10 Things Doctors Can Do to Help Patients Lose Weight

Losing weight is difficult and often frustrating for patients... and doctors.  When it comes to weight loss, usually both parties want the same outcome - a healthy weight - but both may feel helpless to achieve it.  Obesity is not about willpower. Obesity is a multifaceted disease with genetics, hormones, microbiome, nervous system, stress, and life events all playing a role.  But there are things that we doctors can do to help our patients with weight loss success.  Here are ten quick suggestions we can quickly integrate into clinic visits.

Recognize weight bias and work to prevent weight stigma.

Now is a great time for all healthcare professionals to check in with their weight biases.  Medical research shows that someone with obesity is more likely to be perceived as lazy and lacking willpower. These biases go so deep that there is even a recognized wage gap between people with obesity and their normal-weight counterparts.  A medical professional may subconsciously make inaccurate assumptions about a person's ability to eat healthy foods, manage stress, exercise, or follow a meal plan.  Just like we can't assume that a lean patient has great wellness habits, we also can't assume that a person with obesity has poor lifestyle habits.  We should treat people with obesity with the same respect that we treat people with other medical conditions --  without blame or shame. 

Use respectful language.

Recommended terminology may have changed since our training. "People first" language is recommended.  Instead of referring to a person as an "18-year-old obese female", we can instead refer to her as an "18-year-old female with obesity".  The term "morbid obesity" can be respectfully replaced with "severe obesity". 

Ask for permission to discuss weight and weight loss

Weight loss is hard, weight is a sensitive topic, and some people need a rest from talking about their weight. If we need to discuss weight or weight loss, we can respectfully first seek permission.   A simple "would it be all right if we talked about weight" can keep the discussion positive.

Note: Sometimes we don't need to talk about weight to help with weight loss.  As a pediatrician and weight management specialist, children were referred to me for medical weight loss.   Together, we created personalized programs and had a variety of specialists like sports medicine, exercise medicine, cardiology, and endocrinology as members of the team. Despite their referral specifically for medical weight loss, we regularly would do the entire weight management visit without talking about weight.  We used medical words like metabolism, health, food choices, and sports agility to address their specific needs and goals.  They often succeeded with weight loss by keeping the focus on their specific goals.

Express empathy

Let them know that we know this is hard. "It must have been frustrating to follow a diet and not see the health benefits."

Incorporate Motivational Interviewing.

We don't need extensive training in motivational interviewing before implementing it into our medical practice. By including a few motivational interviewing techniques in our visit templates, we will automatically begin practicing motivational interviewing in our medical visits.

Take, for example, the "readiness ruler" for people considering a lifestyle change.  Here is how it works for someone who is considering limiting soda to help with her weight loss goals and insulin resistance.

Weight loss Doctor: I know everyone has a lot going on in their lives, so I want to understand how important weight loss is to you.  On a scale of 1-10, 10 being extremely important and 1 being not important, how important is it for you to reach your weight loss goal? 

Patient: Probably about a 6

Weight Loss Doctor: So it is fairly important to you to lose weight, but why is it important?  Why is it 6 and not, say, a 4? 

(This hopefully elicits change talk - in their own words they will describe why change is important)

Patient: Well I know I need to lose about 5 pounds to lower my risk of diabetes in the future. 

Weight Loss Doctor: That does sound important. 

Then you can expand, asking about confidence ruler...

Determine your patient's motivation for losing weight.

People seek to lose weight for a variety of reasons. Here are some common motivators to lose weight and keep the weight off:

• to undo weight gain that slowly crept up over the years. 

• to respond to an abnormal blood test

• to improve medical conditions like heart disease, gestational diabetes, or insulin resistance. 

• to increase clothing options (this is a common goal stated by many young women in our program)

• to improve sports agility

• to decrease body fat for a major life event

• to prevent future medical complications

Some people want to improve health and wellness and just need a little medical supervision to enact their goals in a healthy way.

Once we find out their motivation, we can frame all goals in terms that matter to them.   For someone who wants to improve their diet to control diabetes, "Can I share with you some food adjustments that have been shown to help people with diabetes improve their blood sugar?" For the sports enthusiast, "would you like information on eating unprocessed foods to help your athletic performance?"

Offer a little dose of body positivity.

Sometimes people with excess weight have lost faith in their body or their health.  Following a weight loss program is easier with confidence that one's body is functioning well.  Large amounts of reassurance can help support confidence in their abilities.  We can start by pointing out some amazing things their bodies do daily "Your strong legs helped you jump right onto the exam table. Your exercise is making you stronger." 

Remember that effective medications exist.

There is a middle ground between advising lifestyle modifications (physical activity and improved eating habits) and referral to a weight loss center for a medical procedure.  This middle ground can be quite productive! In an appropriate patient, consider medications in addition to healthy nutrition and exercise patterns.  Medical research shows that medications can help support healthy weight loss, but that most people eligible for weight loss medications are not prescribed them.

Do a (quick) deep dive on nutrition and exercise

Even without the support of registered dietitians, any healthcare professional can probably identify some changes to the diet and exercise that can help a patient lose weight. Instead of focusing on calories or temporary diets, try focusing on slow, sustained changes.  Here is guidance to help improve nutrition for kids.

Set SMART Goals and Follow Up.

We know the drill when we assist with goal setting, make it SMART - Specific, Measurable, Attainable, Relevant and Timely.  Lets do it, and document it.

And then we can offer follow up.  "Some people find that they are more likely to achieve their weight loss goals if we schedule a follow-up appointment.  Would you like to set up a time for us to review your progress?"

When it comes to weight loss, we can do a lot to help our patients in a short amount of time. 

I hope these 10 tips help.