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Talking with Patients about Weight Loss: Tips for Primary Care Providers cover

Talking with Patients about Weight Loss:
Tips for Primary Care Providers

As a health care provider, you are in an ideal position to talk to your patients about weight control. This publication offers tips and resources for addressing this sensitive topic with your patients.

Why talk to patients about their weight?

Two-thirds of American adults are overweight or obese. This excess weight may put them at risk for diabetes, heart disease, and other medical problems. Weight control may help patients delay and reduce these issues.

Research has shown that patients who were counseled in a primary care setting about the benefits of healthy eating and physical activity often took positive action. They lost weight and exercised more than patients who did not receive counseling.

Studies show that talking with patients about weight control helps to promote behavior change. But many providers fail to do so for these reasons:

  • lack of office time with patients
  • lack of training on how to talk to patients about weight

People who are overweight or obese often want help in setting and reaching weight-loss goals. But it may be tough for some patients to talk about their weight. By speaking with patients caringly and working with them as partners, you can play a key role in helping patients improve their health.

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Which patients might benefit the most?

Measuring your patients' body mass index (BMI) on a regular basis can help you identify those who may benefit the most from information on weight loss. The BMI measures body fat based on a person's height in relation to weight and provides a score to signal whether someone is at a healthy weight.

Approach the subject of weight loss if your patient has

  • a BMI of 30 or above
  • a BMI between 25 and 30 plus two or more health problems linked to weight, such as a family history of heart disease or diabetes
  • a waist size over 35 inches (women) or 40 inches (men)—even if BMI is less than 25—and two or more health problems linked to weight

See the Resources for Health Care Providers section of this fact sheet for a web link to an online BMI calculator.

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How do I bring up the topic?

Patients do not want their health care providers to assume that all their problems are weight related. Address your patients' main health concerns first. Allow them to talk about other issues that may be affecting their physical or emotional health, such as family or work issues.

Open the discussion about weight in a respectful way. Find out if your patient is willing to talk about the issue. Use terms preferred by patients, such as "weight," "excess weight," "unhealthy body weight," and "BMI," or ask your patient what terms he or she prefers. You may want to start like this:

  • "Ms. Brown, your BMI is above the healthy range. Excess weight could increase your risk for some health problems. Would you mind if we talked about it?"

Be alert to cultural differences that your patients may bring to the table about weight, favorite foods, social norms and practices, and related issues. Patients may be more open when they feel respected. See Resources for Health Care Providers for a link to the Weight-control Information Network (WIN) publication Medical Care for Patients with Obesity, which offers tips for respectful treatment of obese patients in medical settings.

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What do patients want to know?

Patients often want information on safe and effective ways to control their weight. A patient who is not yet ready to attempt weight control may still benefit from talking about healthy eating and regular physical activity.

Ask patients about their eating habits. Encourage them to replace foods high in fat, refined grains, and/or sugar with healthier options. Make them aware of the healthy eating resources available from the U.S. Department of Agriculture. For example,

  • "What kinds of foods do you eat on a typical day?"
  • "What does 'healthy eating' mean to you?"

Find out if your patients are meeting the Government recommendations for physical activity. Make them aware that being inactive, especially sitting for long periods of time at work or at home, may not be good for their health. You may want to ask,

  • "How much time do you spend sitting down each day?"
  • "Do you know how much physical activity you should do each week to stay healthy?"

See Healthy Eating and Physical Activity Tips to Share with Your Patients at the end of this page for tips and resources to share with patients.

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How can I help my patients set goals?

Ask your patients how ready they are to adopt healthier eating and physical activity habits. Work as a partner with each patient to develop a plan. Some questions to ask are these:

What is a sensible weight-loss goal?

  • Losing weight too quickly may contribute to health problems, such as gallstones.
  • A 5-to-7 percent reduction in body weight over 6 months is a sensible weight-loss goal.
  • One-half to 2 pounds per week is a safe rate of weight loss.
  • "What are your goals regarding your weight?"
  • "What kind of changes would you be willing to start with?"
  • "What kind of help would you like from me about your weight?"

Partner with your patients to identify concrete actions they can take to meet their weight goal over the next 6 months.

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How can I help my patients stick with their goals?

Praise can help inspire your patients to maintain new behaviors. When you see patients again, note their progress. Offer praise to boost self-esteem and keep them motivated.

Some patients may lose weight very slowly, which can be discouraging. Note any advances in related risk factors, like blood pressure, blood sugar, and high cholesterol. Improving the health numbers related to these factors may motivate patients, especially if changes are made despite slow weight loss.

Discuss any setbacks, and help your patients to overcome challenges. Work with your patients to set new goals. Discuss eating and physical activity habits to change or maintain.

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What if a patient needs more help?

What type of patients may be best suited for bariatric surgery?

Bariatric surgery may be the next step for patients who remain severely obese after trying approaches other than surgery‚ especially if they have a disease linked to obesity.

Among adults, bariatric surgery may be an option if the patient has

  • A BMI ≥ 40 or
  • A BMI ≥ 35, along with a serious health problem linked to obesity, such as type 2 diabetes, heart disease, or severe sleep apnea

In some cases, you may prefer to refer your patient to a weight-loss program or a registered dietitian who focuses on weight control. The Academy of Nutrition and Dietetics offers referrals to registered dietitians throughout the United States. See the Resources for Patients section for contact information.

