Talking with Your Patients about Weight

On this page:

• Why should I talk with patients about their weight?
• Which patients should I talk with about weight loss?
• How does weight stigma affect patients with overweight or obesity?
• How can I prepare a welcoming environment for my patients?
• What words should I use to talk about weight?
• How can I start a conversation about weight?
• How can I help my patients make healthy lifestyle changes?
• How can I treat patients who could benefit from weight loss?
• What if a patient needs more help?
• Will I be reimbursed for talking with my patients about their weight?
• What other resources may help?

As a primary care professional, you are in a unique position to talk with your adult patients about managing their weight. Sometimes, these conversations can be challenging or uncomfortable.¹ If your patient has overweight or obesity, the tips and resources below may help you talk with them about their weight in a sensitive and effective way.

Why should I talk with patients about their weight?

Studies suggest that many patients with overweight or obesity welcome guidance from health care professionals about managing weight to reduce health risks.^2,3 However, some patients may find it hard to start these conversations themselves.

Patients with overweight or obesity may benefit from discussions about weight-loss or weight-maintenance goals, lifestyle changes, weight-loss plans and programs, or treatments such as medicines or surgery. By speaking with your patients respectfully and collaborating with them, you may be able to help them reach and maintain a healthier weight.

Which patients should I talk with about weight loss?

Weight-loss information and counseling may benefit patients who have—or are at risk of developing—health problems related to overweight or obesity. In general, this risk can be higher in adults who⁴

• have overweight, with a body mass index (BMI) of 25 to 29.9
• have obesity, with a BMI of 30 or higher
• have a waist size of more than 35 inches for women or 40 inches for men
• have metabolic syndrome or high blood pressure, unhealthy lipid levels, or high blood glucose levels

BMI and waist size don’t directly measure the amount of fat in your patient’s body. As a result, BMI and waist size may not be enough information to assess health risks related to excess body fat in some people. Some patients with lower BMIs and waist sizes may also have a higher risk of developing health problems related to excess weight. Likewise, some patients with higher BMIs and waist sizes may not have an increased risk of certain health problems.

Weight loss may not be an appropriate goal for every patient with a BMI of 25 or higher.⁵ To help you decide if your patient could benefit from weight loss, consider other relevant factors, such as their age, race and ethnicity, sex, health status, medical history, and risk factors for cardiometabolic disease. In some cases, helping your patient avoid additional weight gain may be a more appropriate goal.

How does weight stigma affect patients with overweight or obesity?

People with overweight or obesity often experience negative attitudes, prejudice, and discrimination about their weight from other people, including health care professionals. Negative assumptions about patients based on their body weight can prevent health care professionals from providing effective communication and compassionate care to their patients.¹ When talking with your patients about weight loss, remember that their weight can be affected by many different factors, not just lifestyle habits.

Experiencing stigma about weight can harm patients by⁶

• lowering their self-esteem
• increasing their risk of depression, anxiety, stress, social isolation, eating disorders, and substance use
• leading them to avoid physical activity and engage in unhealthy eating behaviors
• making them more likely to avoid, delay, or stop medical care for overweight, obesity, or other health problems

How can I prepare a welcoming environment for my patients?

Ensure your waiting area and consultation rooms include furniture and equipment appropriate for all patients, including those who have overweight or obesity. A welcoming environment may include⁷

• a scale that can weigh patients with overweight or obesity and is stable, accessible, and placed in a location that ensures privacy
• sturdy examination tables and waiting room furniture, such as sofas and armless chairs
• gowns and blood pressure cuffs that fit a range of sizes

What words should I use to talk about weight?

When talking about weight with patients, word choice matters. Some words that people use to talk about overweight or obesity could have a harmful impact on a patient’s self-perceptions, attitudes, and behaviors.⁸ Because your patient might prefer certain terms, you may want to ask them about the words they feel most comfortable using when talking about their weight.⁸

Avoid judgmental terms

Some terms about weight may suggest you are judging a patient’s weight or lifestyle. To use less judgmental terms when talking with a patient about their weight, you may want to

• discuss what measurements such as their BMI and waist size could mean for their health
• use terms such as “weight” or “having too much weight for their health” instead of “heavy,” “fat,” “overweight,” or “obese”
• offer to help them “lower” their weight instead of “improve” their weight
• talk about reaching a “healthier weight range” instead of an “ideal weight”
• discuss whether they have “excess weight” instead of a “weight problem”

Use person-first language

Using person-first language emphasizes that you do not define your patients by their weight but rather see them as a whole person. It can be used to describe what your patient “has” rather than what your patient “is.” For example, consider using phrases such as “people who have excess weight” or “people who have obesity” instead of “obese people.”

