Honest Conversations About Obesity

Obese people lack motivation.”

Obese people just need to be motivated.

If you lost some weight you’d have less back/knee/hip pain.


It’s important that we are honest with our patients.

  • Yes. Obesity is harmful to your health. Full stop.

 

  • Yes. Many conditions that obese individuals experience could be improved if they lost some weight. Full stop.

 

 

  • BUT. It will always be better to be healthy and at a normal weight than healthy and obese. Full stop.

However, we need to stop perpetuating this belief that a lack of motivation is a primary cause of obesity. It’s not. Motivation is a factor to some degree but it’s much less than many of the other societal, environmental and psychological factors relating to obesity.

That’s only a handful of these other factors. I haven’t even touched on portion size (which people tend to underestimate),  health literacy, medical misinformation in the media, stigma, childhood exposure to trauma, food deserts, knowledge of exercise, transportation to fitness facilities, income/cost of healthy living programs, access to healthcare, and eating habits such as eating while watching TV, etc. 

Let’s also not forget that obese individuals do attempt to lose weight fairly often (and in increasing numbers) but many fail, close to 70% annually.

(If you’re interested in a thorough review of factors relating to obesity and how to best address them read our open-access paper published in Progress in Cardiovascular Disease.)


 

Healthy living is a learned behavior.

 


Too often are obese individuals with various complaints also told to just lose weight. Back pain? Lose weight. Knee pain? Lose weight. Breathlessness? Lose weight.

Cool.

But what are you gonna do for them right now or in the meantime until they lose weight? People need tenable and actionable solutions. They don’t need someone just repeating the obvious or fixating on something that’s a long term goal for what is a much shorter-term problem. Again what are you going to do to help them now?

It takes time to lose weight, especially significant and meaningful amounts. Even 20lbs of body weight is a lot to lose and that’s probably not gonna happen in 1 month (without surgery), and quite honestly probably shouldn’t happen. Weight loss should be sustainable and with realistic goals. For those reasons, successful weight loss is often gradual. Quite often one of the reasons why people fail to lose weight is that they set unrealistic goals for weight loss and get quickly discouraged when they invariably fail to meet to said goals.

In summary, I agree that it’s important to be honest with our patients but let’s perpetuate honesty to our patients.

On Difficult Cases

There was a discussion recently in a Facebook group regarding frustrations with difficult patient encounters and advice on how to best manage these cases. Here below, I have provided a brief list of advice imparted onto me by mentors of mine. Hopefully this helps…..


One of the best pieces of advice a professor of mine gave me was “that you cannot control how people act, you can only control how you react”. This simple quote or credo is so incredibly true and is a great approach to life in general. People can be irrational and their actions frustrating, both of which may become magnified surrounding episodes of poor health.

Another thing to consider, which is a message I’ve adapted from an icon of mine Cael Sanderson, is that every challenge that you face is an opportunity for growth and that we should look forward to challenges; they make us better. Difficult patient encounters are opportunities to learn how to manage difficult patient encounters and it will get easier. It’s also always important to consider that the people we serve could choose elsewhere. They don’t have to be in our clinics. Even in public or federal systems, the patient can still choose to not show up. Take it as a privilege that YOU get to SERVE them and even though they may state that they don’t want to be there, they still decided to show up. Also realize, (and I’ve learned this working with many disadvantaged populations) for many people, even getting to the clinic may be more difficult than you may ever realize.

Regarding verbose patients; there are many people who come to our clinics who have never had the opportunity to speak to a healthcare provider about their problems. Some may not have the opportunity to share their frustrations with anyone who cares or has concern for them. This issue of social isolation and loneliness is a real and growing problem in our modern society. Therefore, consider it a privilege that they are comfortable enough to be verbose with you. Just taking time to listen to them can go a long way. In terms of managing verbosity, because there are time constraints to clinical practice, what I have found to be useful is to try to steer their conversation around the goals for the session or intercede with questions that may help redirect it.  Always try to acknowledge what the patient has said before talking, this helps convey that you did listen to them (you really should be), which is important for building trust and rapport. This process can be difficult but it gets easier over time as well.
Regarding patients who are difficult to convince or establish buy-in for your plan of care, especially those who may believe in more liberal interpretations of physiology, be persistent and steadfast but always be respectful and considerate. Remember that few people possess the specific knowledge of human physiology to determine a falsehood from truth as it pertains to disease and 88% of US population is insufficiently healthcare literate. Given these factors, and others it is incredibly difficult to change someone’s views once they have internalized information; ie “You can’t sell meat to vegans and you can’t convince a carnivore to eat vegetables”. If their views interfere with your best judgment as a provider, consider referring them elsewhere; it’s probably best for both. We as a profession and field (healthcare) need to do a better job addressing this process of translating knowledge to our communities both at the clinic level and institutional level. But it all starts with a conversation and re-framing expectations with each individual. At the fundamental level, a clinician is an educator and motivator.

These are just some recommendations and tips. I don’t practice as much now but can recall how difficult it can be in the clinic and realize that things are rarely ideal and we all have our limits. However, if you consider some of these basic principles and perspectives, it helps make difficult situations a bit less stressful when they do occur.

 

(Image courtesy of Gomerblog.com)