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Chapter 6: Counseling Patients about Weight

There are many steps you can take to improve your interaction with patients about their weight. An important consideration is your choice of language. Studies indicate that patients prefer to discuss weight using the terms "weight," "excess weight," and "BMI." Avoid terms such as "excess fat," "obesity," "large size," "weight problem," and "unhealthy body weight."

The Yale Rudd Center for Food Policy and Obesity offers an excellent online toolkit, Preventing Weight Bias: Helping without Harming in Clinical Practice. This toolkit provides information and tools on motivational interview for diet/exercise. The following section is based on information found in this toolkit. 

This chapter presents important steps in effective counseling on weight.

Initiate the Conversation

  • Greet the patient using a title and surname.
  • Ask the patient’s permission to discuss weight – "Can we take a few minutes to discuss your height and weight?"
  • Raise the topic of weight loss (or preventing further weight gain) in the context of an overall treatment (or prevention) plan for the weight-related condition.  – "Your current BMI suggests you are at risk for diabetes. What do you make of this?"
  • Ask the patient about their current lifestyle – do not assume that the patient is not exercising or eating healthy foods 
 

Assess Readiness for Change

  • Ask open-ended questions whenever possible, clarify and summarize the information stated by the patient, and maintain good eye contact. – "How is your weight affecting your life right now?"; "How do you feel about changing your exercise or eating habits?"
  • Validate the patient’s experience. – "I can understand why you feel that way." 
  • Confirm that the patient has control over the decision. – "It’s up to you to decide if you’re ready to make a change."
  • Make a direct statement about how weight loss will benefit the patient medically. – "I believe that your extra weight is putting you at risk for heart disease. Making some lifestyle changes could help you lose weight, and improve your health substantially."
  • Openly discuss the costs and benefits associated with making change. 
 

Advise

  • For patients who are ready to take action, identify a specific weight goal and time frame for reaching that goal. A healthy weight loss rate is 0.5 to 2 pounds per week. 
  • Assist patients in creating a plan for reach their goal. Offer a number of options for patients to consider – replacing soda with a healthy alternative, using stairs instead of elevators, using healthier cooking techniques (e.g. baking instead of frying).
  • Help patients assess barriers to implementing change and brainstorm solutions together.  – "What things stand in the way of taking the first step?"
  • Identify resources and programs that may support the patient. (see Chapter 7 for resources and programs).
  • Help patients identify social support (family, friends) who can support them in making a change.
  • Supply food and exercise diaries.
  • Communicate your belief in the patient’s ability to make a change. Remind patients that even a 5% weight loss can make a difference. 
 

Address the Whole Person

  • Screen for depression, trauma, and other mental health issues that can make it difficult to implement change, and refer as needed.
  • Screen, counsel and refer the patient regarding any other issues that arise during the discussion.
 

Follow-up

  • Encourage the patient to have regular preventive exams and screening tests.
  • Refer patient to a registered dietician.
  • Arrange for a one-month followup visit to discuss progress and challenges. 
  • Finally, consider discussing weight loss surgery for patients with clinically severe obesity (BMI >40) or for patients with a BMI >35 with health conditions
 
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