How should doctors discuss obesity with patients?

How should doctors discuss obesity with patients?

January 7, 2020 2 By Ewald Bahringer


For many years I really struggled with bringing up the subject
of obesity with my patients. I didn’t really know how to begin. It seemed rude to tell patients
that they were fat. And it’s a shame really because
I missed many opportunities. I’ve been working recently
with some younger doctors trying to find ways for them to bring up
the subject of obesity for their patients in a way that the patients
are really happy with. And this is
what we’ve come up with really. Listen to the patient’s problem first and then say something like,
“You’ve mentioned that your knees are hurting “and they are very painful,
I can see that’s a problem for you. “I just wonder whether your weight
might be a factor for this. “Are you interested in discussing this
as an approach? Because I think it could help.” And having mentioned it
and asked permission is very important
that you then wait for permission, for the patient to say, “Yes it’s okay.” So you see what I’m doing here
is the framing of your questions, so you’ve listened
to the patient’s problem and then you’re framing
the idea of obesity in terms of this could be helpful
for the problem the patient has mentioned and then you’re waiting for permission. So I’m saying to the patient, “Is this
something you’re interested in exploring?” And then I’m waiting. In five years I’ve only had one patient who hasn’t given permission
to discuss their weight. All the others have said,
“Yes, I know I’m heavy.” So all the other patients have said to me,
“Yes this is something I’d like to explore.” I think it’s so important that
this is done in a collaborative way, so that you’re not telling
the patient they’re fat. You’re framing this as part of the solution
to the problem that the patient has and then seeking permission. And then…
often the next thing I do is I say, “Well if we’re going to work on this together
would you mind if we took your weight now so we’ve got the baseline
and then we’ll know when it improves?” And again I’m seeking permission. And the number of patients that tell me
they haven’t been weighed for years and they’re frightened
of what the result will be, but the minute they buy in
to that initial weighing is a really good sign that
they’re going to do something about it. So that we’ve changed something that
I personally didn’t like to ask about before into a completely caring thing. It is not callous to ask about weight as long as you’re doing it
as part of the solution to the problem that the patient
feels is important to them. So I hope you can see
it doesn’t have to be a problem.