Communicating about weight – can we bring patients and healthcare professionals together in support? #obsmuk blog by Fiona Quigley

Communicating about weight – can we bring patients and healthcare professionals together in support?

Obesity is a medical condition described as excess body weight in the form of fat. When accumulated, this fat can lead to severe health impairments. The prevalence of obesity across the world continues to rise, and this is now recognised as one of the most important public health problems facing the world today.

Subsequently, conversations about obesity between patients affected by obesity and healthcare professionals is an important and necessary aspect of at least some of their encounters.

However, it isn’t easy for healthcare professionals or for patients to talk about weight and we know there are many reasons for this. Research shows that healthcare professionals worry that talking about weight might upset patients, as if they are delivering bad news. In turn, patients of a higher weight can often feel shamed and blamed. More research is needed on how to raise the topic of weight sensitively, how best to support patients, what language is best and when or if the topic of weight should be raised.

We can do better

We know that good communication between patients and healthcare professionals can help patients to improve their health - if it is sensitive, accurate and honest. The challenge with weight management is that it is complex and there are no quick fixes - patients need time, understanding and support. In 2018, the All-Party Parliamentary Group on Obesity reported that 42% of people weren’t comfortable talking to their GP about obesity, and only 26% of people felt respected when seeking treatment. These days, everyone is talking about weight and everyone has an opinion on how people should maintain a healthy weight. The ‘obesity crisis’ has been a big part of government and public health messages for the last few years. Healthcare professionals are under pressure to raise the topic of weight, but many have had little training in this area. There is some evidence to suggest that healthcare professionals think that being of a higher weight has become so normal that patients don’t care about their weight. Most patients disagree with this.

Weight stigma – shaming and blaming doesn’t work

Weight stigma, defined by the World Health Organisation (WHO) as ‘negative attitudes towards, and beliefs about, others because of their weight’, can stop people from getting help and support. If you are of a higher weight, your body seems to be ‘fair game’ for comment and ridicule. Research shows that people of a higher weight are often seen as lazy, greedy and non-compliant. When talking to people of higher weight, healthcare professionals spend less time and make more assumptions about the cause of symptoms being related to weight. Patients often avoid healthcare appointments because they worry about being blamed and shamed. Family and friends, who think they are trying to offer helpful advice, add to the feelings of shame and blame.

The complexity of weight management and obesity

The complexity of weight management and obesity is not well understood, and we don’t know how to define success when discussing weight. For example - should we talk about health in general, or focus on BMI? The ‘eat less, move more’ message is common but this does very little to help people with long-term weight challenges. People living with obesity have little chance of having sustained weight loss through lifestyle changes alone, yet access to bariatric surgery for many parts of the UK is poor, compared to the rest of Europe. Also, there is no available pharmacotherapy in the NHS (except orlistat which has modest effects).

In the UK, if weight is discussed, it is usually brought up only briefly during a clinical consultation. Often referrals to commercial weight loss programmes are offered or suggestions to use self-monitoring and goal setting apps to track food and activity. There is no shortage weight and lifestyle interventions, but we don’t know how to give people specific, personalised advice to help with long-term weight management.

So where does that leave us with how to communicate effectively on weight and obesity in healthcare settings? Does the worry about damaging the patient relationship or lack of time and resources present too many barriers for good weight-related conversations? Is it possible to reframe weight-related conversation to help patients and healthcare professionals work together more effectively - and are we working with best evidence?

Please join us in our #obsmuk chat on 26^th June 8PM UK time to discuss communication about obesity. The following questions will be discussed.

Question 1: What is the impact of discussing weight - for the healthcare professional, or for the patient? And how should the discussion be initiated?

Question 2: How do we define success when discussing weight? Should we go beyond BMI?

Question 3: What are the barriers to supportive conversations about weight? How can we overcome them?

Question 4: How do we address the potential of weight stigma in weight-related discussions?

Question 5: What evidence could inform personalised discussions about weight?  

About me

Fiona Quigley is a PhD student based in Ulster University, Belfast Northern Ireland. She is researching weight-related communication in healthcare settings and hopes to develop a training tool for healthcare professionals.

Bibliography

1.      Blackburn, M., Stathi, A., Keogh, E. and Eccleston, C. (2015) Raising the topic of weight in general practice: perspectives of GPs and primary care nurses. BMJ Open, 5(8), e008546.

2.      Flodgren, G., Gonçalves‐Bradley, D. and Summerbell, C.D. (2017) Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in children and adults with overweight or obesity. Cochrane Database of Systematic Reviews, Issue 11. Art No.: CD 000984.10.1002/1465/1858.CD00984.pub3.

3.      Gray, L., Stubbe, M., Macdonald, L., Tester R. and Hilder J. and Dowell A.C. (2018) A taboo topic? How General Practitioners talk about overweight and obesity in New Zealand. Journal of Primary Healthcare, 10(2), 150-158.

4.      McAloon, A.P. Fitzsimons D. and Coates V. (2015) An investigation of health care professionals’ attitudes to obesity and the associated impact on clinical management: an online factorial survey. Thesis, (PhD). Ulster University.

5.      McPherson, A.C., Knibbe, T.J., Oake, M., Swift, J.A., Browne, N., Ball, G.D.C. and Hamilton, J. (2018) “Fat is really a four-letter word”: Exploring weight-related communication best practices in children with and without disabilities and their caregivers. Child: Care, Health and Development, 44(4), 636-643. 

6.      Mold, F. and Forbes, A. (2013) Patients' and professionals' experiences and perspectives of obesity in health-care settings: a synthesis of current research. Health Expectations, 16(2), 119-142.

7.      Moorhead, S., Coates, V., Gallagher, A., Nolan, G., Murphy, K. and Hazlett, D. (2013) Obesity communication among patients by health professionals: Findings from the Weight Care Project. Health, 5(8C), 100-109.

8.      Phelan, S.M., Burgess, D.J., Yeazel, M.W., Hellerstedt, W.L., Griffin, J.M. and van Ryn, M. (2015) Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 16(4), 319-326.