How can I start a conversation about weight?

Try to open a conversation about weight in a way that shows respect for your patient’s preferences and builds trust.

Address your patient’s main health concerns first

Some patients with obesity say that health care professionals dismiss their main health concerns to immediately focus on their weight.² Address your patient’s main health concerns first, before talking about their weight. Doing so may show that you are listening and responding to your patient’s concerns and needs.

Ask for permission to talk about weight

Ask for your patient’s permission to start a conversation about weight.⁷ For example, you may want to ask, “Would it be OK if we talk about your weight today?”

If your patient says, “Yes,” ease into the conversation by asking how they feel about their weight. This can help center the conversation around the patient’s perspective. If your patient says, “No,” respect your patient’s choice. You can ask if it would be OK to revisit the topic in a future visit.

How can I help my patients make healthy lifestyle changes?

Many patients with overweight or obesity—even those who do not wish to lose weight—may benefit from talking with you about healthy eating and physical activity habits.

First, ask your patient about their eating and physical activity habits, their weight history, and if they have a history or current symptoms of an eating disorder. If your patient has an eating disorder, you may want to refer them to a mental health professional.

You may also want to talk with your patient about the stages of changing habits that could improve their health. If they have thought about making lifestyle changes, try to determine if they feel ready to start. If they are ready, you can help them set lifestyle change goals, monitor their progress, and plan how they might overcome barriers and challenges.

Talk about healthy eating and drinking habits

Many adults who want to lose weight and keep it off will need to reduce the number of calories they take in from foods and beverages. Online resources such as MyPlate can provide patients with information about choosing healthy foods and drinks. The U.S. Department of Agriculture also provides resources on food security and access that may help patients find or afford healthy foods.

You may want to start a conversation about eating and drinking habits by asking your patient questions, such as

• “I’d like to learn more about your eating habits. What kinds of foods and drinks do you consume on a normal day?”
• “What barriers might keep you from having healthy foods or drinks? For example, is it hard to find healthy and affordable options where you shop for food or at restaurants?”
• “In the past 12 months, have you ever been worried your food would run out before you got money to buy more?”⁹
• “Would you like help to track how many calories you consume or how much physical activity you get?”

Talk about the benefits of physical activity

To talk with your patient about physical activity, start by discussing the important health benefits of being active, even for short periods of time, on a regular basis. You may want to ask about their physical activity habits, such as

• “What do you currently do to stay active? Would you like to add some physical activity into your daily routine?”
• “Are there any barriers that prevent you from being active? For example, is it hard to find a good time or a safe place to be active?”
• “What kinds of activities do you enjoy? Do you like walking? Seated aerobics such as arm raises or knee lifts? Do you prefer activities you can do alone, with someone else, or in a group?”

Let your adult patients know that they may benefit from¹⁰

• at least 150 minutes a week of moderate-intensity aerobic activity, such as brisk walking
• more than 300 minutes a week of moderate-intensity aerobic activity if they want to lose at least 5% of their starting weight and keep the weight off

Help patients set lifestyle change goals

Using behavior change strategies, such as shared decision-making, with your patients can help them make informed choices and become active participants in their care. You can work with your patients to make SMART goals for lifestyle changes that are

• specific
• measurable
• achievable
• realistic
• time-based

For example, your patients could set a goal to replace sugar-sweetened beverages with water for a month. They could aim to walk for 30 minutes at lunchtime on Mondays, Wednesdays, Fridays, and weekends.

To start conversations with your patients about setting goals, you may want to ask questions, such as

• “What are some goals you would like to set about your weight?”
• “What lifestyle changes would you be open to starting with?”
• “What kinds of support would help you meet your goals?”

Follow up with patients and recognize their progress

Encourage your patient to monitor the changes they make to their lifestyle habits. They can also track changes in their weight. Smartphone apps or online trackers may help them keep track of the foods and beverages they consume, how much physical activity they get, and their weight. These tools may help your patient stick with lifestyle changes and stay motivated.

Agree on a time frame for regular visits to follow up with your patient. At follow-up visits, review their progress. Recognize and praise successes in meeting their behavior-change goals or making improvements in their health, such as lower blood pressure or cholesterol levels, regardless of changes in weight. Focus on their ability to accomplish daily tasks and improvements in how they feel, rather than focusing on weight loss alone. Noticing improvements in their health, along with praise, may help motivate patients and boost self-esteem.

