How to Talk to Patients About Weight: Compassion, Curiosity, and Customization by Dr. Nina Crowley

Discussing weight with patients can be challenging, especially in an environment where weight is often tied to stigma, emotions, and even self-worth. As healthcare professionals, we must approach this sensitive subject with compassion, curiosity, and a personalized touch. Drawing from both practical experience and insights into the psychology of weighing, read on to see how we can foster productive and empathetic conversations about weight with our patients.

Key Tips for Talking About Weight

Balance Expectations with Respect for Experience:

Your patients come with a history—one that often includes countless attempts to address their weight. Rather than making assumptions, start the conversation with curiosity. Ask open-ended questions like, “Would it be okay if we discuss your weight today?” This shows respect for their autonomy and signals a partnership in their care.

Connect Weight to Overall Health

Instead of focusing on the number on the scale, try to connect weight to other health concerns. For example, you could say, “You mentioned fatigue and joint pain. These may be related to your weight. Would you like to explore this further to see how we can help improve your symptoms?” This approach helps make the conversation about health, not just numbers.

Ask Permission and Build Rapport

Establish trust by ensuring patients feel comfortable before discussing weight. Ask for permission to bring up the topic, and take the time to build rapport, understand their reasons for seeking care, and find a natural opening to discuss weight if necessary. This can make patients more receptive and open to engaging in a meaningful dialogue. A simple “Would it be okay if we discuss your weight?” can help ensure the patient is comfortable and open to the conversation.

Moving Beyond BMI

While BMI is still commonly used in clinical settings, it doesn’t provide a complete picture of health. Explaining this to patients can be helpful: “BMI helps us gauge excess weight, but it doesn’t reflect body composition or who you are as a person.” Highlight factors like body fat percentage, waist circumference, and muscle mass to give a fuller understanding of their health.

 Focus on What Matters to the Patient

Ask the patient, “What matters most to you?” This will help you understand their core values and what motivates them. Whether it’s improving energy levels, better sleep, or being more active with their family, goals that align with their values will keep them engaged.

• Non-Scale Victories to Celebrate
  • Health Improvements: Focus on changes in blood pressure, cholesterol, blood sugar, or other health markers that show improvement, regardless of weight loss.
  • Energy and Activity: Celebrate improvements in energy levels, the ability to do things they couldn’t do before, and fitness milestones.
  • Mental and Emotional Health: Enhancements in mood, sleep quality, and mental sharpness are all victories worth acknowledging.
  • Clothing Fit or Fit in Environment: Sometimes, how a person feels in their clothes or their confidence in social situations speaks louder than the scale. Being able to sit in an airplane seat without a seatbelt extender is a major victory for many patients!

Information Doesn’t Equal Action
Awareness and education don’t automatically lead to behavior change. Instead of assuming that giving information will inspire action, try a more personalized approach. Use motivational interviewing techniques to guide the conversation, helping patients explore their ambivalence and make connections between their current behaviors and where they want to be.

Avoid Burnout: Don’t Just Give Handouts
Burnout is real, and it’s easy to feel frustrated when you feel like patients are not following your advice. Instead of just handing out information, stay curious about what really motivates them. Elicit what they know about a topic before you dive into advice-giving. Ask permission before providing any information, and be sure to do it neutrally, not loaded with what they “should” be doing. While someone else’s reasons may seem odd or strange to you, people will only really work on what matters to them in the long term, so it’s worth both of your time to let them guide the goal setting!

Making the most of Limited Time

We often have only a few minutes with a patient, so how can we provide an individualized approach in such a short time?

• Set One Goal: Ask the patient, “What’s the one thing you want to discuss today?” Focus on helping them leave with at least one actionable step that aligns with their values. Remind them that you plan to work together long term, so will have plenty of time to build!
• Keep It Simple: Avoid blanket recommendations that sound like “eat less, exercise more.” Instead, tailor your advice to their specific situation and personal health goals. Simple can be something small they can master before they move on to more complicated changes.
• Personal Metrics: Focus on meaningful metrics beyond weight, like bloodwork or body composition, and track progress over time. Look at their individual data as a starting place to trend as they make changes over time.

Bringing it all Together

Talking to patients about weight doesn’t have to be uncomfortable or overwhelming. By approaching the conversation with empathy, curiosity, and respect for the patient’s individual journey, you can foster meaningful discussions that lead to better health outcomes. Remember to focus on non-scale victories, build trust through personalized care, and always ask for permission before diving into weight-related topics. In doing so, you help patients feel heard, supported, and empowered to make sustainable health changes.

RESOURCES:

For an in depth conversation about discussing weight with your patients, visit Exam Room Nutrition, hosted by Collen Sloan, PA-C, RDN where she talks with Dr. Crowley about ‘The Right Way to Talk Weight: Simple Tips for Busy, Burned-Out Clinicians”

We did a series on the “Psychology of Weighing” which gets into this topic in detail. Check out our webinar and Practice Guide for more actionable tips for clinicians.