Discussing weight management with their patients calls for sensitivity on the part of your physician customers
Few people question the connection between excess weight and ill health. Even so, patients with weight management issues aren’t necessarily eager to talk to their doctor about it. That means that if the physician believes the patient’s weight threatens his or her good health, it’s up to him or her bring it up. How they do so makes a difference, says Alan Schwartzstein, M.D., FAAAP, a family physician in Oregon, Wisconsin, and speaker of the American Academy of Family Physicians Congress of Delegates.
“I don’t know how other physicians address weight with their patients, but a common thing I hear from my patients is something along these lines: ‘I went to see Dr. Jones about my high blood pressure and all he wanted to talk about was my weight,’” says Schwartzstein.
“That may not be the way doctor really approached it, but that’s what the patient hears.”
In his practice, Schwartzstein refrains from bringing up the topic of weight unless 1) the patient asks for assistance in weight management, or 2) Schwartzstein believes the patient’s weight may contribute to or exacerbate a chronic condition.
“In the first case, the patient has brought it to my knowledge, so the issue is on the table,” he says. “But in the second case, while addressing a chronic issue such as osteoarthritis, I carefully share something like, ‘One of the contributors to the pain you’re experiencing might be weight.’ Then we talk about how the patient might benefit from weight management.”
Relationship is everything
The stronger the relationship between primary care doctor and patient, the easier it is to discuss sensitive topics, including weight, says Schwartzstein.
“Some issues, like strep throat, can be addressed by any clinician, whether they’ve seen the patient before or not,” he says. But with issues such as weight, the relationship can make all the difference. “When I walk in the room, they trust that I will be sensitive to their issues. That’s why an ongoing relationship with a primary care doctor is so vital.”
Years of experience have taught him other strategies about discussing weight with patients.
- Know when to stop. If a patient questions why the office staff insists on taking his or her height and weight prior to an exam, explain patiently. If he or she still resists, let it go.
- Seek context. Tie conversations about weight to the patient’s overall health, including chronic conditions.
- Watch for verbal or non-verbal clues as to how serious the patient is about weight management. Even when addressing weight in the context of diabetes, arthritis or hypertension, if the patient is clearly not interested, let it go. “Pushing beyond that point because I think it is better for them isn’t being patient-centered,” says Schwartzstein.
- If a patient asks for help managing his or her weight, let them know you are happy to work with them as a partner. “I’m making it clear it’s not my problem to fix, but at the same time, I’m letting them know we can work together as a team to address it.”
- Steer the discussion away from diets, even if the patient asks for advice on which diet to follow. “Rather than talk about diet, I emphasize habit change,” says Schwartzstein. That’s because for many people, the amount and type of food they eat are actually habits from adolescence or early adulthood. “I point out that when they were more active and still growing as adolescents, they needed the calories. But later in life, you’re not always eating to satisfy caloric needs.”
- Watch your language. “When I talk to patients in the office, I do not use the words ‘obesity’ or ‘weight loss,’” he says. “Instead I use the term ‘weight management.’ It’s less confrontational.”