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Managing Obesity Starts with Patient Engagement

 |  By Lena J. Weiner  
   February 20, 2015

"Disrespect" shown by some healthcare providers "may discourage future visits or delay essential care that could lead to weight loss or the detection of diseases associated with obesity," a researcher says.

With more than one-third of Americans suffering from obesity, clinicians are struggling to find the key to help these patients get and stay healthy. But a new report suggests that cultural changes in healthcare and properly educating clinicians about obesity might be the secret weapon to engaging these patients.

"Many health professionals view people with obesity as lazy or lacking in willpower," says William H. Dietz, MD, PhD, and director of the Sumner M. Redstone Global Center for Prevention and Wellness at Milken Institute School of Public Health at the George Washington University.

Attitudes that obese patients are a lost cause, are lazy or non-compliant and are personally responsible for their condition were found to be widespread among medical professionals.

"The disrespect shown by some providers may discourage future visits or delay essential care that could lead to weight loss or the detection of diseases associated with obesity," says Dietz, who adds that judgmental clinicians, chairs in waiting rooms that cannot properly accommodate an obese person, and scales situated in high-traffic areas all inhibit obese patients from seeking timely medical care or asking for information about losing weight.

Published in The Lancet this week, the report draws conclusions based on obesity management literature and studies published between 2000 and the end of 2013.
Among the researchers' other findings:

  • Changes in policy and environment can prevent people from becoming obese, but they do not help the currently obese to lose weight.
  • Prejudice against overweight patients is partly rooted in a lack of education about underlying causes of obesity during medical school and other clinical training.

"Clinicians need to become more comfortable addressing obesity," Dietz says. "Their biases and assumptions get in the way of providing these patients with good clinical care." His prescription is to provide better information on obesity at every level of clinician training, from undergraduate education through residency.

Watch Your Language
Dietz's first prescription for healthcare workers is to change the way obesity is talked about. "We need to encourage the use of people-first language…. Obesity has become an identity, not a disease," he says.

Dietz also found that clinicians need to brush up on their approach when attempting to engage patients who are obese. "We need undergraduate education that teaches [future clinicians] how to talk about this problem. They need to understand what the common consequences are, how to assess the severity of the problem, and how to proceed in treatment."

Frequently, a clinician will bluntly tell a patient that he or she has a weight problem, then begin to discuss steps they believe the patient should take to lose weight. But Dietz and his coauthors found that this approach is not likely to be helpful.

"The problem with this approach is that patients have usually already tried some of those things, and that they have a weight problem is no surprise to them," says Dietz. Instead, he suggests a technique called motivational interviewing which attempts to engage the patient in a conversation about health, including possible changes that can be made.

Many clinicians believe that a major lifestyle overhaul would be most beneficial. But Dietz and his coauthors found that small changes that can easily be work into a patient's routine are best for taking weight off and keeping it off. These may include eliminating a daily snack, having vegetables on a pizza rather than pepperoni, or taking the stairs rather than the elevator once a day.

Role Models
Other changes need to take place at the hospital, says Dietz, who sees a parallel between changing attitudes toward tobacco and obesity. "When hospitals eliminated vending cigarette machines and took tobacco products out of the gift shop, when doctors stopped smoking, it sent a message that this is an unhealthy behavior. Hospitals can be role models," he says.

Dietz suggests that hospitals stop selling fast food in their lobbies and ensure that their cafeterias offer nutritious, healthful options at all times. He points to a recent experiment at Massachusetts General Hospital where cafeteria options were color-coded by level of healthfulness. He also says that physicians who themselves have healthy eating habits are more likely to be comfortable engaging patients around obesity.

Dietz is hopeful that these cultural changes can lead to a near future where obese patients are treated in a more enlightened way by healthcare professionals.

"Our findings suggest that we must take steps now to transform the way obesity is treated, with more emphasis on partnerships, better training for health professionals, and initiatives aimed at erasing the stigma surrounding this serious health condition," Dietz says.

Lena J. Weiner is an associate editor at HealthLeaders Media.

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