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How to you tell someone they need to lose weight?
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The best way to start the conversation is to ask the person about their exercise and diet routines, along with your normal line of medical questioning, as if you ask every patient regardless of size these questions. Not only will it get the patient thinking about their diet and exercise, but it'll give you as a practitioner a good idea of why this person is overweight. If they don't know what to say about their diet, you can ask questions like what they had for breakfast or dinner last night, ask them when the last time they did a stress-relieving activity like taking a walk in the park etc...
One random side note, while I'm overweight and my bf is thin/fit, he drinks a lot more alcohol than I do. I decided to actually weigh and measure all of the alcohol he drank in an evening together and told him the calorie count and he was astounded. He had NO IDEA alcohol could add up to that many calories. It was enough for him to reduce his drinking. I have all sorts of tricks like this... heh heh heh.
I worked in the medical field for 7 years.1 -
DrifterBear wrote: »What does "in the medical field mean"? Are you a doctor? I don't understand why a doctor would need to ask people on a forum how to tell people to lose weight, that's your job.
Let's call it continuing education. I'm a PA and no we (as well as MDs/DOs/NPs) are taught minimal information on weight loss let alone how to counsel someone. Can someone ask a question to see how it may have encouraged others to change? Just trying to be a better practitioner.
I think it is pointless to just say "lose weight."
If someone is obese, point out what their weight can contribute to down the road.
More importantly, ask some simple questions, such as: would you like a referral to a dietician? Do you know about MFP?1 -
DrifterBear wrote: »What does "in the medical field mean"? Are you a doctor? I don't understand why a doctor would need to ask people on a forum how to tell people to lose weight, that's your job.
This is a common misconception amongst most people who have not worked in the medical field. I found doctors, PAs, nurses all to be extremely undereducated when it came to weight loss, and what appropriate weight for sex/height/etc.. was. I even had a GP tell me I needed to lose weight when I was 130 lbs, and about 20% body fat without asking what my diet and exercise routine was at all. He had no idea I lifted weights or anything. In my experience working in the medical field for 7 years, there's more ignorance around weight and what to do with it than information.1 -
I work in the medical field and at least 50% of my patients are overweight if not obese. It is a crisis in the US and most of the Westernized countries. We counsel them on smoking and alcohol, but what about weight? What is your reaction to someone or a medical practitioner telling you to lose weight? Most of the responses I get are eye rolls (and I'm very delicate about how I address it), but what would cause someone to wake up and understand that its more than just aesthetics and more about health in general. The majority of the ailments I see can be directly correlated with being overweight or obese. Any thoughts? Any one who has had this happen and actually take the advice and be a success story? TIA
When you tell an overweight or obese person they need to lose weight. Trust me, They have heard it many times. The eye roll can be the many times they struggled with diet and exercise. Some have given up on themselves out of frustration of not finding real long term solutions. Obesity is a disease and weight loss will not be a one size fits all treatment.
Fantastic obesity advocacy in my area.
If a person is identified with a disease, Staff start the conversation on treatments.
Clinics and hospitals hand out pamphlets on several treatment options. Nutritionist/dieticians, medically supervise weight loss, therapy, counseling, eating disorders, support groups, information on insurance coverage for treatment, and the different types of bariatric surgery (Roux-en-Y gastric bypass. Sleeve gastrectomy. Duodenal switch with biliopancreatic diversion. Gastric Bypass)
The clinics/hospitals refer people to an information seminar. Dr's, Surgeons, Nurses, and Dieticians present detailed information on treatments, statistics, possible complications etc. People that have been successful with weight loss are on hand to share their experiences with treatment.
At the end of the seminar, participants have the option to sign up for the treatment of their choice. They submit insurance information and get the ball rolling.
