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How to engage in effective clinical conversations about obesity


Small shifts in your communication style and tactics when discussing obesity with patients can significantly impact how your message is received.


As healthcare providers, one of the most critical aspects of our role is to clearly and effectively communicate with our patients. While time constraints and complex topics can often hamper our best intentions with communication, it’s our responsibility to cultivate meaningful, two-way discussions to develop long-term, trusting relationships with our patients.

Changing Patient Behavior Through Better Communication

Providers often have limited time with their patients to walk through a diagnosis or treatment plan, which can lead to the provider talking at the patient instead of with the patient. It’s a challenge we face every day, but taking the time to structure a conversation to establish and maintain trust in the therapeutic relationship motivates the patient to engage in the treatment.

It’s important to recognize that people with obesity are subject to stigmatization and bias, especially in healthcare. As a result, they may be less likely to seek treatment, which can negatively affect their health. Clinicians need to be attuned to language and behaviors that may indicate prior negative experiences in order to provide a new experience through improved communication.

A simple way to improve the patient experience and encourage behavior shifts is to use “people-first” language, which puts the person before the disease. For example, instead of saying “obese,” “morbidly obese,” or using other words with negative connotations, use phrases like “person affected by obesity” or “person with obesity.” Small shifts in your communication style and tactics can significantly impact how your message is received.

Elevating Clinical Conversations to Improve Outcomes

Just as we continually improve our clinical knowledge, the same care must be given to interpersonal skills. Learning about and implementing different communication frameworks can be a beneficial approach to enhancing your clinical conversations.

Some of the most common communication frameworks include:

Motivational Interviewing (MI): MI is a conversation style comprised of three key elements: collaboration (creating a relationship founded on the patient’s perspectives and experiences), evocation (evoking the patient’s motivators and skills for change), and autonomy (honoring a patient’s goals and decisions while maintaining a caring presence). This style can be particularly effective for obesity treatment, as patients who worked with providers that employed an MI approach demonstrated greater confidence in changing their diet.

Shared Decision Making (SDM): With an SDM framework, patients are empowered to express their preferences throughout the decision-making process. This approach is particularly helpful when patients and providers need to review and discuss multiple treatment options. Ultimately, the goal of an SDM framework is that the patient and provider arrive at a decision that reflects the patient’s preferences and is guided by the clinician’s expertise.

Health Coaching: This approach incorporates health education and promotion within a coaching context to achieve the patient’s goals. Health coaching recognizes the link between the key benefits of a coaching mindset and the possibilities of health education.

Each patient responds differently to specific communication approaches, so it’s crucial to understand the patient’s goals, motivations and openness to various forms of communication. By advancing your knowledge of communication best practices, you can engage with your patients on a more meaningful level, leading to improved relationships and better outcomes.

Avoiding Communication Missteps

Unfortunately, communication roadblocks and challenges may come up — it happens to everyone. However, you can help mitigate difficulties in your patient relationships by keeping some things in mind when having a conversation with a patient. Always try to avoid:

Telling a patient what to do before first understanding their perspective, answering their questions, and addressing their concerns

Using statistics without proper context could scare patients and prevent them from hearing and understanding the information

Dictating a specific treatment regimen

Talking more than listening

Engaging in Patient-Minded Conversations

Communicating about weight is a sensitive topic that deserves to be addressed with care and consideration. Patients may struggle to manage their weight for various physical and emotional reasons, so a discussion about obesity or weight should be handled with additional nuance.

When starting a conversation about obesity, there are some helpful ways to phrase questions to encourage patient engagement, such as:

Would you be willing to discuss your weight?

Would it be alright to discuss your weight?

Do you have any concerns about your weight?

Giving the patient control over the topic opens a door for a more trusting, honest conversation around obesity and weight management. Focus on two main issues to keep the discussion productive: health and the long game. Health-centric conversations are more effective because you can help the patient make the connection between their concerns, symptoms, function and lifestyle choices. Forward-focused discussions about long-term options can empower patients to understand how to approach a chronic disease like obesity.

Finally, take the time to understand what has worked and hasn’t worked in their weight management efforts. By showing respect for your patient and learning more about their history, you can foster an environment of mutual trust.

For additional information and resources on treating patients with obesity, join the Obesity Medicine Association (OMA). OMA is the largest clinical obesity organization in the U.S. and offers specialized resources to help providers implement evidence-based treatment in their practices.

Sandra Christensen, MSN, ARNP, FNP-BC, FOMA, is a board-certified nurse practitioner and has specialized in obesity treatment since 2005. She owns Integrative Medical Weight Management in Seattle, Washington, where she provides personalized, comprehensive obesity treatment. She holds the Certificate of Advanced Education in Obesity Medicine from OMA and is the author of “A Clinician’s Guide to Discussing Obesity with Patients.”

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