Talking About Obesity

Addressing Barriers to Communicating Effectively About Obesity

There are conversations that many of us dread. The subject matter is difficult. It may not be the first time we’ve had this discussion with the individual—and maybe our previous interactions did not go very smoothly. We know we should think about options—and plan—for the interaction, but we don’t have much time to do so. We even consider avoiding the conversation because it would be easier to avoid any potential disagreements or hurt feelings. And when we’re talking about obesity, the unease often comes from both our patients and ourselves.

So, how can we effectively discuss obesity by addressing the barriers that would otherwise limit our conversations?

A Quick Re-Set on How We Think (And Talk) About Obesity

First, remember that ‘people’ should be first in our consideration, not their disease. We have patients with obesity and, like all our patients, they seek compassionate care for dealing with their disease.

Second, obesity is a chronic condition that requires long-term management. For people with obesity, their bodies may actually be counteracting all their efforts to lose weight (more on that in a separate article). Well-meaning suggestions by health care providers, family members, friends, or strangers posting online to simply ‘eat less!’ is not enough.

Third, there continues to be a significant stigma around people with obesity—including in health care settings. Bias—both conscious and unconscious—takes a heavy toll on our patients each and every day. While images of models, actors, and advertising have shifted in recent years to be more inclusive of body size and other attributes, there continues to be an abundance of discrimination towards people with obesity. This has a number of consequences for their physiological and physical health and may lead to avoidances of health care as well as disruption of the provider-patient relationship. Consider your own biases and how they may manifest in your interactions with people with obesity, whether in the clinical setting or outside the office walls.

Need for Ongoing Training and Resources

The good news is that talking about obesity with patients can lead to weight loss. Health care providers must understand how to effectively engage in these conversations with people living with this disease. Understanding obesity and what language to use can lead to more discussions and to improved patient outcomes.¹

There are four areas that this article will address:

• Need for training on effective communication strategies, including guidelines for discussing weight management
• Fear of offending patients
• Limited time in the clinical encounter
• Countering social media misinformation

Effective Obesity Communication Strategies

Health care providers exemplify lifelong learning. They are continually seeking the newest and updated guidelines and applying them in clinical practice. Why should learning about how to talk about obesity or other topics be any different? Just like we no longer look to film strips or eight-track tapes for the latest information, we shouldn’t continue to use constructs or terms that are outdated to communicate about obesity with those whom we serve.

Where can you find pertinent information or training on communication strategies—particularly those focused on weight management? The Obesity Society‘ has patient and health care provider resources that can help guide your conversation and provide a take-home reference for patients and their families. PCNA also has patient resources such as healthy eating resources in the Heart Healthy Toolbox.

Fear of Offending Patients

Biases against people with obesity include the incorrect perceptions and assumptions that these individuals are lazy and lack willpower—and these traits lead to their obesity. By acknowledging that obesity is instead a chronic disease, the focus can be on improving health rather than reaching and maintaining an ‘ideal’ weight.

Initiating and continuing discussions based on compassion and empathy for an individual and their circumstances, rather than a judgmental one-way directive from the health care provider about what a patient should be doing, can create an atmosphere where information can be effectively exchanged. In such an environment, both individuals can work towards a shared decision-making model where the patient shares their desires and values and works with their health care providers to identify management and treatment strategies that make the most sense for them.

There are resources available to better prepare health care providers to effectively lead patient-centered discussions. While not specific to obesity, the Department of Health and Human Services has a free, online program, Culturally Competent Nursing Care: A Cornerstone of Caring, to equip health care providers with knowledge and skills to provide the best care possible across diverse populations.

Limited Time in the Clinical Encounter

It doesn’t matter if the patient has obesity or another chronic or acute condition—both the health care provider and the patient will often remark that there is not enough time for the clinical encounter. To maximize the value in the exchange and ensure that there is time not just to impart information but to work collaboratively toward a shared goal, consider:

Preparation for the Visit—By Both the Health Care Provider and the Patient

1. Consider a questionnaire for the patient to complete in advance and bring to the visit to identify their readiness to talk about this chronic illness.
2. Read through previous interactions in the file or electronic medical record and plan ahead for possible barriers and potential solutions.
3. Do you know, for example, that many of your patients live in an area that is a food desert (or at least makes it challenging to find healthy food)? Are there community or other resources that can help support all your patients with access to healthy nutrition, including your patients with obesity?

Team-based Care

• Are there others in your clinical setting who could assist in the decision-making or the application of results, such as social workers, nutritionists or dieticians, or other members of the team?
• Are there trusted community resources available, such as support groups, pharmacists, nutritionists at grocery stores, or others?

Counteracting Social Media Messages About Obesity

Health care providers are abundantly aware of the impacts of social media on their patients. Weight bias in the media is well documented ^3,4,5 and social media is no exception. For those online, social media may provide a breadth of supportive information and links to pertinent and trustworthy resources but can just as easily highlight unproven strategies such as fad diets.

As with other patients, a non-judgmental conversation about long-term, outcomes-based strategies focused on the patient’s specific needs will help guide them toward effective management practices. HCPs can assist patients through ongoing compassionate conversations and providing trusted, accurate resources to support them in their efforts.

Clinical Takeaways for Talking About Obesity

1. Recognize the role of our own potential unconscious or conscious bias in working with patients with obesity, and the barriers that patients face each day. Seek out training and information at your organization or other trusted resources.
2. Plan what to say—and even practice the conversation with a trusted colleague—in advance of the clinical encounter. Be mindful of the shared decision-making process in your conversation and the vested interest of the patient in the discussion.
3. Identify what trusted resources you can share with your patients—in your practice, in the community, and online.

References

1. Albury C, Strain WD, Le Broca S, Logue J. The Importance of language in engagement between health-care professionals and people living with obesity: a joint consensus statement. May 2020 The Lancet Diabetes & Endocrinology 8(5):447-455. DOI:10.1016/S2213-8587(20)30102-9
2. Puhl FM, Heuer CA. Obesity Stigma: Important Considerations for Public Health. Am J of Public Health. 100, 1019_1028, https://doi.org/10.2105/AJPH.2009.159491
3. Selensky JC, Carels RA. Weight stigma and media: an examination of the effect of advertising campaigns on weight bias, internalized weight bias, self-esteem, body image, and affect. Body Image.2021 Mar:36:95-106.
4. Ata RN, Thompson JK. Weight Bias in the Media: A Review of Recent Research. Obes Facts. 2010 Mar; 3(1):41-46. Doi: 10.1159/000276547.