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I am also a health care professional, and I kind of work it into the conversation....like I lost 60 pounds....then I wait for them to ask the question, "how did you do it?"....I then tell them about mfp, a FREE web site. and go from there. You can lead a horse to water, as the saying goes. No point to tell someone that they are overweight and then not give them the tools to help themselves. Cruel, if you ask me. Also need to gauge how ready they are to make changes. Then I try to give them small goals, if you lost 5 pounds you may find that you move better, feel better, etc. You have to earn their trust first...don't let it be the first thing that comes out of your mouth.
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I am also a health care professional, and I kind of work it into the conversation....like I lost 60 pounds....then I wait for them to ask the question, "how did you do it?"....I then tell them about mfp, a FREE web site. and go from there. You can lead a horse to water, as the saying goes. No point to tell someone that they are overweight and then not give them the tools to help themselves. Cruel, if you ask me. Also need to gauge how ready they are to make changes. Then I try to give them small goals, if you lost 5 pounds you may find that you move better, feel better, etc. You have to earn their trust first...don't let it be the first thing that comes out of your mouth.
The bolded is likely why the approach that was taken worked with me, but I'd add another element. When you truly respect the opinion of a specific person, it goes a long way. Unfortunately, I don't hear about this much in the doctor/patient relationship much anymore. Trust and respect are not the same thing, and honestly, given the hackneyed, disproven garbage from the 60s-80s that a lot of older doctors are still spouting, I'm amazed that a lot of them garner either.
Appeal to authority and all of that, I guess.1 -
I think it is something to bring up when it's relevant to the issue the patient is presenting for.
I was seriously pissed off when I went to a new doctor with a very badly infected throat, I had no voice and could barely walk, I was so sick - but the doctor chose that time to lecture me about Iosing weight. I did not want to discuss anything other than something to stop the pain every time I swallowed, and I couldn't talk anyway. That was completely inappropriate and was not appreciated - I have no doubt he got an eye roll, though it would have been more if I had any voice.
So, in context - yes absolutely talk about it, but do it matter of factly, and with some empathy and useful strategies not just a lecture.1 -
Thank you everyone for your replies. I'm just trying to be a better practitioner and not fat shame anyone. I was fat at one time and after years of poor medical advice and prescription diet pills I just want to see others be their best and get healthy as well. I know it is a personal decision just like quitting smoking and cutting back/abstaining from alcohol, but I've seen too many young people with ailments no one their age should have on top of being disabled. I will take your advice to heart and hope for the best! Thanks!0
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I would keep this simple, honest, and authentic. I model our ER Chief who stressed physical readiness and involved the entire staff in daily PT. He was blunt and direct with his patients and brutally honest, some patients listened and some did not, but everyone respected his input.
He would explain everything from a matter of risk. Sure you could live a normal healthy life for the next 40 years, or you could contract a life threatening disease tomorrow, but why carry unnecessary risk? Bottom line there is no benefit to being overweight.2 -
When there was 100 lbs more of me, I was embarrassment personified. If anyone actually said anything about it or acknowledged it, I'd want to die. (Not literally, but it sure felt like it sometimes.)
But ... now that I'm on the other side, I've been wondering why no one ever said anything to me. No one cared enough to ask if anything was going on? How I was feeling? My stress level? How I felt about life and myself? The impact -- if not now then certainly eventually -- on my health?
It's one thing to need to lose 10 lbs or 20. Maybe 30. But when you have 60 or 80 or 100 to lose, couldn't that -- possibly? -- be a symptom of something else going on? I mean, you have to work steadily and constantly to get to that weight. For the person gaining weight, perhaps there is no self awareness. I mean, when I was gaining, I was just gaining. I couldn't see me the way a friend or loved one might. You get bigger clothes. And bigger clothes. And bigger clothes. You stop doing things. How does something so abnormal become normal?
Someone in the medical profession wouldn't ignore a broken bone, so why this? Perhaps not the best analogy, I know. Anyway, I've been thinking about this a lot -- had someone lovingly said something to me, offered to help, stopped the trend and then reversed it (without judging me), I wonder how different my life would be. I certainly wouldn't have wasted the last 15 yrs not being strong, fit, feeling good, feeling confident, able to have fun doing things. Fifteen years!!
