Weight Dialogues: Optimism and Challenges - Annals of Internal Medicine: Fresh Look Blog


Wednesday, December 20, 2023

Weight Dialogues: Optimism and Challenges

“I paid a $50 copay, and my physician told me I’m overweight,” shared a member of the cleaning staff at our hospital. He said he found out he has a fatty liver and needs to lose weight, but he didn’t like being reminded, especially when he’s paying. Another staff member who was standing beside him quickly said he prefers the doctor to remind him if he’s overweight. He shared his own story from about 15 years ago when he was obese. Back then, his primary care doctor never talked to him about losing weight. He confessed that, deep down, he knew he was obese, but he was scared and uncomfortable admitting it or taking steps to lose weight at that time. He voiced that he wants a physician who will discuss his health concerns up front.

Over 40% of adults in the United States fall under the category of obesity (1). Some clinicians still believe a person’s weight is solely under their control, placing blame on patients for their obesity. Even clinicians may unknowingly hold biases and associate negative traits with patients who are obese, just like most of society (2). This may result in neglecting recommended lifestyle and dietary changes. Patients can feel sidelined when their weight becomes the primary focus, overshadowing other health concerns. Conversely, clinicians face uncertainty regarding communication strategies, the efficacy of weight loss interventions, and apprehensions about potentially offending patients. Although primary care physicians are advised to engage in discussions about obesity and provide resources, the optimal means of effectively communicating and offering weight loss interventions to promote both weight loss and overall health remain unclear.

How physicians offer guidance on weight management is likely to influence the perception of this advice and individuals’ decisions to follow it. Even when advice is well-intentioned, the use of language in suggesting lifestyle and dietary changes can have a huge impact on patients’ adherence. A study published in Annals of Internal Medicine in November 2023 highlighted that, when talking about unhealthy weight at the doctor’s office, telling people that losing weight is a positive opportunity can result in higher adherence and greater weight loss (3). The researchers identified 3 interaction patterns characterized by the delivery of “news.” The “good news” approach emphasized positivity, optimism, and the benefits of weight loss, presenting the program as an “opportunity.” On the other hand, the “bad news” approach highlighted the “problem” of obesity, with physicians asserting expertise, focusing on challenges, and conveying pessimism. The “neutral” approach, the most common, lacked clear positive or negative features. The patients receiving counseling through the least common “good news” approach achieved the highest agreement to attend the program, higher attendance, and greater weight loss after 12 months (3). The median duration of conversations across all 3 delivery styles was only 78 seconds, suggesting that even brief counseling can have a positive impact. This study emphasizes the potential for improved outcomes by integrating optimism into discussions about weight management. It aligns with my philosophy of consistently using positive language in communication with patients and their families, providing a mix of hope alongside evidence-based information. Clinicians and health care professionals should establish an environment that is free from judgment, ensuring psychological safety for all patients, regardless of their age, gender, race, or body weight.

The conversation about weight and obesity was influential enough to make me skip eating my cheesecake. Words can be more powerful than cravings!


  1. Stierman B, Afful J, Carroll MD, et al. National Health and Nutrition Examination Survey 2017–March 2020 prepandemic data files—development of files and prevalence estimates for selected health outcomes. National Center for Health Statistics; 2021. doi:10.15620/cdc:106273
  2. Wee CC, Cornell JE. Conversations about obesity and weight: good news we can use. Ann Intern Med. 2023;176:1546-1547. [PMID: 37931270] doi:10.7326/M23-2568
  3. Albury C, Webb H, Stokoe E, et al. Relationship between clinician language and the success of behavioral weight loss interventions. A mixed-methods cohort study. Ann Intern Med. 2023;176:1437-1447. [PMID: 37931269] doi:10.7326/M22-2360

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