Talking with Patients about Weight Loss
More than one-third of adults in the United States are obese. The U.S. Government views obesity as one of the most severe health concerns facing the nation. With so many people struggling with obesity, almost all health care providers can expect to care for patients who are obese. This fact sheet offers helpful tips for health care providers to overcome the challenges unique to providing optimal care to these patients, no matter what weight-loss treatment is used.
What Is Obesity?
“Obesity” refers to an excess amount of body fat. It develops when the number of calories (energy) consumed in food and beverages exceeds the number of calories that the body burns to function. There are few studies in humans that link direct amounts of total body fat to sickness and death. There are also no formal standards issued by the National Institutes of Health (NIH) that define obesity based on the amount or percentage of a person's total body fat. A common way to screen for obesity is the body mass index.
What Is the Body Mass Index?
The Body Mass Index (BMI) is a tool used to measure weight as it relates to height. BMI has its limits. It does not assess body fat or muscle directly. BMI is measured by dividing a person's weight in pounds by height in inches squared and multiplying by 703.
Men and women can have the same BMI but different body fat percentages. As a rule, women usually have more body fat than men. A bodybuilder with large muscle mass and low body fat may have the same BMI as a person who has more body fat. However, a BMI of 30 or higher usually suggests excess body fat.
The NIH currently defines overweight as a BMI of 25 to 29.9 and obesity as a BMI greater than or equal to (>) 30. Obesity is further broken down into Class I (BMI of 30 to 34.9), Class II (BMI of 35 to 39.9), and Class III (BMI > 40) or “extreme obesity.” An online tool for measuring BMI is available at www.nhlbi.nih.gov.
What Are Some of the Challenges to Treating Patients with Obesity?
Patients with obesity may delay seeing a health care provider for routine medical care. They may also be less likely to receive certain health tests, such as Pap smears, breast exams, and pelvic exams. Lack of routine medical care is most likely the result of both patient and provider factors. Both the patient and the health care provider play a role in the health of the patient.
Here are some issues that may prevent patients with obesity from seeking help:
- Being ashamed or embarrassed about their weight
- Hearing hurtful comments that the health care provider or staff may say about their weight
- Being disrespected by staff or health care providers in the past
How Can Health Care Providers Offer Optimal Medical Care to Patients with Obesity?
Health care providers can take steps to make sure that their patients receive quality care. Health care providers should do the following:
- Treat patients with respect.
- Have suitable equipment and supplies on hand to improve patient access to care.
- Support healthy behaviors and self-acceptance even if the patient does not wish to lose weight or cannot successfully lose weight.
To create a positive office climate‚ medical and other staff should review this fact sheet.
Here are some issues that may prevent a health care provider from providing the best care to patients who are obese:
- Lack of suitable medical tools to correctly assess and treat patients
- Lack of training in providing the physical and emotional support that patients may need
- Belief that a patient’s weight is mainly due to lack of willpower
- Challenges performing exams‚ such as pelvic exams‚ due to a patient’s size
Create a positive, open, and comfortable office space
- Provide sturdy‚ armless chairs and high‚ firm sofas in waiting rooms.
- Provide sturdy‚ wide exam tables bolted to the floor to prevent tipping.
- Provide a sturdy stool or step with handles to help patients climb onto the exam table.
- Provide extra-large patient gowns.
- Install a split toilet seat. Provide a specimen collector with a handle.
- Provide reading materials in the waiting room that focus on healthy habits‚ rather than physical looks or being “thin.”
Use medical devices that can correctly assess patients with obesity
- Use large adult blood pressure cuffs or thigh cuffs on patients with an upper-arm circumference greater than 34 cm.
- Use extra long needles to draw blood and have large vaginal specula on hand.
- Have a weight scale with the capacity to measure patients who weigh more than 400 pounds.
Be respectful when talking about the patient’s weight
- Weigh patients in a private area and only when medically needed.
- Record weight without comments.
- Ask patients if they wish to discuss their weight or health.
- Avoid using the term “obesity.” Your patients may prefer such terms as “BMI” or “weight.” Ask your patients what terms they would like you to use when discussing their weight.
Track and test for the following health problems linked to obesity:
- type 2 diabetes
- hypertension (high blood pressure)
- sleep apnea (when breathing pauses while sleeping)
- nonalcoholic steatohepatitis (fatty liver disease)
- lower extremity edema (swelling of the legs and feet)
- skin compression (ulcers)
Offer well-care services
- Allow enough time during office visits to provide well-care services.
- Suggest or provide such services as Pap smears‚ breast exams‚ mammography‚ prostate exams‚ and stool testing.
Promote healthy behaviors
- Ask your patients if they would like to talk about weight loss. If they want to talk about losing weight‚ let them know that a weight loss of 5 to 7 percent of body weight may lower their chance of developing diabetes. Work with your patients to establish realistic goals.
- Start small. Encourage patients to start with simple goals such as walking for 10 minutes‚ three times a day. Once they achieve this goal‚ they can build on it.
- Offer patients information and referrals to registered dietitians‚ other health providers‚ and support groups‚ as needed.
- Promote self-acceptance and encourage patients to lead full and active lives.
Health care providers have the power to help improve the lives of patients with obesity. Changes that foster respect for the patient and a supportive and well-designed space for receiving services are within reach of most health care providers. The suggestions outlined in this fact sheet offer a solid starting place. Additional resources to help achieve these changes are listed at the end of this fact sheet.
Changes that foster respect for the patient and a supportive and well-designed space for receiving services are within reach of most health care providers.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts and supports a broad range of basic and clinical obesity research. More information about obesity research is available at https://www.obesityresearch.nih.gov.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
Additional Information for Health Care Providers
Davis NJ, Shishodia H, Taqui B, Dumfeh C, Wylie-Rosett J. Resident physician attitudes and competence about obesity treatment: need for improved education. Medical Education Online. 2008;13:5. Available at http://www.tandfonline.com/toc/zmeo20/current. Accessed March 2011.
Huizinga MM, Cooper LA, Bleich SN, Clark JM, Beach MC. Physician respect for patients with obesity. Journal of General Internal Medicine. Nov 2009;24(11):1236–1239. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771236/?tool=pubme. Accessed March 2011.
National Heart, Lung, and Blood Institute, NIH. Body Mass Index Tables. https://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm. Accessed June 2011.
National Task Force on the Prevention and Treatment of Obesity. Medical care for obese patients: advice for health care professionals. American Family Physician. 2002;65(1):81–88. Available at https://www.aafp.org/afp/2002/0101/p81.html. Accessed March 2011.
Shay LE, Shobert JL, Seibert D, Thomas LE. Adult weight management: translating research and guidelines into practice. Journal of the American Academy of Nurse Practitioners. Apr 2009;21(4):197–206. Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1745-7599.2008.00383.x/full. Accessed March 2011.
Medical Supplies and Equipment
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Body Mass Index Table
To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight (in pounds).
The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.
Body Mass Index Table 1 of 2
|Body Weight (pounds)|
Body Mass Index Table 2 of 2
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Rebecca Puhl, Ph.D., Yale University; Lynn McAfee, Council on Size and Weight Discrimination