It's tricky because I think body shaming is terrible, but I don't think ignoring it means you aren't shaming someone. I wouldn't ignore someone's alcoholism (though, obviously, that is also something people don't say anything about). ... Maybe what is missing regarding this "obesity epidemic" is talking about in ways where the person is supported, cared for, and that losing weight is necessary (not just a nice thing to have happen some day).
Again, I'm not saying this is how it ought to be and, of course, I am mostly using my own experience here, which may not "translate" for others ... Truly, this is just something I keep thinking about.7 -
I think no matter what anyone says to you, you will only lose weight when YOU are ready. So doctors and nurses can talk your ear off about the benefits of weight loss but it wont matter until you're ready. I used to smoke cigarettes but that "warning" label on the side of the pack did not deter me from smoking, it wasn't until I was ready to quit...and now here i am almost 5 years later and still not smoking.3
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Spliner1969 wrote: »You're probably being too delicate. It wasn't the deciding factor but it was one of the major ones for me when my doctor handed me my first prescription for high blood pressure meds and told me I was morbidly obese. Then she asked me if I knew what that meant, and if I needed help losing weight. Her approach was very straightforward, she simply told me the facts, warned me that if this trend continued that bad things would happen, she even mentioned making sure my life insurance was up to date. It struck a note with me.
I agree with all of this. I think it's the responsibility of a doctor to discuss health problems. I wouldn't expect a physician to sidestep around weight problems any more than any other health problem.2 -
Wow this is something that is a thorny issue.
If I was in you're position I would be pointing out that you are there providing medical help then swiftly pointing out that the patient needs to be helping you out with a little effort themselves.
How about set up a walking group to get a few moving approach some health clubs to see what they can provide in the was of facilitating some that would take on some life changing moves.
Good luck with it1 -
That being said, I did roll my eyes at the MA who tried to fat shame me when I had high blood pressure at an urgent care clinic while waiting to be seen for a sinus infection. She gave me a snide, "Is your blood pressure always this high?" when it was barely over the normal range. Fun fact: Sinus infections can cause higher than normal blood pressure in some people.
Blood pressure even barely over normal over an extended period of time can be damaging. High blood pressure also doesn't only happen to overweight people. I think it's a jump to assume that was fat shaming.
I think a big problem is that so many people get defensive or look at any mention of weight related issues as a personal character judgment, even in a Dr's office. Most medical professionals really don't care aside from the implications for your health.1 -
I work in the medical field and at least 50% of my patients are overweight if not obese. It is a crisis in the US and most of the Westernized countries. We counsel them on smoking and alcohol, but what about weight? What is your reaction to someone or a medical practitioner telling you to lose weight? Most of the responses I get are eye rolls (and I'm very delicate about how I address it), but what would cause someone to wake up and understand that its more than just aesthetics and more about health in general. The majority of the ailments I see can be directly correlated with being overweight or obese. Any thoughts? Any one who has had this happen and actually take the advice and be a success story? TIA
...I am in the field as well...the best way is to give detailed health scares ..being visibly fat is one thing but heart, kidneys, gastro issues. Pancreas, liver, etc...depending on the person you can hit that "sweet spot" and give a wake up call to someone....then again u can't change someone who is not willing and also maybe a psych visit won't hurt. Psychs get a bad reputation for only seeing people with problems or are "crazy ",however I see over eating as a problem or eating 3,000 + calories a fay without any exercise to be crazy0 -
That being said, I did roll my eyes at the MA who tried to fat shame me when I had high blood pressure at an urgent care clinic while waiting to be seen for a sinus infection. She gave me a snide, "Is your blood pressure always this high?" when it was barely over the normal range. Fun fact: Sinus infections can cause higher than normal blood pressure in some people.
