San Francisco Marin Medical Society Blog

Approaching Weight Loss with Conviction, Sensitivity, and a Solution



By Sean Bourke, MD

Statistically, roughly 70% of our patients are overweight. How do we best approach our patients with excess weight? First, with evidence based conviction that doing so matters. Second, with sensitivity wrapped in verbal and non-verbal language and an actionable solution that makes sense.


First, the conviction

Physicians can effectively inform patients about weight related health risks, augment patients’ motivation to lose weight, and direct them toward opportunities to reduce weight related health risks. Post physician counseling, patients were, more likely to understand the risk of obesity, the benefits of weight loss, and were at a higher stage of readiness for weight loss.1 After being told they are overweight, patients are more than twice as likely to attempt to lose weight in the following year (OR 2.5).2

Second, the sensitivity

As a medical community working within a larger society where prejudice toward obesity is commonplace, we need first take a hard look at the stigma healthcare providers unconsciously transfer to patients suffering from obesity.

50% of physicians view obese patients as awkward, unattractive, ugly, non-compliant.3 60% of physicians state that “lack of motivation” is the cause of obesity.4

Call me heretical here, but when I look at the CDC maps outlining the stunning growth of obesity over the last 30 years, my reaction is, my God, obesity is happening to people. That’s a longer conversation. But, let’s start with the possibility that, for certain patients with the underlying genetic proclivity, our current food environment is toxic and obesity is the external manifestation of that environmental illness.

But then, what to do about it as providers? How to approach that group to motivate them to achieve healthier weights?

  • Avoid words that might convey judgment like “obese,” “fat,” or “morbidly obese.” Try more neutral words: “weight” and “unhealthy weight.”
  • Recognize the patients struggle and approach it with sensitivity. “I notice that you’re up 10 pounds since your last visit. Is that a concern to you? Are you aware of the health risks associated with as little as 10-20 extra pounds?”

Third, the solution

Lastly, recognize our limitations in the office, partner with the patient in making a commitment to healthy change, and have an actionable and sensible solution in your pocket. The reality is that sustainable weight loss is not about a diet. It’s about lifestyle changes tailored to each individual and from which weight loss, improved health and quality of life flow as byproducts. Changing habits or lifestyle occurs incrementally, slowly, and over long periods of persistent effort.

That’s not something easily performed in a primary care setting – according to studies suggesting physicians feel ill equipped to manage weight loss and typically provide insufficient guidance on weight management strategies.5

That’s okay. In primary care, when we have a problem best served in the realm of the cardiologist, endocrinologist, or gynecologist, we refer to optimize care. Obesity sadly reigns as the number one cause of preventive death in our country today. If we don’t have the answers in our traditional practice model, why wouldn’t we refer our patients to physicians with specific weight management expertise and superior outcomes stemming from systems designed to nurture effective long-term success? 

References:

  • Acad Med. 2004 Feb;79(2):156-61.
  • Arch Intern Med. 2011 Feb;171(4):316-21.
  • Obes Res 2003 Oct  11; (10): 1168-77.
  • Obes Res 2005 Apr 13(4): 787-95.
  • Acad Med. 2004 Feb;79(2):156-61.

  • Editor's note: This is a SFMS guest blog. SFMS invites our physician members and industry experts to submit commentary or updates on topics of importance to San Francisco physicians and patients. These blogs are not written or edited by the San Francisco Medical Society. The authors are solely responsible for the content.

    Sean Bourke, MD is a Stanford-trained physician and CEO of JumpStartMD, Northern California’s largest nonsurgical medical weight management practice. A member of the SFMS and the American Society of Bariatric Physicians, Dr. Bourke has made it his goal to cure obesity, the number one cause of preventable death in the United States.

    Click here to read the first installment of Dr. Bourke’s blog post on obesity and patient care.


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