Patients face difficulty talking about weight with doctors

Doctors rarely talk about weight concerns with patients who are overweight or obese, and when they do, patients’ experiences tend to be negative, according to a new review of research based on interviews.

Most often, doctors avoid the topic, leaving patients feeling stigmatized and neglected, the study team reports in the journal Clinical Obesity. When doctors do talk about weight issues, they often seem to assume patients simply aren’t trying to address their weight, and offer “banal” advice.

“As a doctor myself, ‘listening’ to these patients’ stories was, in many cases, uncomfortable. Many patients recounted tales where they had been patronized, marginalized unintentionally, or occasionally insulted,” senior study author Paul Aveyard of the University of Oxford in the UK told Reuters Health in an email.

“We know that obesity is caused by a collision between susceptibility due to our genetic make-up and a food environment that makes appetite control really hard,” he said. “You would imagine that doctors and nurses would know this, and this might be uppermost in their mind when they consulted patients.” More than 2.5 billion adults worldwide - about 40% of the population - are overweight or obese worldwide, Aveyard and colleagues note in their report. Being overweight increases risks for diabetes, cancer, heart disease and poor mental health.

Guidelines recommend that doctors intervene when a patient is obese, but it’s unclear how many do and how patients respond, Aveyard and colleagues write.

To better understand how obesity is discussed in clinical visits, they analyzed 21 studies that interviewed a total of 466 people who were overweight or obese about appointments with their primary care doctors. Eleven studies were conducted in the U.S. or Canada, and the rest in the UK, Germany, Norway, Australia and New Zealand.

Overall, patients and doctors didn’t discuss weight concerns often, yet many patients said they would have liked to have those conversations. Some patients believed the discussions didn’t happen because they were viewed as “unworthy of medical time” or doctors didn’t think their weight was a “serious risk.” Patients also internalized stigmas around weight and picked up on clues that suggested doctors judged them negatively.

When conversations did occur, patients said doctors offered “banal” or “flippant” advice, which assumed the patient didn’t eat well, exercise or try to address weight problems. In addition, patients felt doctors assumed their symptoms were related to their obesity, even without taking a full medical history or performing an exam, and these patients feared a serious illness may have been missed as a result.

For several patients, the term “obese” made them feel demotivated and hopeless. Others had experiences with nurses or doctors who directly said a procedure would be “a lot easier if they were smaller.”

“It seems that the general view, that obesity is due to a failure of willpower, is so ingrained that this dominates thinking, at least on some occasions,” Aveyard said. “As a result, doctors and nurses sometimes say unhelpful things that undermine the motivation of their patients to lose weight.” At the same time, patients tended to respond positively to supportive advice around weight loss and active monitoring of weight control. Some said when a doctor commented on weight loss, even small changes, they felt motivated to keep going.

“It doesn’t take a lot for the conversation to be a big positive for patients,” Aveyard said. “Doctors and nurses could notice small changes in weight, perhaps by regularly weighing their patients, and commenting on modest losses.”

Doctors and nurses can also discuss a range of options available and offer referrals, he said.

“There are many missed opportunities to discuss the health risks associated with overweight and obesity with doctors. These missed opportunities can lead to misunderstandings between doctors and their patients,” said Kristen Glenister of the University of Melbourne in Australia, who wasn’t involved in the study.

“Discussions regarding overweight and obesity in the context of increased risk of developing chronic diseases are important to have but need to be undertaken with the appropriate language and tone, permissive approach, with trusted clinicians, adequate time and tailored advice,” Glenister told Reuters Health by email.