I don't know if that really constitutes fat shaming...my HBP was caught at a random visit to an orthopedic where I was asked the same thing...it easily could have just been high due to the pain I was in...the next time I saw my GP I told him about it and we started monitoring...wasn't an isolated case...I have HBP and an orthopedic checking out my foot was the one who caught it.1 -
cwolfman13 wrote: »
That being said, I did roll my eyes at the MA who tried to fat shame me when I had high blood pressure at an urgent care clinic while waiting to be seen for a sinus infection. She gave me a snide, "Is your blood pressure always this high?" when it was barely over the normal range. Fun fact: Sinus infections can cause higher than normal blood pressure in some people.
I don't know if that really constitutes fat shaming...my HBP was caught at a random visit to an orthopedic where I was asked the same thing...it easily could have just been high due to the pain I was in...the next time I saw my GP I told him about it and we started monitoring...wasn't an isolated case...I have HBP and an orthopedic checking out my foot was the one who caught it.
To you and @extra_medium: I guess you had to be there. Her attitude and body language suggested much more than a statement of fact. She was also making a large assumption that I wasn't aware of my own usual blood pressure and flat ignoring the part that sinus infections can cause higher than normal blood pressure in some people, which is why I added that. I really don't appreciate people making assumptions about me and I doubt it was out of concern based on the rest of our interaction; I seriously doubt the same assumptions would have been made had I been thinner. I also said tried because I was having none of it.1 -
You're a doctor, it's not your job to coddle their sensibilities, it's your job to give people the advice they need to preserve their health. My doctor sat me down at 38yo and 123kg and told me flat out if I did not do something NOW I would have full blown diabetes by the time I was 40. Best thing he could have done for me IMO. Scared me into action and here we are 4 years down the track, 36kg lighter and never healthier.3
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extra_medium wrote: »
That being said, I did roll my eyes at the MA who tried to fat shame me when I had high blood pressure at an urgent care clinic while waiting to be seen for a sinus infection. She gave me a snide, "Is your blood pressure always this high?" when it was barely over the normal range. Fun fact: Sinus infections can cause higher than normal blood pressure in some people.
Blood pressure even barely over normal over an extended period of time can be damaging. High blood pressure also doesn't only happen to overweight people. I think it's a jump to assume that was fat shaming.
I think a big problem is that so many people get defensive or look at any mention of weight related issues as a personal character judgment, even in a Dr's office. Most medical professionals really don't care aside from the implications for your health.
If I hold my breath while they're taking my blood pressure (I actually have to make myself do "yoga" breathing for some reason) my blood pressure is high. I've actually inadvertently tested it at the doctor's office. I've had medical professionals say or ask things that made me wonder how they made it through medical school, and asking someone with a sinus infection if their slightly elevated blood pressure was normal would qualify.
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People who are significantly overweight know it. No one needs to tell them. The question to ask would be why? No one wants to be fat. Is there an emotional reason? Is there a health reason? Do they have any knowledge at all about nutrition? If these issues aren't addressed a person may lose weight but they will gain it back. I would hope doctors would really try to help people rather than just insult them.1
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I'm in an online group with lots of bigger women, and their reaction to a doctor saying something about weight is "find another doctor". They are offended. "Don't doctors know I'm overweight?, you can be overweight and healthy". IDK what the answer is... A doctor looking out is shunned for trying to help... but not doing anything isn't good either...1
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My doctor told me "Keep smoking and being fat so you can make me lots of money in the future." and "You aren't that young, you are already half dead." Those two things woke me up into action.3
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I work in the medical field and at least 50% of my patients are overweight if not obese. It is a crisis in the US and most of the Westernized countries. We counsel them on smoking and alcohol, but what about weight? What is your reaction to someone or a medical practitioner telling you to lose weight? Most of the responses I get are eye rolls (and I'm very delicate about how I address it), but what would cause someone to wake up and understand that its more than just aesthetics and more about health in general. The majority of the ailments I see can be directly correlated with being overweight or obese. Any thoughts? Any one who has had this happen and actually take the advice and be a success story? TIA
Since you're in the medical field, you can talk to people directly. You're not at a social event where you need to mind your own business or be polite. Health is your job. You might save somebody's life. Hearing the facts in the doctor's office is often what people need to wake up.
