Overweight and obese patients not only have few interactions with physicians about their weight, but the encounters they do have are largely negative experiences, a new systematic review of patients’ perspectives on the subject reveals
This is an edited version of an article first published by Medscape
‘The overwhelming theme [from this review] was that interactions between patients and doctors about being overweight, and weight loss, were rare, [and] for participants, not discussing these issues had several meanings…the most profound [being] that people who were overweight felt stigmatized and assumed others, including the doctor, were judging them negatively,’ writes Thanusha Ananthakumar, MD, University of Oxford, in an article published in Wiley Online.
Physicians should be encouraged to start a discussion with the assumption that a person may well already be taking action to lose weight and that what is required is guidance and support. Clinicians should note that a person’s harshest critic of weight status is usually themselves and, therefore, avoid making statements of moral intent.
Raise the subject of weight, but address it sensitively
In their review the authors included 21 qualitative studies in which people with obesity had consulted a primary care physician and given their reactions to consultations during which weight could have been, or was, discussed.
When the issue of weight was not discussed, some patients indicated that they felt their healthcare providers’ silence suggested they were not worthy of their time, or that being overweight or obese was not a serious health issue.
On the other hand, there was uncertainty, and mixed views, about whose responsibility it was to bring up weight in a consultation. A few respondents thought that their physician should ask permission to discuss their weight before initiating a conversion about it — even though some participants indicated they would have liked their physician to actually start a discussion about it, at least in part because they were ashamed of being overweight and unable to lose the weight.
‘Where it was mentioned, most participants reacted negatively to doctors describing them as ‘obese’, the authors note. In some cases, the word demotivated participants to lose weight as it made them feel ‘hopeless’ or beyond help. For many patients, even the tone of voice and the manner in which weight was raised by the physician created negative feelings, again undermining their motivation to lose weight.
‘A recurrent theme across studies was that doctors often assumed a person who was overweight must have an unhealthy diet,’ the investigators write, ‘[and] these assumptions reflected a common belief that people who are overweight eat a lot of ‘junk food’ and are not physically active.’
Physicians also sometimes offered advice about weight loss that patients felt was banal, implying that the patient was either not trying to look after themselves or they were too stupid to not have already realised what physicians themselves were suggesting, and not to have already done something about it.
Doctors assume symptoms are weight-related without due diligence
Many patients also reported that they visited their doctor with symptoms that may have been related to being overweight or obese but their physician immediately assumed their symptoms were weight-related without taking a history, or doing a physical exam.
‘This left participants feeling dismissed and anxious that a more serious cause for their symptoms might go undetected,’ the authors point out. In so doing, patients also felt they had been denied a legitimate treatment and were, instead, being made to suffer in a punitive manner because of their weight.
‘Clinicians should take care when linking weight to a presenting medical issue, and discuss weight loss as one of a range of treatment strategies rather than presenting excess weight as the cause of the problem, and weight loss as the only cure,’ the authors emphasise.
When physicians did address the health risks of being overweight or obese, nobody appreciated being scolded or made to feel personally responsible for their presumed weight-related symptoms, as this attitude reflects an all-too-common belief that obesity is a failure of willpower, the authors explain.
On the positive side, patients said that when they trusted their doctor, discussions about being overweight and weight loss were easier, and that trusting their physician motivated them to act on their doctors’ advice.