Back in my early years of practice, I distinctly recall a college student patient whose chief complaint was “desire to lose weight.” Before I entered the room I thought, “Okay. I can just give him suggestions to eat less and exercise more; I can easily wrap this up quickly.”
Upon entering the room, he handed me a printed excel spreadsheet with his meal entries and exercise progress from the last 3 months; obviously he had prepared for our appointment as he undoubtedly prepared for his midterms.
He went on to describe how he was always the “chubby one” in his family; he tried to eat healthy foods but sometimes the dorm cafeteria options weren’t the best choices, especially since he was vegetarian. He walked to all his classes and would exercise at the health facility on campus at least 3 times a week. Clearly, he was making an effort to self-manage his weight and wasn’t making headway as he thought he should be. After all, this is why he made an appointment with a doctor. I praised him for his efforts and gave a few more suggestions that in retrospect were not nearly enough because as I know now, helping patients succeed in losing weight is more than simply telling them to eat less and exercise more. Unfortunately, I don’t know how he fared as he did not return for follow up.
When I look back on this encounter now, it really showcases the obstacles that both patients and physicians still have today when addressing the topic of body weight. Physicians may be concerned about time constraints and inadequate training for such a delicate topic, as well as uncertainty of reimbursement for the visit and our own body weight perceptions. Patients may feel dread, embarrassment and failure. Suffice it to say, body weight is a sensitive topic for most every one of us.
Patients seem to distinguish themselves into 3 broad categories with regards to weight conversations:
- Patients who are concerned about their weight and come to us asking for assistance,
- Patients who need to be concerned about their weight, wait for us to bring up the topic and are open to further discussion and,
- Patients who need to be concerned about their weight, wait for us to bring up the topic and are not ready to discuss.
However, do not fear, March starts National Nutrition month; a perfect segue for providers to initiate a body weight discussion with every patient who needs our direction.
An excellent tool in facilitating this physician-patient dialogue is the “Why Weight?” guide developed by the STOP (Strategies to Overcome and Prevent) Obesity Alliance. Take a moment to download the full PDF version. In it you will find conversation starters, tips for motivational interviewing and pertinent information reminding us that successfully helping our patients lose weight is more than just saying “eat less and exercise more.”
Successful management of obesity requires more than a single office visit, as well as a multidisciplinary approach. My work in managing patients with weight struggles could not be accomplished without the expertise of a Registered Dietitian Nutritionist. My RDN colleague, Nanette Cameron, of Nutrition First, states that she finds it “essential to give every patient she sees an individualized meal plan with realistic nutritional and behavioral recommendations carved out for each person. Without a sustainable plan, patients continue in the pattern of gain/lose/regain and then so often quit.”
You and your patients can discover more about National Nutrition Month for 2017 here, including locating an RDN near you using the Find an Expert button. Let’s use March to start those crucial conversations with our patients and lead them in the direction to better health. Really weight no longer!
Barbara Ciesliga, MD trained in Med-Peds and currently sees teens and adults for weight concerns at Unasource Weight Management in Troy. http://www.unasourceweightloss.com/home/