Some patients may benefit from information on bariatric surgery as a treatment for obesity. You may find WIN's publication Bariatric Surgery for Severe Obesity helpful to give to patients (see Resources for Health Care Providers). Be prepared to make a referral to a specialist who can work with the patient to find out if weight-loss surgery is a good option for him or her.

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Resources for Health Care Providers

Additional Reading from the Weight-control Information Network

You can access brochures and fact sheets listed below on the publications section of this website. You may also request copies by calling WIN toll-free at 1–877–946–4627.

  • Bariatric Surgery for Severe Obesity explains how this surgery on the stomach and/or intestines helps patients with extreme obesity to lose weight. Health care providers can use this fact sheet to discuss options with patients who have extreme obesity.
  • Medical Care for Patients with Obesity is a fact sheet from WIN to help health care providers offer optional medical care to patients who are obese. This fact sheet features a complete BMI table.

Other Resources on Weight Control

  • 3 Steps to Initiate Discussion About Weight Management With Your Patients, from the National Heart, Lung, and Blood Institute (NHLBI), offers tips to health care providers about initiating respectful dialogue with patients about weight management. Available at http://www.nhlbi.nih.gov/health/prof/heart/obesity/aim_kit/steps.pdf. [PDF - 52 kb]
  • Aim for a Healthy Weight Provider Kit is a patient education kit from the NHLBI that helps health care providers develop effective programs for weight management in their offices or clinics. The kit is available at http://www.nhlbi.nih.gov/health/educational/lose_wt/.
  • BMI Calculator is a free tool from the NHLBI for the iPhone, Palm OS, and PocketPC. This tool is available at http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/bmitools.htm.
  • Screening for and Management of Obesity in Adults: U.S. Preventive Services Task Force Recommendation Statement provides information on the Task Force recommendation that clinicians screen adults for obesity and provide appropriate referrals. Annals of Internal Medicine. 2012. The article is available at http://annals.org/ Exit Disclaimer.

Inclusion of resources is for information only and does not imply endorsement by NIDDK or WIN.

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Healthy Eating and Physical Activity Tips to Share with Your Patients

Share these ideas with your patients to support their efforts to lose weight or keep a healthy weight.

Set goals for weight control

Encourage your patients to

  • Identify specific goals for losing excess weight or maintaining a healthy weight.
  • List concrete actions they will take to increase healthy eating and physical activity.
  • Set sensible weight loss goals, such as losing 5 to 7 percent of their body weight over 6 months.

Create a healthy eating plan

Encourage your patients to

  • Check out the Government's tip sheets on healthy eating at the MyPlate website (http://www.choosemyplate.gov).
  • Eat more of these foods: beans, fat-free or low-fat cheese and milk, fruits and vegetables, lean meats and seafood, nuts, whole grains (brown rice and oatmeal).
  • Limit these foods: breads and pasta made with refined grains, foods with butter or other fats that are solid at room temperature, and sugar-sweetened drinks and desserts.

Be more active

Encourage your patients to

  • Check out the Government's physical activity guidelines.
  • Do 150 minutes a week of moderately intense aerobic activity (about 30 minutes on most days). Tell them that aerobic activity uses their large muscle groups (back, chest, and legs) to increase their heart rate and breathing.
  • Choose aerobic activities that are fun, like brisk walking, dancing, playing a sport, or swimming.
  • Build strength with weight lifting or other weight-bearing exercises at least 2 days per week. If they don't have weights, they can use books or cans of food to do arm curls.
  • Get up and get moving. Sitting for long periods of time may lead to weight gain. They can go for a walk or take the stairs, making sure the stairs are well lit.

Resources for Patients

Reading from the Weight-control Information Network (WIN)

You can access brochures and fact sheets listed below on the publications section of this website. You may also request copies by calling WIN toll-free at 1–877–946–4627.

Other Resources

Inclusion of resources is for information only and does not imply endorsement by NIDDK or WIN.

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Research

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 http://www.obesityresearch.nih.gov  Exit Disclaimer.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For more information, visit http://www.clinicaltrials.gov  Exit Disclaimer.

The Weight-control Information Network (WIN) is a national information service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). WIN provides the general public, health professionals, and the media with science-based, up-to-date, culturally relevant materials and tips. Topics include healthy eating, barriers to physical activity, portion control, and eating and physical activity myths.

Publications produced by WIN are reviewed by both NIDDK scientists and outside experts. This publication was also reviewed by Rebecca Puhl, Ph.D., of the Rudd Center for Food Policy & Obesity at Yale University.

This publication is not copyrighted. WIN encourages you to duplicate and distribute as many copies as desired.

NIH Publication No. 05–5634
Updated November 2012

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To contact WIN, call toll free 1–877–946–4627; fax: 202–828–1028; email: win@info.niddk.nih.gov;
or write Weight-control Information Network, 1 WIN Way, Bethesda, MD 20892–3665.

Last Modified: September 4, 2014

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