That's what helped me. My doctor told me last summer I was at high risk of a heart attack or stroke due to my high cholesterol, high blood pressure, and being obese. I could not forget his matter of fact words -- and still can't. I lost weight, began to exercise every day, changed my diet, and am a much healthier person now. Just give people the facts. What they do about it is up to them.
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I work in the medical field and at least 50% of my patients are overweight if not obese. It is a crisis in the US and most of the Westernized countries. We counsel them on smoking and alcohol, but what about weight?
"Your current body fat levels are correlated with increased risk of {insert chronic diseased states / sick aging phenotypes}. If you'd like help with reducing your body fat and risk, I can write you a referral."What is your reaction to someone or a medical practitioner telling you to lose weight? Most of the responses I get are eye rolls (and I'm very delicate about how I address it), but what would cause someone to wake up and understand that its more than just aesthetics and more about health in general. The majority of the ailments I see can be directly correlated with being overweight or obese. Any thoughts? Any one who has had this happen and actually take the advice and be a success story? TIA
Realistically, your job as a doctor is to inform the patient to your findings and prescribe as needed - whether the prescription is merely rest, antibiotics, chemotherapy, or exercise and nutrition.
There is also where your obligation ends. You can no more make a patient move more and eat less any more than you can made a type II diabetic lower their raw sugar intake, or get an asthmatic give up smoking.0 -
I was told my midsection was obese but a very thorough but very blunt doctor. I'm pretty sure he has Aspergers. He reminds me of the doctor on House, on;y less mean and more blunt.
I was shocked. I knew I was overweight and getting an apple shape but to have my midsection called obese was a real eye opener. It helped spur me on to follow his low carb advice.
I was a bit annoyed when he still called me midsection obese after I'd lost 30 lbs, was a normal BMI and a size 10. At that point it was some fat, but it is also loose and stretched out skin from having three children and getting as fat as 190 lbs (at only 5'8"). Skin doesn't bounce back as well in middle age, for me. Bikini days are gone. LOL
I would be blunt. "You are obese and that can cause A, B and C. To help yourself try D, E and / or F."0 -
NYCDutchess wrote: »I'm in an online group with lots of bigger women, and their reaction to a doctor saying something about weight is "find another doctor". They are offended. "Don't doctors know I'm overweight?, you can be overweight and healthy". IDK what the answer is... A doctor looking out is shunned for trying to help... but not doing anything isn't good either...
Well this is truly sad state of affairs.4 -
My doctor told me that I was about to fall off of a cliff and my obesity related health problems were going to really start damaging me. Oh and speaking of being blunt, I just had a plastic surgeon tell me to "quit being a *kitten*" because I wear a band over a big painful scar on my arm. That actually made me laugh.0
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"You are overweight." seems simple enough.0
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"You are overweight." seems simple enough.
Yes, because I am sure that most people who are overweight, to the point of it threatening their health, are blissfully unaware. The point is, a lot of people don't seem to realize how damaging it can be, until they are given a T2D diagnosis.0 -
NYCDutchess wrote: »I'm in an online group with lots of bigger women, and their reaction to a doctor saying something about weight is "find another doctor". They are offended. "Don't doctors know I'm overweight?, you can be overweight and healthy". IDK what the answer is... A doctor looking out is shunned for trying to help... but not doing anything isn't good either...
These people are just living in denial. Just because they don't want to hear it doesn't mean it's not a Doctor's place to tell them. Not "oh you're fat" but "carrying this much extra weight increases your risk of ..." - focusing on the health issue. I've been a big girl - morbidly obese at one point (123kg and 5'9") but I can't handle people who carry on about being big and healthy. Sorry but no, you're not. That excess body fat does effect your health, even if you are currently young enough not to be feeling the long term effects ... yet.
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