When it comes to providing solutions to weight management, shared decision-making and patient involvement can produce positive results. The role of physicians in counselling patients for weight management, along with the clinical assessment, is discussed in this article.

Weight management and obesity

Weight management and obesity are clear problems people are facing all over the world including India. Significant proportions of the population are considered to be either overweight or obese. The costs of excessive weight include an increased risk of developing debilitating and potentially deadly diseases, combined with substantial related healthcare costs to the individual and at the national level.

PCPs, by virtue of the continuity of care they provide their patients, are uniquely positioned to help combat the problem of excess weight. PCPs can be effective in these efforts by using appropriate tools for assessing weight-related issues and honing their communication skills with patients.

The role of the PCP

Studies have presented clear data, as noted by the Harvard School of Public Health, that excessive weight reduces overall health and increases an individual’s risk of developing diabetes, heart disease, and even some malignancies.

A person’s weight at age 20 and again in midlife has a strong association with the development of atherosclerosis, according to authors of a study in Atherosclerosis, and there is a moderate association with an increase in weight between these two-time points. Obesity diminishes the quality of life and the length of life, according to the authors.

PCPs typically see the same patients year after year and have access to their medical and physical history, including weight measurements from prior visits. Therefore, PCPs can be among the first healthcare professionals to detect changes in weight and play a pivotal role in helping their patients maintain good health and prevent future diseases through weight management

With the opportunity to address unhealthy weight in adolescence, and monitoring for any weight gain through midlife, the PCP’s role is critical.

To manage weight in the primary care setting, PCPs need effective tools for both evaluating and communicating with their patients. A discussion in the American Journal of the Medical Sciences (AJMS) offers some guidance.

Clinical assessment and criteria for overweight

PCPs can access easy-to-use tools to assess and identify patients who are considered overweight. Currently, body mass index (BMI) is the most office-friendly means to identify and monitor overweight patients. A BMI of 25 to <30 kg/m2 is defined as overweight, and a BMI of ≥30 kg/m2 is considered obese.

While calculating BMI is relatively straightforward, there is no need to perform manual calculations, as most electronic medical records can auto-calculate BMI and plot weight trajectories. For patients who are overweight but otherwise “healthy,” utilising waist circumference may be more appropriate, according to the AJMS discussion, as waist circumference is linked to increased weight-related health risks. 

Nonjudgmental discussions about weight 

It can be tricky to start a dialogue about weight with patients, as it can be a very sensitive topic. The best approach is to structure the discussion around health, not size. Instead of saying, “Your weight is just going up and up,” try saying, “I’ve noticed your weight has increased since your last visit, and this could have an impact on your health.” Framing the discussion about health is the key to sparing patients from feeling judged or embarrassed. 

Physicians should ask their patients about their thoughts in terms of current lifestyle obstacles or challenges that are contributing to their weight gain.

Physicians can also identify the patient’s goals and their openness to treatment options, including dietary changes, medication, or surgical procedures. This patient-centred approach allows patients to be more active participants in their weight management plans and may lead to better outcomes for weight loss. 

Personalised options for weight loss 

PCPs should have a general understanding of all currently available weight management options and be able to communicate with patients about the risks and benefits of each one. Weight management interventions are not one-size-fits-all and can range from simpler lifestyle or behavioural modifications to pharmacotherapy. 

PCPs should stay abreast of evidence-based weight management guidelines in order to appropriately treat patients based on their current weight and comorbidities. Not all patients are a good fit for certain treatment types.

This story is contributed by Soha Mahmoud and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.