According to the CDC, more than 40% of adults living in the US meet the criteria for being obese. That number is rising, including the number of children and adolescents who are becoming obese. As doctors, we know that obesity is a risk factor for many diseases, including diabetes mellitus, heart disease, certain cancers, and more. Not only is obesity a risk factor for other diseases, but it can lead to complications with other conditions, such as orthopedic conditions.

Doctors know that obesity is one of the most difficult conditions to address with patients. Some patients become offended or emotional when discussing this problem. Our visit in the exam room is very limited and leaves little time for addressing lifestyle issues that may be contributing to the problem.

We need to keep in mind that most of our patients know they are obese and have struggled with the problem for many years. They likely tried many remedies that failed or worked for just a limited amount of time. They are frustrated, annoyed, and sometimes depressed. They know that being overweight/obese is unhealthy, but they also live with the reality that they can’t find clothes that fit comfortably or feel crammed in to a space that wasn’t built for their size. Most want to change and have tried.

What can we do to address obesity in the exam room?

• Talk in terms of BMI. There is a healthy BMI and an unhealthy BMI. Telling a patient that they are obese may be upsetting, but putting it in terms of health can be easier to hear.
• Listen to the patient. It is important to know how their weight is affecting them. Is it causing their knees to ache, which makes activity harder? If that is the case, just telling them to exercise may not be very helpful. What have they tried in the past? Telling them to diet when they previously tried every fad diet is not likely to be effective.
• Don’t assume they are lazy. Most patients I see have tried many strategies to lose weight. They want advice and help.
• Keep in mind emotional factors. Some people eat when they are stressed or anxious. Additionally, obesity can often lead to depression. Treating the root cause may eliminate emotional eating and help with weight loss.
• Know what the latest fad diets are. We need to know how our patients eat. If they say they are using intermittent fasting, we need to understand the science behind it. If they are eating a ketogenic diet, it is helpful to know what this means and how it may be affecting our patients’ other conditions. I’ve seen many patients with elevated lipids after following a ketogenic diet.
• Make specific recommendations. We need to offer better advice than “diet and exercise.” It is better to tell patients to cut carbs and start walking rather than giving a non-specific recommendation.
• Make time. Yes, our time in the exam room is limited, but we fail our patients when we don’t make time to address lifestyle issues. No medication is a magic cure and won’t work as well without healthy lifestyle changes. If we make an effort to ask our patients at every visit about their lifestyle, it will save time down the road. For example, rather than increasing medication doses, it makes more sense to see what may be making the medication not work as well.
• Education is key. As doctors, we should be the primary source of medical education and information for our patients. If we are not, our patients will go to other sources, and we all know how much misinformation is available online these days. Know key websites to direct patients to that have reliable information. Get staff on board with educating patients.

Obesity is a growing problem around the globe. While we have new medications and bariatric surgeries to help address the issue, the most important treatment modality is a healthy lifestyle. People can regain weight after bariatric surgery if they slip back into bad eating habits. Medications will not be as effective, or even effective at all, without modifying an unhealthy diet or inactive lifestyle. Addressing obesity is also the treatment for many other diseases and can prevent many future ailments. We need to do a better job addressing it in the exam room.