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How To Bring Up The Topic of Weight With Obese Patients

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How To Bring Up The Topic of Weight With Obese Patients
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Featuring Dr. Ali Zentner, MD, FRCPC, Internal Medicine, Obesity

Duration: 3 minutes, 27 seconds

The most important thing that we can do to provide patients with a proactive environment to approach their obesity is really just to create a safe space, where they feel that we’re cheering them on, as opposed to policing them.

Patients talk all the time about accountability, and I think we actually need to reframe that word in one of support. Where they come in, they absolutely know what they need to do, and it’s not about us setting a list of goals for the patient.

These are dieting experts. They have done the math, they have been to the movie, they have bought the t-shirt, they’ve done it all. They don’t need us teaching them about nutrition. What they need us to be is a place of empathy, a place of support and encouragement, where they can set safe goals and they can restructure how those goals are going to happen, whether or not they’re going to be successful with them, and how to reframe that conversation overall.

The most important thing that you need to do when a patient comes to your office is to ask permission. This is a disease that is rife with guilt and shame, and patients come to us with what I would call a host of dieting baggage.

The world has ostracized them, the health profession has made them feel like this is their fault, when it’s absolutely not, and as such I think we need to ask for permission. So, the big question would be “How would you feel” or “What do you think? How would you feel about discussing your weight today? Would it be okay if…What do you think if we have a discussion about weight loss today?”

Quick things that we could do within a first visit are most importantly establish rapport. A patient has to have a sense of trust and safety in order to create any goals. It can be as simple a goal as “What do you think you could do with regards to exercise? How would you feel about keeping a food diary? What sorts of changes do you want to make in what you’re eating every day or what you’re drinking every day?”

It involves taking a really brief history about where the patient thinks they’re at in terms of where the food changes are, what worked for them in the past, what sort of a small move towards change do they want to do?

Whether it’s just cutting out their fruit juice or liquid sugars, or whether it’s as simple as looking at the amount of carbohydrates or micronutrients that they’re eating every day and making small adjustments. The key here is being that place that the patient feels that they can come to where they set the goals. As opposed to you handing them a food plan and a whole meal plan that they have to stick to, and if they don’t you’ll never see them again.

The beauty of treating this disease properly is that it really does ignite in us the reason we all went into medicine. We have the opportunity for I think the first time in a very long time to bring back the humanity and the empathy to a profession. This is a disease that’s begging for us to stop judging and stop pre-judging to help erase some of the shame and guilt that exists with our patients and very much be that empathic place that our patients are looking to us to provide.

Presenter: Dr. Ali Zentner, Family Doctor, Vancouver, BC

Local Practitioners: Family Doctor

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.