Three Hurdles to Clear When Talking With Your Doctor About Weight

Conversations with a healthcare provider about weight are not always productive. Unfortunately, most healthcare providers do not get any training about obesity. They may not know a lot about treating it or how to discuss it.

This is slowly changing as the treatments for obesity become more evolved and well-established. But when it comes to chatting with a healthcare provider right now, the conversation can be hard. Knowing what to expect can help.

Common miscommunications with healthcare providers

I want to highlight 3 common miscommunications that happen. As a nutritionist, I often involve a client’s doctor in their care. And there are themes to what clients often tell me about those conversations. Hurdles, if you will, get in the way of a productive conversation.

It is typical to make educated guesses about people based on their appearance. Guesses based on appearance give first clues on how to approach someone or what to approach them about.

Healthcare providers do make educated guesses to give them a starting place. And it is a necessary part of their diagnostic process. But sometimes, like when there is lack of training for a lesser understood condition like obesity, those guesses can be based on hurtful stereotypes.

Hurdle 1: The assumption that you haven't tried to lose weight

You may have a healthcare provider assume that you’ve never tried to lose weight before. That the suggestion to do so is novel, even! And that you must have obesity because you have never tried to lose weight before.

If you have tried – and maybe even succeeded – this assumption can feel very dismissive. It feels like your efforts are not noticed or appreciated. Or that you are being accused of not taking care of your health, even though you are trying your best to do so.

To avoid this, my suggestion is to offer a detailed history of what you have done previously to manage your weight. Offer it to start off the conversation. Describe what you have done in some detail. Include the method, how much weight you lost (if any), and if you were able to sustain it.

This background information can help to give them perspective. Fill in details they may have forgotten to ask you about. The conversation can then begin on a more accurate and productive note.

Hurdle 2: The assumption that you have the tools you need to lose weight

"Eat less, move more, and come back in 3 months!"

This may sound familiar, and it is frustrating. If a healthcare provider expects you to lose weight, it is reasonable to expect support. The advice to "eat less and move more" is not an actionable suggestion. And it makes the assumption that you already have the tools and resources you need to lose weight.

Ideally, you would be referred to some sort of intensive lifestyle therapy, at a minimum. That may be offered by a dietitian or a commercial program, as a few examples. Weight loss medication or bariatric surgery may or may not be appropriate depending on your case, but it is reasonable to walk through all the options with your provider.

If your health improvements are depending on weight loss happening, consider challenging whether or not it’s the right course of action for you. Ask questions, and make it clear if you need support. If you are not confident you have the tools and support you need to lose weight, make it clear that your health issues may need to be addressed in other ways.

Hurdle 3: The assumption that you want to lose weight

Many healthcare providers take it for granted that you would want to lose weight. Our society biases us toward the idea that weight loss is always the right thing to do. So, everyone must want to lose weight.

But in reality, weight loss is a very intensive process that you may not be in a place to take on. Money and time are required for planning your meals, learning more about your food and behavior, tracking your food intake, or making the time and space for exercise. There may be times in life where the resources are not in place for it to happen, and it is perfectly reasonable for you to be honest with your provider about that.

Another possibility is that you do not want to lose weight because the process is too uncomfortable physically or emotionally. Many people experience significant discomfort during weight loss, such as fatigue, hunger, or headaches. And some people can develop disordered eating patterns from constant dieting.

So if you dread the idea of losing weight, share that with your provider. They may be able to give you new approaches to make weight loss more comfortable or healthy for you. And they may have other alternatives to help you with your health problem.

Finally, some people do not want to lose weight because it changes their appearance and identity. Some people find larger bodies more attractive, and for some people, their weight is a major part of their identity. If this is the case for you, that should be understood and respected by your provider. You always have a choice to engage in a specific treatment or not.