The worldwide prevalence of obesity has more than doubled between 1990 and 2022, with more than 890 million adults living with obesity in 2022.1 International guidelines recommend that clinicians offer weight loss support to their patients living with obesity, and effective communication from clinicians is associated with patient weight loss.2 Clinicians and patients think these conversations are important, and clinicians who do not specialize in treating obesity want to know how to introduce and offer support and treatment for weight loss.3
Overall, conversations should be grounded in an understanding that obesity is a complex, chronic, relapsing condition, and the patient is not to blame or at fault.3 Clinicians should avoid perpetuating weight stigma and bias in their language, including avoiding the term obese.3 Throughout conversations, clinicians should communicate with respect, empathy, without judgment, and in a person-centered manner.3
The following specific techniques have been shown to support brief, effective, and well-received conversations about weight loss.2 The Table provides examples generated from conversation analysis of real UK patient-clinician encounters.4
Examples to Incorporate Into Weight Loss Conversations:
Evidence from 237 recorded consultations showed that gentle initiation of communication about weight loss supported more positive and well-received conversations.5 This may be achieved by forecasting an upcoming discussion of weight, rather than initiating the conversation abruptly. Clinicians can mention a time when weight, or a condition relevant to weight, was discussed previously; speak slowly; provide meta-assessments, which preemptively assess the conversation (eg, “this might be a bit of an awkward conversation…”); and soften communication by using qualifiers to present weight loss as achievable, rather than insurmountable (eg, “did you know that if you did lose a little bit of weight…”).5
When a patient does not wish to talk about weight loss, acknowledging the legitimacy of the response and accepting the patient’s decision is the most effective approach.6 In a conversation analysis of primary care interactions, attempting to convince patients to talk about weight was unsuccessful and led to patients becoming angry and frustrated.6
Tailor Communication to What Is Relevant for the Patient
Clinicians should tailor conversations and avoid making assumptions about what is important to a patient, what patients know (or do not know), and what actions they have previously taken regarding their weight, all of which have been found to be received negatively.7 Presenting weight loss as personalized and relevant for each patient can support positive discussions. Evidence shows that this can be achieved through “referencing back,”5 where a clinician raises something relevant to the patient from earlier in a consultation (eg, “We’ve been talking about your back, and one of the things that could really help your back is to lose some weight”). Another way to tailor information to individual patients is to ask questions and personalize responses to the patient’s answers. For example, this could include asking if a patient has tried a specific approach, exploring their perspective on its acceptability, and then recommending or advising approaches a patient has identified as relevant and acceptable. These question-and-answer formats create a collaborative conversation, which often results in positive responses from patients.8 Using these approaches, the conversation is likely to link directly to what individual patients find important.
Communicate Positively and Emphasize the Benefits of Weight Loss
Focusing on the harms of obesity can be demotivating, evoking feelings of blame and stigma,3 and may lead to patients becoming upset or angry.2 In contrast, communicating positively and emphasizing the benefits of weight loss, rather than the harms of obesity, is more effective and better received. An analysis of recorded consultations showed that focusing on the benefits of weight loss was well received by patients, associated with a greater likelihood of accepting referrals for treatment (absolute risk difference, 0.45 [95% CI, 0.34 to 0.56]) and increased weight loss at 1-year follow-up (adjusted difference, −3.60 [95% CI, −6.58 to −0.62] kg).2 Positive communication can be achieved by highlighting the specific anticipated benefits of weight loss for the patient, including optimistic projections, and using explicitly positive words and tone of voice (eg, “weight loss could positively help…”).
Offer Specific Treatment, Rather Than Advice Only
A study of 159 recorded family practice consultations showed that clinicians often inadvertently communicated scientifically unsupported advice about weight loss.9 Almost all consultations included vague and abstract advice, provided without “reason, justification, or evidence”9 to explain how to implement the suggested changes, or how these changes might support weight loss (eg, “Make sure you have a low-fat, low-sugar, high-fiber diet. Little of it, lots of exercise, and see how you go”).9 One-third of advice given was superficial and unlikely to be effective (eg, “I would advise you to look at ways of changing your lifestyle a bit”), often including “eat less and move more” messaging. This approach may imply that a patient lacks knowledge of simple actions they should take or may have already taken, resulting in negative reception from patients.7 To avoid providing unhelpful and unscientific advice about weight loss, clinicians can access information and training through the Strategic Centre for Obesity Professional Education.
Patients are more likely to lose weight when offered definitive treatment rather than advice. For example, in a 2016 trial, 1882 patients with obesity were offered either a referral for weight loss support or advice at the end of a consultation.4 Support involved recommending a behavioral weight loss program, offering a referral, and providing an appointment for a specific program. At 12 months, among participants offered support, 25% achieved at least 5% weight loss and 12% lost at least 10% of their body weight. In contrast, in the advice-alone group, only 14% of participants achieved at least 5% weight loss and 6% lost at least 10% of their body weight. Analysis of the consultations showed that clinicians appeared more effective when they communicated clearly and positively about available treatment programs, provided information about where and how they could be accessed, and stated their cost.10 It is important to avoid communicating a high patient activity burden (eg, “You’ll need to work hard and lose a significant amount of weight”), and instead to emphasize the immediate next step (eg, “Please do go to the first session”).
Other treatments are available for obesity, including antiobesity medications and bariatric surgery, although there is currently no direct evidence on how these are best communicated. The principles above may apply for clinicians discussing referrals to comprehensive obesity treatment programs: endorse the value of treatment over self-directed weight loss in a positive manner and make a clear offer clarifying relevant patient considerations.
Bron: JAMA | Published Online: February 3, 2025