Doctors, nurses must talk about weight

Your clothes are a little tighter. You don't remember the last time you went to the gym. You've been reaching for the remote more regularly - and for the chips instead of an apple. You are not looking forward to those blood-test results, either.

But the doctor didn't say anything about your weight, so you shouldn't be concerned about it. Right?

The reality is that health-care providers and patients often fail to discuss excess weight and obesity when they should. If the American obesity epidemic is going to get better, it's going to have to start with improved communication.

A 2009 study published in the journal Patient Education and Counseling found that patients whose health-care providers told them they were overweight or obese were almost nine times likelier to perceive their excess weight as damaging to their health.

Belief and action

But can such communication motivate lifestyle changes? In a word, yes. People can be persuaded to make lifestyle changes through dynamic conversations with doctors and nurses or family and friends. Several steps need to occur before a person will take action, though.

The health belief model has been used to explain the reasons people make or don't make changes in health behaviors. One premise of it is that people must understand and accept that they are susceptible to something harmful before they change their behavior. So believing that your weight may be harmful to your health is one of the first steps toward taking action to lose weight.

Connecting a behavior change to other health improvements - for example, losing weight to lower one's blood pressure and reduce the need for medication - also helps. And, finally, patients must believe that the expected health benefits are worth the effort it takes to change their behavior.

All of these steps need to occur for a patient to embrace lifestyle changes, and health-care providers can ignite the process.

How should health-care providers do that? First, they need to speak honestly and sincerely to overweight and obese patients about the health consequences of their excess pounds. Health-care providers are uniquely positioned to review a patient's medical history and clearly communicate the relationship between his or her weight and other potentially related problems, such as high cholesterol, gout, sleep apnea, and diabetes.

Health-care providers can also inform their patients that, contrary to popular belief, making small, realistic eating and exercise changes consistently over time can help reduce body weight and improve overall health. And losing excess weight is a more cost-effective course of action than treating a chronic condition, such as diabetes, that may develop as a result of being overweight. Practicing a healthy lifestyle is difficult, but it's well worth the investment of time and money to prevent or delay the onset of chronic disease.

Given the complexity of the obesity problem, some patients may also require an integrated approach with support from a team of professionals, including nurses, dietitians, psychologists, exercise physiologists, physical therapists, and certified diabetes educators.

Goes both ways

Communication also has to go both ways. Health-care providers need to share medical and weight data, identify any barriers to behavior changes, and help patients develop weight-loss plans. Meanwhile, patients need to be honest and accountable for their daily behaviors that affect their weight.

Both providers and patients have a role in starting the conversation about weight and enabling more of us to take charge of our health.

Denice Ferko-Adams is a registered dietitian and the director of the MacDonald Center for Obesity Prevention and Education in the College of Nursing at Villanova University. The center is hosting a conference on weight and communication for health-care providers starting Friday. For more information, see www.villanova.edu/cope.