Conversations about weight gain can be a delicate matter for doctors when engaging with their patients. To provide practical guidance on this issue, we’ve compiled some practical and prescriptive tips from Melbourne Bariatric and Laparoscopic Surgeon Mr. Jason Winnett and psychologist Georgie Beames. Their advice will help you navigate discussions about weight with your patients more effectively.
Have “the talk” sooner – because 1% is a lonely number
“Late in 2022, BMI requirements changed for the first time in 30 years,” says Mr Winnett.
“This means GPs need to start having this conversation with their patients sooner than ever before.”
Clinical indicators for bariatric surgery are now:
- A BMI of 30 or more with comorbidities, and 35 with no comorbidities.
- When BMI or waist circumference is increasing between GP visits.
- When the waist is more than 80cm for women and 94cm for men.
“We know in obese patients that they have tried many diets that don’t work, and generally medication or surgery is the only option. Yet currently less than 1% of people who meet criteria for bariatric surgery are actually getting it.”
Be wary of size-ism in medicine
“Unfortunately, there is still a great deal of stigmatisation against overweight and obese patients,” says Georgie Beames.
“Despite the fact most people in Australia are now overweight or obese, we are still living in an age of “fat discrimination” where the totality of the stigma often defines a severely obese person’s whole existence.”
Fat shaming in past decades has been endemic in the medical profession with doctors far more likely to advise CT scans, blood work and other tests for non-obese patients compared with obese patients, according to an American Psychological Association report.
It also found that overweight patients were far less likely to have medical symptoms investigated than healthy weight patients which led to significantly undiagnosed medical conditions (e.g., endocarditis, ischemic bowel disease or lung carcinoma), indicating misdiagnosis or inadequate access to health care.
Even in 2023, an Australian study of 900 health students in 39 Australian universities found both explicit and implicit bias against obese patients.
“Weight bias exhibited by health care students may continue into their future practice, compromising the provision of care that people living with overweight or obesity receive,” the Lancet, e-Clinical Medical journal reported.
“This highlights the need to comprehensively examine the extent to which weight bias is present among health care students and the factors that may be associated with students’ weight bias.”
Current Australian of the Year and body positivity advocate Taryn Brumfitt, also says weight management was too complex for a standard GP consultation and that weight bias remained the ‘last remaining legal form of discrimination’.
Mr Winnett adds: “Whilst I agree a standard consultation is not long enough to cover weight issues on the back of another medical issue the patient may have come in for, I do believe more and more Australian GPs are sensitive and highly adept and having these discussions. My main concern for GPs is time. And my one tip would be that if the patient comes in for a short consult, encourage them to come back for a longer consult to deal with the issue more fulsomely.”
Have a health related segue into the conversation
“The chief medical concern should be addressed first and addressed thoroughly, whether it’s a sore knee or a swollen ankle,” says Mr Winnett. “Only after that do we discuss any weight issues.” And he says to try to provide non-blameful cues for the patient to respond to.
“Many medications patients use for psychiatric disorders, diabetes, or other conditions may contribute to weight gain or difficulty losing weight.”
“Reviewing patient medications and a discussion about substituting for others that may be weight-neutral or cause weight loss is a good way to segue into the conversation.
“Highlighting the relevant illnesses that cause weight gain (such as thyroid disease, congestive heart failure, PCOS, diabetes or Cushing’s Syndrome), is helpful from a self-esteem perspective. Then it becomes about ‘the issue’, not about ‘the patient’.”
And he says if GPs are concerned about raising the issue they shouldn’t be because 68% of obese patients prefer their doctors DO discuss it, according to an international study of more than 14,000 patients with obesity.
Avoid negative questions and comments
Georgie recommends to avoid any comments that may inadvertently make patients feel shameful, such as:
- “You’re ankle is swollen because you’re carry too much weight”
- “How much do you weigh now?”
- “What size are your clothes?”
- “You really need to lose weight.”
- “What did you eat today?”
“I have never seen shame affect meaningful weight loss,” she says.
Instead, use positive statements
- Why did you come to see me today? (Address their primary medical concern first).
- Ask if it’s OK to measure their waist and leave it at that. If they seem uncomfortable, try again next time.
- Take cues from the patient to keep the conversation going.
- Express concerns about high blood pressure or weight-linked medical issues and ask: “Can we discuss this?”
- Ask the patient to make a longer appointment if necessary or suggest referring to a dietitian, weight loss surgeon or weight-focussed psychologist.
- Understand the importance of body positivity and body image movements in social media that many patients are exposed to, rather than taking a weight neutral approach if you don’t use social media often.
Remember, it’s all about approaching these conversations with empathy, respect, and a focus on their overall health. If you have any questions or would like to talk about this further, feel welcome to contact our team at Winnett Specialist Group. Let’s continue working together to provide the best care possible for our patients.
Mr Jason Winnett
Laparoscopic and Bariatric Surgeon
P (03) 9417 1555 firstname.lastname@example.org
Queens Terrace, 382 Victoria Parade, East Melbourne 3002
Explicit and implicit bias among health care students: a cross-sectional study of 39 Australian universities, The Lancet E-clinical Medicine, 2023.
RACGP Clinical Resources – national guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.