Approaching the Topic of Weight Loss with Sensitivity

The complex and sensitive nature of weight management can make it difficult to initiate conversations about weight with patients. An empathetic approach and asking permission are a helpful starting point. Results from the study by Caterson, Alfadda et al.¹ showed that two thirds of people with high levels of excess weight would like their healthcare professional to bring up their weight. These findings emphasise the importance of having a clinic-wide approach to addressing weight management, which includes all clinic staff.

Research indicates that when an empathetic approach and other techniques consistent with motivational interviewing (more information here) are employed, patients are more likely to attempt weight loss through changes in eating and activity habits.

To initiate a conversation with patients about their weight, it is important to first ask for permission. This should be done after addressing the patient’s primary reason for attending your clinic. Without permission, talking about weight may be a sensitive and unwelcome topic.

Suggestions for opening this conversation include:

“While you’re in the clinic today, would you mind if we spoke about your weight? Where do you think you’re at?”

“There are a number of health benefits associated with reducing your overall weight, such as improving other weight-related areas such as mood disorders and immune health. Would you be interested in discussing these benefits, and whether weight management could be an appropriate goal for you?”

‘Mrs X, I’m glad we have covered your main concern. I would also like to discuss your weight and how we can help you stay fit and healthy, if you are comfortable with that today?’

There are a few key points to incorporate in your communications with patients when discussing their weight which reflect the sensitivity of the subject matter:

Use language (including tone and non-verbal gestures) that is:

• Free from judgement or negative connotations, particularly try to avoid the threat of long-term consequences or scolding (‘telling off’)
• Person-centred, (also known as ‘person-first’) to avoid labelling a person as their condition.
• An example is talking about ‘a person who is overweight’ rather than an ‘overweight person’
• Collaborative and engaging, rather than authoritarian or controlling

Remember language matters³

• Be aware that language, both verbal and non-verbal, has enormous power that can have positive or negative effects

Some words are unacceptable

• Recognise that some words, phrases and descriptions are potentially problematic, whatever the intention of the user

Avoid combat and humour

• Avoid using combative language when referring to people’s efforts to reduce overweight, and never use humour or ridicule

Stick to the evidence

• Communicate accurate, evidence-based information/data when discussing weight

Don’t Blame

• Avoid language which attributes responsibility (or blame) to a person for the  development of their excess weight or its consequences

Don’t generalise

• Avoid language that infers generalisations, stereotypes or prejudice

Be empathic

• Use or develop an empathic language style which seeks to ascertain a person’s point of view of their condition, rather than making assumptions

Listen and explore

• Show genuine interest in patients’ replies and avoid interrupting
• Listen out for a person’s own words or phrases about their weight and body image and explore or acknowledge the meanings behind them
• Consider how to limit any negative effects from language. Listen out for negative language used by others around you and consider ways to address this
• Rephrase patients’ comments – this shows patients you have understood what they have just told you

Avoid scaremongering

• Keep the conversation positive

Involve the patient in active problem-solving⁴

• Individuals who self-select their mode of intervention have been shown to be twice as likely to sustain improvements. This finding was regardless of the intervention selected.