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Discussing obesity with patients

What we cover:

1. Importance of timely intervention

Recent estimates suggest that half of the world's population will be living with overweight or obesity by 2035.1 In Australia alone, 2 in 3 adults are currently living with overweight or obesity. The Australian cohort of ACTION IO* found that there is a gap of nearly 9 years between patient self-concern about weight and initial weight management discussion with a healthcare professional.2 As overweight and obesity have been associated with an increase in all-cause mortality,3 initiating weight management conversations at an early stage in patients with BMIs in the overweight category may play an important role in combating the increasing prevalence of obesity and higher BMIs that is becoming commonplace in today's society.

2. Employing an empathetic approach

The complex and sensitive nature of obesity can make conversations difficult to have with patients. An empathetic approach and asking permission is a helpful starting point. Results from ACTION IO showed that 2/3 of people living with obesity would like their healthcare professional to bring up their weight.4

Research indicates that when healthcare professionals employ an empathetic approach and other techniques consistent with motivational interviewing, patients are more likely to attempt weight loss through changes in eating and activity habits.5

3. Ask permission

When opening the conversation it’s important to ask for permission as talking about weight may be a sensitive topic.4,6

"Would it be alright to discuss your weight today?"

Once you have permission to discuss weight, ensure you use positive, motivational and patient-first language at all times.7 Below are two examples of how to discuss obesity with your patient, one is best practice and the other is language you should avoid.7

"Would you mind if we discussed your weight today and put together a weight management plan?"

"I have noticed you are obese, have you tried eating less and moving more?"

If a patient does not give permission and doesn’t want to have a discussion about their weight, do not push it further and inform them that you will be available to discuss in the future if they change their mind.6

4. Other things to consider

As you initiate the conversation with your patient with obesity, it is recommended to advise about the health risks associated with obesity.6

To balance the discussion of health risks associated with excess weight, consider advising your patient on how a weight loss of 5% has significant health benefits, and a sustained weight loss of 10-15% or more can further enhance these benefits and provide additional improvements to health.8-14

Below are some talking points:

"Because of your weight, you are also at risk of developing several weight-related complications including high blood pressure, coronary heart disease and diabetes" 15

"With weight loss of as little as 5% you can achieve significant health benefits, and a sustained weight loss of 10-15% or more can further enhance these benefits and provide additional improvements to your health" 8-14,16

For more information on obesity-related complications, click here.

In this video, Dr Sandy Van invites you to consider treating obesity like you would any other chronic medical condition like diabetes, or cardiovascular disease - with a comprehensive plan that not only includes lifestyle treatment, but also evidence-based interventions.

*The Awareness, Care and Treatment in Obesity MaNagement – an International Observation (ACTION IO) Study is the first international study to investigate barriers to obesity management among people with obesity and healthcare professionals in 11 countries worldwide, including Australia. A total of 14,502 people with obesity and 2,785 healthcare professionals completed the survey.4

Access further information and resources about Novo Nordisk treatments

References

  1. World Obesity Atlas 2023. Available at: https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023. Accessed November 2023.
  2. Rigas G, Williams K, Sumithran P, et al. Delays in healthcare consultations about obesity - Barriers and implications. Obes Res Clin Pract. 2020;14:487–490.
  3. The Global BMI Mortality Collaboration. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388:776–786.
  4. Caterson I, Alfadda A, Auerbach P, et al. Gaps to bridge: misalignment between perception, reality and actions in obesity. Diabetes Obes Metab. 2019:21:1914–1924.
  5. Pollak K, Ostby T, Alexander S, et al. Empathy goes a long way in weight loss discussions. J Fam Pract. 2007;56:1031–1036.
  6. Vallis M, Piccinini-Vallis H, Sharma A, et al. Modified 5As. Canadian Family Physician. 2013; 59:27–31.
  7. Wadden T and Didie E. What’s in a Name? Patients’ Preferred Terms for Describing Obesity. Obesity Research. 2003;11:1140–1146.
  8. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.
  9. Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34:1481–1486.
  10. Dattilo AM and Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992;56:320–328.
  11. Coggon D, Reading I, Croft P et al. Knee osteoarthritis and obesity. Intl J Obesy. 2001;25:622–627.
  12. Christensen R, Bartels EM, Astrup A, et al. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007;66:433–439.
  13. Zelber-Sagi S, Godos J and FS. Lifestyle changes for the treatment of nonalcoholic fatty liver disease: a review of observational studies and intervention trials. Therap Adv Gastroenterol. 2016;9:392–407.
  14. Glass LM, Dickson RC, Anderson JC, et al. Total body weight loss of >/= 10 % is associated with improved hepatic fibrosis in patients with nonalcoholic steatohepatitis. Dig Dis Sci. 2015;60:1024–1030.
  15. Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–1529.
  16. Seagle H, Witt Strain G, Makris A, et al. Position of the American Dietetic Association: weight management. J AM Diet Assoc. 2009;109:330–346.
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