Obesity is a significant global public health concern, and health care providers play a crucial role in addressing it by offering healthy lifestyle counseling and weight management support. Evidence demonstrates that even brief counseling on healthy behaviors can lead to meaningful changes and sustained weight management. However, weight consultations are often underutilized in primary care due to various barriers, including biases against patients with obesity, misconception of physicians with obesity, or concerns about stigmatizing them by initiating discussions about weight. This paper explores the impact of biases, misconceptions, and stigma on the communication and treatment of patients with obesity and proposes strategies to overcome these challenges. Practical solutions include fostering inclusive health care environments for individuals of all body sizes and utilizing the 5A model (Ask, Assess, Advise, Agree, Assist) to guide respectful and effective weight management conversations.
StiermanBAffulJCarrollMD, et al. National Health and nutrition examination survey 2017-march 2020 prepandemic data files-development of files and prevalence estimates for selected health outcomes. Natl Health Stat Report. 2021;158:1-21.
2.
ScottJGCohenDDiCicco-BloomB, et al.Speaking of weight: how patients and primary care clinicians initiate weight loss counseling. Prev Med. 2004;38(6):819-827.
3.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults--the evidence report. National institutes of health. Obes Res. 1998;6(Suppl 2):51s-209s.
4.
DietzWH. The obesity (under) treatment conundrum. Obesity. 2019;27(12):1928-1929.
5.
SheerAJLoMC. Counseling patients with obesity. In: StatPearls. Treasure Island (FL) Ineligible Companies. Disclosure: Margaret Lo Declares No Relevant Financial Relationships with Ineligible Companies. St. Petersburg, FL: StatPearls Publishing LLC; 2024.
6.
US Preventive Services Task ForceCurrySJKristAH, et al.Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US preventive Services Task Force recommendation statement. JAMA. 2018;320(11):1163-1171.
7.
JacksonHSticklerEBiddleSTrilkJL. Do pregnant women perceive being counseled about Nutrition by Healthcare Providers? A cross-sectional study of the Recall and satisfaction of Nutrition Counseling of Patients throughout the course of their pregnancy. Am J Lifestyle Med. 2023;155982762311728.
8.
GaluskaDAWillJCSerdulaMKFordES. Are health care professionals advising obese patients to lose weight?JAMA. 1999;282(16):1576-1578.
9.
National Institutes of Health. Talking with patients about weight loss: tips for primary care professionals. Bethesda: National Institutes of Health, 2015.
10.
KimTN. Barriers to obesity management: patient and physician factors. J Obes Metab Syndr. 2020;29(4):244-247.
11.
KennedyABTaylorSSLavieCJBlairSN. Ending the stigma: improving care for patients who are overweight or obese. Fam Pract Manag. 2022;29(2):21-25.
12.
SwiftJAChoiEPuhlRMGlazebrookC. Talking about obesity with clients: preferred terms and communication styles of U.K. pre-registration dieticians, doctors, and nurses. Patient Educ Counsel. 2013;91(2):186-191.
13.
ThomasSLHydeJKarunaratneAHerbertDKomesaroffPA. Being 'fat' in today's world: a qualitative study of the lived experiences of people with obesity in Australia. Health Expect. 2008;11(4):321-330.
14.
HanssonLMRasmussenFAhlstromGI. General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care. BMC Fam Pract. 2011;12:7.
15.
Maderuelo-FernandezJARecio-RodríguezJIPatino-AlonsoMC, et al.Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: a systematic review. Prev Med. 2015;76(Suppl):S39-S55.
16.
AlbrightCLCohenSGibbonsL, et al.Incorporating physical activity advice into primary care: physician-delivered advice within the activity counseling trial. Am J Prev Med. 2000;18(3):225-234.
17.
VolgerSWaddenTASarwerDB, et al.Changes in eating, physical activity and related behaviors in a primary care-based weight loss intervention. Int J Obes. 2013;37(1):S12-S18.
18.
BleichSNBennettWLGudzuneKACooperLA. National survey of US primary care physicians’ perspectives about causes of obesity and solutions to improve care. BMJ Open. 2012;2(6):e001871.
19.
KoJYBrownDRGaluskaDAZhangJBlanckHMAinsworthBE. Weight loss advice US obese adults receive from health care professionals. Prev Med. 2008;47(6):587-592.
20.
FosterGDWaddenTAMakrisAP, et al.Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11(10):1168-1177.
21.
PuhlRMBrownellKD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity. 2006;14(10):1802-1815.
22.
BleichSNBennettWLGudzuneKACooperLA. Impact of physician BMI on obesity care and beliefs. Obesity. 2012;20(5):999-1005.
23.
HeintzeCMetzUHahnD, et al.Counseling overweight in primary care: an analysis of patient–physician encounters. Patient Educ Counsel. 2010;80(1):71-75.
24.
HuangJYuHMarinEBrockSCardenDDavisT. Physicians’ weight loss counseling in two public hospital primary care clinics. Acad Med. 2004;79(2):156-161.
25.
HartJYellandSMallinsonAHussainZPetersS. When is it ok to tell patients they are overweight? General public’s views of the role of doctors in supporting patients’ dieting and weight management. J Health Psychol. 2016;21(9):2098-2107.
26.
PotterMBVuJDCroughan-MinihaneM. Weight management: what patients want from their primary care physicians. J Fam Pract. 2001;50(6):513-518.
27.
O’SheaDKahanSLennonLBreenC. Practical approaches to treating obesity: patient and healthcare professional perspectives. Adv Ther. 2021;38(7):4138-4150.
WarrWAveyardPAlburyC, et al.A systematic review and thematic synthesis of qualitative studies exploring GPs' and nurses' perspectives on discussing weight with patients with overweight and obesity in primary care. Obes Rev. 2021;22(4):e13151.
30.
GudzuneKAClarkJMAppelLJBennettWL. Primary care providers’ communication with patients during weight counseling: a focus group study. Patient Educ Counsel. 2012;89(1):152-157.
31.
FitzpatrickSLWischenkaDAppelhansBM, et al.An evidence-based guide for obesity treatment in primary care. Am J Med. 2016;129(1):115.
32.
WhitlockEPOrleansCTPenderNAllanJ. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med. 2002;22(4):267-284.
33.
AnanthakumarTJonesNRHintonLAveyardP. Clinical encounters about obesity: systematic review of patients' perspectives. Clin Obes. 2020;10(1):e12347.
34.
SrivastavaGJohnsonEDEarleRLKadambiNPazinDEKaplanLM. Underdocumentation of obesity by medical residents highlights challenges to effective obesity care. Obesity. 2018;26(8):1277-1284.
35.
MoyerVAU.S. Preventive Services Task Force. Screening for and management of obesity in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):373-378.
36.
KirkSPenneyTMcHughT-LSharmaA. Effective weight management practice: a review of the lifestyle intervention evidence. Int J Obes. 2012;36(2):178-185.
37.
WhiteheadLGlassCCAbelSLSharpKCoppellKJ. Exploring the role of goal setting in weight loss for adults recently diagnosed with pre-diabetes. BMC Nurs. 2020;19:67.
