primary care providers should play in obesity management (Torti et al., 2017). In conversations with 28 patients being treated for obesity in a network of primary care practices, several important needs emerged:

(1) A Trusting Supportive Relationship

• Expectation: Patients expect clinicians to talk to them about weight, but they want it to be in the context of a supportive therapeutic relationship.
• Lesson: Put effort into building rapport with patients before bringing up the topic of weight.

(2) Substantive Interventions

• Expectation: Patients want conversations about weight to be substantive and to go beyond saying “Eat less and exercise more.” They also say they want more advanced education.
• Lesson: Spend time going into details with patients of how to eat less and exercise more. For example, take the time to suggest healthy dietary changes that are relevant to the patient, such as eating the whole fruit rather than juice or adding a serving of vegetables a day. Track interventions over time so that you can cover different topics each visit and provide more advanced education over time.

(3) Address the Many Root Causes of Obesity

• Expectation: Patients think that multiple factors contribute to their obesity and that the reasons underlying why they eat too much or don’t exercise enough need to be addressed.
• Lesson: Talk to patients about the root causes of their weight problems, not just calories and exercise.

(4) Address Individual Obesity Drivers

• Expectation: Since a complex set of factors drive each individual’s obesity, patients want assistance in weight loss that is tailored to their particular needs.
• Lesson: Take the time to consider what interventions are most likely to help each individual achieve weight loss, including medical, socioeconomic, and educational needs.

(5) Treat Weight as Part of Health

• Expectation: Patients want clinicians to consider their weight in the context of their overall health.
• Lesson: Address weight as an integral part of overall health and not as a separate concern.

(6) Long-term Support

• Expectation: Patients want longer-term follow-up in weight-loss counseling.
• Lesson: Provide for long-term follow-up that continues during the maintenance period. Think of obesity as a chronic disease, like diabetes, that will need ongoing care. Some sort of support is recommended at least twice per month during weight loss and then regularly for years of maintenance (Jensen et al, 2014).

(7) Better Referrals

• Expectation: Patients want better connections to weight-loss resources and programs.
• Lesson: Be prepared with a list of local resources, such as:
  • medical or commercial weight-loss programs
  • support groups
  • one-on-one counseling with a trained interventionist, such as a dietitian

(Torti et al.,2017)

Clinicians who consider the individual needs of patients who need to lose weight, in the context of a supportive relationship, and who go beyond simple advice to provide comprehensive, long-term support are likely to enhance their effectiveness in patient weight management.

References

• Jensen M, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults . Journal of the American College of Cardiology. 2014. Available at: Accessed on: 2015-01-21.
• Kirk SF, Price SL, Penney TL, Rehman L, et al. Blame, shame, and lack of support a multilevel study on obesity management. Qual Health Res. 2014;24(6):790–800.
• Torti J, Luig T, Borowitz M, et al. The 5As team patient study: patient perspectives on the role of primary care in obesity management. BMC Fam Pract. 2017;18:19. doi:10.1186/s12875-017-0596-2.