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December 20, 2019

Why patients hate talking about their weight (and how to help them open up)

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Dec. 22, 2020.

    While many patients want to discuss concerns about their weight with their doctors, patients often feel that doctors approach the conversation in a negative way, which leaves patients feeling neglected, stigmatized, and sometimes even insulted, according to a systematic review published earlier this month in the journal Clinical Obesity

    Are doctors bad at talking about weight?

    About 40% of the worldwide adult population is overweight or obese, and while doctors are encouraged to intervene when they examine a patient with obesity, it's unclear whether they're going about it the right way, the researchers wrote.

    To determine how doctors address weight-related concerns with patients, the researchers analyzed 21 studies that interviewed 466 overweight or obese patients about their primary care visits. Eleven of the studies were conducted in the United States or Canada.

    The "overwhelming theme" among the results was that primary care doctors rarely talk to patients who are overweight or obese about weight concerns, the researchers wrote.

    In cases in which doctors did not discuss a patient's weight, the patients were left feeling stigmatized and assumed they were being judged, the researchers said. Other patients reported feeling that doctors who didn't discuss their weight likely didn't view it as a serious health risk or felt that the patients were "unworthy of medical time."

    In other cases, patients said doctors sometimes attributed all of their medical symptoms to their weight, causing patients to feel "dismissed" or "anxious that a more serious cause for their symptoms might go undetected," the researchers said in the review. 

    When doctors do address weight with patients, patients who are overweight or obese usually viewed the experience as negative, the researchers found. "A recurrent theme across studies was that doctors often assumed a person who was overweight must have an unhealthy diet," the researchers said in the report. In other cases, patients thought their doctors offered "banal" advice such as "eat less," and "move more," while other patients said their doctors did not believe them when they reported making a sincere effort to lose weight using these methods.

    And while most doctors didn't discuss weight with their patients, many patients said they would like to discuss their weight with their clinicians, the researchers noted. Overall, patients were likely to respond positively to supportive advice and active monitoring surrounding weight loss. Some patients said having a doctor recommend small changes for weight loss made them feel motivated.

    How to discuss weight with patients, according to researchers

    Paul Aveyard from the University of Oxford and senior author of the study said, "As a doctor myself, 'listening' to these patients' stories was, in many cases, uncomfortable." He continued, "Many patients recounted tales where they had been patronized, marginalized unintentionally, or occasionally insulted."

    Aveyard said the results are disappointing because doctors know that "obesity is caused by … genetic make-up and a food environment that makes appetite control really hard." Aveyard explained, "You would imagine that doctors and nurses would know this, and this might be uppermost in their mind when they consulted patients." However, he added that the "general view, that obesity is due to a failure of willpower, is so ingrained" in society that even "doctors and nurses sometimes say unhelpful things that undermine the motivation of their patients to lose weight."

    At the same time, the results also show that "[i]t doesn't take a lot for the conversation to be a big positive for patients," Aveyard said. For instance, simply pointing out even "modest" changes in weight and regularly weighing patients could yield a positive experience for patients, according to Aveyard.

    Kristen Glenister, of the University of Melbourne who was not involved in the study, said, "Discussions regarding overweight and obesity … need to be undertaken with the appropriate language and tone, permissive approach, with trusted clinicians, adequate time and tailored advice" (Crist, Reuters, 12/17; Ananthakumar et al., Journal of Clinical Obesity, 12/2; Harrison, Medscape, 12/9).

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