The recent explosion of GLP-1 agonists has led to an increase in the number of patients asking about medication for weight loss. Although you may be happy to encourage patients to achieve their weight loss goals, you may also wonder about the best ways in which to support them.
As a primary care clinician and a certified health coach with a focus on weight management, I do not believe the body positivity movement and weight loss efforts are mutually exclusive. We can and should affirm each person’s self-worth by reinforcing the truth that weight and body size have nothing to do with a person’s value, beauty, or desirability. At the same time, we know that some medical conditions are closely associated with excess weight and that weight loss can improve health for many people.
Talking about weight in a way that minimizes shame, focuses on health markers rather than weight, and empowers people is an important part of supporting weight loss efforts. The goal is long-term, sustainable behavioral change that leads to better health, and primary care clinicians are a critical part of that process.
Always Start By Asking for Permission To Talk About Weight
Always start by asking your patients for permission to walk about weight. It is as easy as asking, “Are you ready to talk about weight?” The simple question opens the conversation and empowers the patient. If your patient says “No,” then you know they aren’t ready, and you can proceed focused solely on healthy behaviors. If they say “Yes,” then it’s time to move the conversation forward in a way that sets your patient up for success.
Address and Avoid Shame Around Weight
Shame around weight is very common in our culture, especially among women. Patients have internalized messages over many years suggesting that they are worth less if they are overweight and have failed if they haven’t been able to lose weight.
Not only is this psychologically damaging, shame is not a good motivator for behavioral change. It just doesn’t work. It can trigger physiological and behavioral changes linked to increased weight gain.
Weight stigma is “the social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape.” There have been interesting lab experiments where people were manipulated to experience weight stigma. Researchers found that when people experienced weight stigma, eating increased, self-regulation decreased, and cortisol levels rose.
Traditional medical advice to just “eat less, exercise more” or “just have more willpower” perpetuates stigmatization and self-blame, undermining the intended effect. By inadvertently increasing a patient’s shame about failed weight-loss attempts in the past, we may be decreasing the chances that future attempts are successful.
Releasing shame is not easy. However, as your patient’s primary care clinician, the message that a person shouldn’t feel shame about their weight and that they aren't a failure can be powerful. The prevalence of obesity in the U.S. rose from 15% in the late 1970s to 41.9% in 2017-2020, and as I often tell my clients the cause of the obesity epidemic is multifactorial, but it’s unlikely that everybody just lost willpower over the last 50 years.
Empower Your Patients to Lose Weight
Many people feel frustrated with their weight and don't believe they can change. It’s important to reinforce a message of empowerment: people can make lifestyle changes and those changes will lead to improved health.
Trying to lose large amounts of weight can feel overwhelming. It can help to remind patients that they don’t need to get down to a BMI <25; small amounts of weight loss lead to improved health outcomes. Weight loss of 5-10% is associated with improvements in blood pressure and cholesterol, and weight loss of 10-15% is associated with improvements in obstructive sleep apnea and metabolic-associated liver disease. As people lose weight, they can expect gradual improvements in quality of life, depression, mobility, sexual dysfunction, urinary stress incontinence, and other health conditions.
Focus on Health Outcomes, Not the Number on the Scale
I tell my clients that they can and should have their own goals and reasons for losing weight, but my reasons for helping them lose weight are solely to improve their health, and that is what we plan to measure.
I have worked with people who wanted to be able to play with their grandkids on the floor; stop wearing a necklace extender; fit easily into airplane seats; or return to their pre-pregnancy weight. However, as healthcare providers, it is helpful for us to stay focused on clinical goals rather than the number on the scale. Try to find another number to follow: blood pressure, blood sugar, lipids, and liver function tests can be useful ways to measure improvements in health.
Be the Support Your Patient Needs
It can be tempting to “tell” our patients how to lose weight with “diet and lifestyle intervention,” but remember that most people who have struggled with their weight for a long time already know a lot about how to lose weight. The problem may not be a lack of knowledge, but rather the complicated interplay of physiology and behavior that contributes to weight gain.
The way we talk about weight and encourage lifestyle change can significantly impact a patient’s ability to lose weight and maintain the weight loss. We can and should help our patients release shame around weight and feel empowered to improve their health for the long run — we just need to be as intentional about this treatment plan as we are about every other treatment plan we develop for our patients.
