As people clamor for weight loss drugs like Wegovy, one could be forgiven for wondering what happened to good old-fashioned diet and exercise as a method for losing weight. But the real question might be: Have doctors tried being nice?
Weight bias and stigma is prevalent among medical providers, study after study has found. It can discourage patients from seeking care and contribute to mental health problems. But something as simple as the provider’s tone of voice could positively impact patient outcomes, a recent report says.
“Obesity, I think, is one of the hardest problems that clinicians face. And part of that is because they’re not trained to address obesity,” says William Dietz, director of the STOP Obesity Alliance at George Washington University’s Milken Institute School of Public Health.
While obesity affects an estimated 40% of the US adult population, it’s not well understood — both by the general public or by many clinicians, says Dietz. It’s a chronic health condition that’s primarily of concern because it raises the risk for many other health problems such as heart issues and diabetes. And although environmental, socioeconomic and genetic factors play a major role in obesity rates, people with obesity are often not only blamed for their weight, but judged.
That dynamic sometimes plays out in the doctor’s office to the detriment of patients. “Often a patient will come to the provider with, let’s say, a sore throat. The provider will say, ‘Okay, here’s how we’re going to treat your sore throat, and by the way, you need to move more and eat better to solve your problem with weight and obesity,’” says Dietz.
In one study recently published in the journal Annals of Internal Medicine, researchers analyzed short conversations in which doctors discussed weight with their patients, and categorized the deliveries as “good news,” “bad news,” or “neutral.” Doctors who employed the good news strategy minimized discussing the “problems” of obesity like body mass index or blood pressure, and instead focused on the “opportunity” to lose weight while smiling and sounding excited. Bad news deliveries, on the other hand, tended to “convey ‘regret’” and presented weight loss as a necessary solution to a problem. The study described the bad news providers’ voices as “creaky” on important words, like “weight,” which reinforced negativity.
Perhaps unsurprisingly, patients whose doctors sounded more optimistic were more likely to follow a weight loss program and see results. (For more on how doctors successfully talk to kids about weight, read my colleague Madison Muller’s story here.)
But provider support goes beyond a single conversation, Dietz and his colleagues have found.
“How about empathy?” he asks.
Physicians should ask for permission to talk about their patients’ weight, and determine whether a patient is actually interested in losing weight before making any recommendations.
“One of the most important principles, if a person is interested in losing weight, is shared decision making,” says Dietz. “Rather than a provider being prescriptive to a patient, which establishes a hierarchy.”
Enjoyed this article? Sign up for our newsletter to receive regular insights and stay connected.