For people who have overweight or obesity, lifestyle interventions can be effective for weight management.1 Empathetic and supportive discussions may help patients to address the challenges of weight management.2
Click on the below sections to explore talking points and resources to shape your discussions with your patients.
Studies have shown that productive conversations between healthcare professionals and patients help people with obesity to be successful with their weight loss goals.3
Studies have also shown that when physicians advised people with overweight or obesity to lose weight, change their eating habits, or become more active, they were more likely to do so than if not.3 While frequent discussions with people with obesity about weight management are helpful, it is the quality of the discussions that actually leads to behavioural changes.2
The complex and sensitive nature of obesity can make conversations difficult to have with patients. An empathetic approach and asking permission is a helpful starting point. Results from the ACTION IO Study showed that two thirds of people with obesity would like their healthcare professional to bring up their weight.4
Research indicates that when healthcare professionals employ an empathetic approach and other techniques consistent with motivational interviewing, patients are more likely to attempt weight loss through changes in eating and activity habits.2
To initiate a conversation with patients about their weight, it is important to first ask for permission.5 Without permission, talking about weight may be a sensitive and unwelcome topic.
Start with a general opening question, such as:
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
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
Would it be alright if we discuss your weight?
If the patient seems unwilling or reluctant to discuss weight management, you can summarise and indicate in their file that the patient is not concerned about his or her weight at this time. You can then assure the patient that if weight becomes a concern in the future, the topic can be revisited.4
For questions for consideration and example baseline questions, please see the Rethink your obesity discussions guide.
It is recommended that you advise about the health risks associated with obesity.5
To balance the discussion of health risks associated with excess weight, consider advising your patient on how even modest, sustained, weight loss of 5–10% can improve their health and reduce risks of complications.5
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.6 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"5
“Because of your weight, you are also at risk of developing several weight-related complications including diabetes, high blood pressure and other cardiovascular complications"7
“With weight loss of as little as 5% of your body weight, you can improve your health and reduce your risks of many other complications"8
“Achieving 5‒10% weight loss is a process that begins with making a few specific lifestyle changes to your eating habits, increasing your physical activity and discussing other treatment options"9
“I can support you in your efforts to improve your health and lose weight. Is that something you would like?”
Following 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:5,9
Assessment of root causes that influence eating and activity behaviours
Understanding of past efforts, challenges and previous weight-loss success
A basis for setting weight-loss goals for each patient
Main components and goals of a focused weight-history discussion
The following talking points and questions may be helpful to achieve a successful weight history discussion.
Changes in weight over time
Everyone gains weight differently. Understanding how and why your patient’s weight has changed can provide insight into weight-gain causes.9
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.9
Descriptions of past weight-loss efforts
Discuss and understand your patient's past efforts with weight loss, including specific programmes or plans, duration and results.1
A discussion about your patient's current eating and activity habits and how they might feel about changing their current habits.10,11
It may be helpful for patients to chart their own history of weight changes over time. Working with patients to graph lifestyle events to body-weight changes can promote an efficient productive patient-centred discussion to help guide treatment decisions.9
Download the Chart your personal weight history handout to be used with your patients.
Chart your patient's personal weight history
Use our interactive tool to help you chart your patient’s weight history and set appropriate goals.
Follow the onscreen instructions and work through the screens entering data in the relevant fields. Click Start to begin and use the Next and Back buttons to move between screens. Upon completion of the tool you will receive a weight history report with your patient’s short and long term goals mapped out.
Record these events with the weight and date by choosing from the list below or entering additional events using the free text boxes. Record a weight and date for each event as it appears in the list on the right of the screen. They will be reordered by date, earliest to latest in the chart on the next page.(maximum of 6)
Key weight change events
What I want to achieve
How I plan to achieve my short-term goal:
What I want to achieve
How I plan to achieve my long-term goal:
A discussion about goal setting is a way to help your patients connect their goals with the changes they can make for better weight management. Align with your patients on realistic and individualised goals as a first step towards achieving meaningful weight loss.5 Try setting goals that are connected to your patients’ values and aspirations. 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.
You may want to start by discussing the "big picture," or the long-term ultimate goals that your patients may have in mind. It can be helpful to refer to the responses to the initial questions about how weight affects medical, physical, emotional and day-to-day well-being and their plans or goals for their lifestyle in the future.
There are several things you can do, working with your patients, to help them set goals and work towards achieving them. To begin the process, some questions to consider asking are:
Use the Goal Setting handout and the discussion topics below to create SMART goals with your patients: Specific, Measurable, Achievable, Relevant, Timely.5
When you are finished discussing the goals, consider establishing a follow-up plan for future appointments.The ACTION IO Study found that only 39% of people with obesity, who had had a conversation with their healthcare professional within in the past five years, reported that a follow-up appointment was scheduled.4
Guide patients to set specific goals for changes to behaviours or habits for healthy eating, activity levels or weight loss.
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 relevant to their big-picture goals.
Using specific dates or occasions can help patients to stick with their plan. Try placing 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, healthy eating and physical activity should always be included alongside medical or surgical treatment.12 As you approach the topic of healthy eating and activity habits with your patients, focus on achievable steps they can take toward sustainable lifestyle changes.
Patients should be encouraged to keep a food and physical activity journal to keep track of what they consume and their activity levels. Also, ask them to record things like:12
By recording the situations and feelings in which people with obesity make decisions about food, you and your patients will be able to identify areas for change. People with obesity should be encouraged to bring their journal to each appointment to discuss general patterns. Healthcare professionals are encouraged to provide positive feedback for progress made.
We have developed a handout to help guide discussions with your patients around healthier eating and increased physical activity.
Like goal setting, the pace of the treatment plan that each patient follows, whether for weight loss or weight maintenance, should be dependent upon individual factors.5,9
A discussion about clinical weight management should help patients
There are multiple comprehensive guidelines that provide recommendations for patients in different stages of weight management. After reviewing the guidelines, consider which options might best serve your patients and explore the decision-making process with them.
Some talking points and questions you can consider to guide conversations with your patients:
Consider each patient's weight history and current situation to determine a follow-up plan for treatment. Follow-up plans should include:4
Assistance in identifying additional drivers and barriers for weight change
Provision of credible educational resources
Referrals to appropriate health care professionals
Weight management appointments (see below for additional guidance)
Scheduling weight-management appointments
People who have overweight or obesity have a chronic disease that requires long term management.13-15
Evidence indicates that frequent face-to-face visits to discuss lifestyle changes can have significant positive effects on weight management and complications.1
Research shows that patients with excess weight feel stigmatised in many areas of their lives, including healthcare settings.16 The language you use and your office environment are key components of successful weight management.
There have been several studies investigating what terms both physicians and people with obesity prefer when discussing obesity. Below is a useful table showing words to avoid and preferred language.17,18
|Terms to avoid||Preferred terms|
Some physicians may feel it is appropriate to use words such as ‘obese’ and ‘obesity’ due to their medical definition, however, it may not be possible for your patients to separate the medical descriptor from the negative associations these words have.17 It is therefore recommended that when speaking to your patients about obesity, the term weight or excess weight should be used instead.17,18
People 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.19
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.19,20