Help with challenges and setbacks

If your patient is making progress toward losing weight, work together to develop a plan to prevent regaining the weight they lost. If your patient is not making progress, don’t judge or show frustration. Setbacks are normal. Acknowledge that the approach is not working and be prepared to discuss other options. Work together to identify barriers and solutions, and help your patient set new goals or adjust existing goals as needed.

How can I treat patients who could benefit from weight loss?

Discuss treatment options

Provide information on obesity treatments that may be good options for your patient.

Lifestyle change programs

The U.S. Preventive Services Task Force recommends offering or referring patients with obesity for intensive lifestyle change programs.¹¹ Safe and effective weight-loss programs should last at least 6 months and provide guidance and support for adopting a healthy lower-calorie eating plan and increasing physical activity. Weight loss varies from person to person, but some researchers estimate adults can lose an average of 5% to 7% of their body weight through lifestyle changes.¹²

Many patients may also benefit from a referral to a registered dietitian.

Weight-loss medications

Research suggests that some people taking weight-loss medications lose 10% or more of their starting body weight.^13,14 However, the amount of weight lost can vary by medicine and by person.

Weight-loss medications may be an option for some adults with

• obesity, or a BMI of 30 or higher
• a BMI of 27 or higher and weight-related health problems, such as type 2 diabetes or high blood pressure

Weight-loss surgery or devices

Studies show that many people who have weight-loss surgery, also called metabolic and bariatric surgery, lose about 20% of their starting weight on average. The amount of weight they lose can vary by person and the type of surgery they have.¹⁵

Weight-loss surgery may be an option for some adults with¹⁶

• a BMI of 40 or higher, also called class 3 obesity
• a BMI of 30 or higher, and serious obesity-related health problems, such as type 2 diabetes, high blood pressure, or sleep apnea

The U.S. Food and Drug Administration has also approved several devices for obesity treatment. However, these devices cause less weight loss than weight-loss surgery, and researchers are still studying their long-term risks and benefits.

Agree on a treatment plan

Use shared decision-making to help your patient be an active participant in their care and make informed choices. Developing a treatment plan together can ensure that it is tailored to your patient’s needs, values, goals, and preferences.

What if a patient needs more help?

Some patients may benefit from additional support from specialists or a health care team. Be prepared to make referrals to

• obesity specialists, such as obesity medicine physicians, registered dietitians, or exercise specialists
• structured weight-loss programs, including hospital-based programs and evidence-based commercial programs
• mental health specialists who can identify and treat factors that may contribute to weight gain, such as anxiety, depression, or eating disorders
• specialists in medical conditions that may be affecting your patient’s weight, such as certain endocrine diseases
• bariatric surgery centers, if appropriate

You can continue helping your patients by coordinating their care, managing their health conditions, and providing support.

Will I be reimbursed for talking with my patients about their weight?

Reimbursement for obesity treatment may vary based on your patient’s age, BMI, health conditions, or health insurance coverage. Check with your patient’s health insurance provider about coverage for obesity screening, weight-loss or nutrition counseling, or treatments such as medications or surgery.

Medicaid plans cover obesity screening and counseling as part of regular preventive care, and some plans also cover nutrition counseling visits.¹⁷ Medicare may reimburse primary care professionals who provide intensive behavioral therapy to patients with obesity.¹⁸

What other resources may help?

These resources may also be useful

• The Body Weight Planner, a resource from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that people can use to create personalized calorie and physical activity plans to reach and maintain a goal weight
• NIDDK’s Diabetes Discoveries and Practice Blog, a resource for health care professionals with emerging trends and tips on helping patients with weight management
• MyPlate, a resource for the public on healthy eating from the U.S. Department of Agriculture
• Dietary Guidelines for Americans, a resource designed for policymakers and nutrition and health professionals to help people consume healthy and nutritious foods and beverages
• Toolkit for Health Professionals, a collection of resources about healthy eating from the U.S. Department of Health and Human Services (HHS)
• Physical Activity Guidelines for Americans, a resource on physical activity and health from HHS
• Weight Can’t Wait: Guide for the Management of Obesity in the Primary Care Setting, developed by the Strategies to Overcome and Prevent Obesity Alliance
• Resources on weight bias and stigma, developed by the UConn Rudd Center for Food Policy and Health
• Food Assistance Programs, a list from the U.S. Department of Agriculture with resources about food assistance programs

References