Type 2 Diabetes Prevention: 10 tips for empathic communication about excess weight

Overweight and obesity have increased significantly in the UK over recent decades, with more than half of all adults and a third of children now affected. The reason this is of such concern and one of the biggest public health issues of modern times, is that excess weight, particularly in the form of fat carried around the middle (abdominal fat), greatly increases the risk of a number of non-communicable diseases, most notably Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD).
It is therefore important that weight management is promoted in all areas of healthcare, particularly for people who have, or are at risk of, T2DM or CVD. The cornerstone of any diabetes prevention programme is weight management through promotion of healthy eating and physical activity.
The first step to helping people with weight concerns is to initiate a conversation about their weight. This is not as simple as you might think, from the perspective of the practitioner. Healthcare professionals can find it uncomfortable to raise the issue of weight, and sometimes feel they lack the skills to do so.
On the other hand, patients can also be reluctant to talk about their weight. While recent evidence suggests that most patients with excess weight are happy to discuss their weight and opportunities for weight loss (Aveyard et al. 2016), this is not true for everyone. Some people can feel embarrassed, guilty or ashamed of their weight.
So what can we do to overcome this problem? How can we raise the issue of weight in a way that facilitates patient-practitioner interactions that are both productive and positive experiences?
The most important thing is to always communicate sensitively, using appropriate language, terminology and attitudes, to make the patient feel comfortable and positive about the conversation. In fact, skilled communication by the clinician can not only enhance patient understanding and trust, but also lead to increased adherence to programmes and ultimately improved health and well-being (Street et al. 2009).

Healthcare professionals can find it uncomfortable to raise the issue of weight, and sometimes feel they lack the skills to do so.

Here are some tips to communicating sensitively and empathically about weight:
1. Ask permission to talk about weight, for example; “Would you mind if I spoke to you briefly about weight management?” This immediately gives control to the patient – they decide if they want to discuss their weight or not.
2. Be aware of the language you use and try to avoid language which may be perceived as negative eg fat, obese. Terms such as excess weight and BMI are generally better received.
3. Be prepared for a wide range of responses. The subject of weight can be a highly sensitive one and produce a variety of emotions and reactions including denial, disinterest, shame and relief.
4. Work on responding constructively to all types of responses. Keep body language and facial expressions, as well as verbal language, positive and constructive.
5. Listen attentively to the patient’s story. General tips for listening include: Ask open ended questions; Do not interrupt the patient; Maintain eye contact; Do not take notes or look at your computer.
6. Communicate empathy, compassion and support. Try to see the world through the patient’s eyes, which is very different from a clinical diagnosis of illness. It can provide a framework for approaching their problems holistically, and uncover diagnostic and therapeutic options.
7. Discourage patients from feeling a sense of guilt. Acknowledge the societal nature of the problem and the influence of the obesogenic environment, which promotes overeating and physical inactivity.
8. Avoid telling the patient what they have to do. As health professions we often have a strong drive to set things right when we see an individual may be doing something that is detrimental to their health. This typically manifests as advice based on how we see the situation, and the more we try to advise or guide an individual the more we can polarise our relationship with them and fail in our attempts to help.
9. Empower your patient. Explore how your patient can make a difference to their weight themselves. Their own ideas about how they can implement changes into their own life are critical. Emphasize their strengths and opportunities for change.
10. Provide clear and accurate information – verbally, visually and/ or in writing. It is vital the patient goes away with a clear understanding of the issues relating to their weight and health.

References
Aveyard P et al. (2016) Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. The Lancet. 388: 2492-2500.
Street RL Jr, Makoul G, Arora NK, Epstein RM (2009) How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 74: 295-301.