Friday, March 14, 2025

by Michael Baker, Physicians Office Resource Staff Writer

Let’s be honest, with the introduction of weight loss drugs, conversations between physicians and patients, about dropping those unwanted pounds are picking up. The nice thing for HCPs is that this sometimes-sensitive subject is being brought up by patients themselves, which hasn’t always been the case. But as you know, there is so much more to the conversation than “weight-loss drugs.”

As front-line healthcare providers, physicians play a crucial role in supporting their overweight and obese patients in achieving and maintaining a healthier weight. However, addressing weight loss in a clinical setting can be challenging due to the complexity of obesity and the stigma often associated with it. This article explores evidence-based strategies physicians can use to help their patients lose weight effectively and sustainably. 

Step 1:

Create a Supportive and Non-Judgmental Environment

Even with patients bringing up the topic of losing weight more than they did in the past, physicians must still approach the topic of weight loss with empathy and sensitivity. Obesity is a multifactorial condition influenced by genetics, environment, behavior, and socioeconomic factors. Avoiding stigmatizing language and focusing on health rather than appearance can help patients feel more comfortable discussing their weight. Terms such as “weight management” or “health improvement” are often more acceptable than “weight loss” or “obesity treatment.” 

A supportive environment can foster trust and open communication. Physicians should actively listen to patients’ concerns, validate their experiences, and avoid assigning blame. This approach helps build a collaborative relationship, making patients more likely to engage in discussions about lifestyle changes. 

Step 2:

Conduct a Comprehensive Assessment

Before recommending weight-loss strategies, it is essential to perform a thorough assessment of the patient’s health, lifestyle, and weight history. This includes: 

• Medical History: Identify comorbid conditions such as hypertension, diabetes, or sleep apnea that may influence weight management.
• Dietary Habits: Assess eating patterns, portion sizes, and food choices.
• Physical Activity: Understand the patient’s current activity levels and any barriers to exercise.
• Psychosocial Factors: Consider mental health conditions, stress, and social support systems.
• Weight History: Discuss previous attempts at weight loss, including what worked and what did not. 

This comprehensive evaluation provides a foundation for tailoring interventions to the patient’s unique needs and circumstances. 

Step 3:

Set Realistic and Individualized Goals

Setting achievable and personalized goals is critical for long-term success. Unrealistic expectations can lead to frustration and disengagement. Physicians should help patients focus on modest weight loss—typically 5-10% of their initial body weight—as even small reductions can significantly improve health outcomes, such as lowering blood pressure and improving glycemic control. 

Goals should also extend beyond the scale. For example, improved energy levels, better sleep, and enhanced mobility can be meaningful milestones that motivate patients to sustain their efforts. 

Step 4:

Develop a Collaborative Weight Management Plan

Physicians should work with patients to create a comprehensive, individualized plan that includes dietary changes, physical activity, behavioral strategies, and, when appropriate, medical interventions. Each component is discussed below: 

Nutrition

Encouraging a balanced, calorie-controlled diet is a cornerstone of weight management. Physicians should:

• Emphasize whole, minimally processed foods such as fruits, vegetables, lean proteins, and whole grains.
• Encourage portion control and mindful eating to help patients recognize hunger and fullness cues.
• Suggest evidence-based dietary approaches such as the Mediterranean diet, low-carbohydrate diets, or plant-based diets, tailored to the patient’s preferences and health needs.
• Refer patients to registered dietitians for specialized nutritional guidance and support.

Physical Activity

Regular physical activity is essential for weight loss and overall health. Physicians should:

• Recommend at least 150 minutes of moderate-intensity aerobic activity per week, as per guidelines from organizations such as the American Heart Association.
• Encourage resistance training to build muscle mass and improve metabolism.
• Help patients identify enjoyable activities that fit their lifestyle, such as walking, swimming, or dancing.
• Address barriers to exercise, such as lack of time, joint pain, or financial constraints, and suggest practical solutions. 

Behavioral Strategies

Behavioral interventions can help patients develop healthier habits and sustain weight loss. Physicians can:

• Encourage self-monitoring of food intake, physical activity, and weight.
• Teach stress management techniques, such as mindfulness or relaxation exercises.
• Promote goal setting and problem-solving to address challenges as they arise.
• Recommend cognitive-behavioral therapy (CBT) for patients struggling with emotional eating or other psychological barriers. 

Medical Interventions

For some patients, lifestyle changes alone may not be sufficient. Physicians should consider:

• Pharmacotherapy: FDA-approved weight-loss medications can be used as adjuncts to diet and exercise for patients with a BMI ≥30 or ≥27 with comorbidities. Physicians must monitor for potential side effects and efficacy.
• Bariatric Surgery: For patients with severe obesity (BMI ≥40 or ≥35 with comorbidities) who have not succeeded with other interventions, bariatric surgery may be an option. Referral to a specialized bariatric center is essential for appropriate evaluation and care. 

Step 5:

Address Psychological and Emotional Factors

Obesity often has psychological and emotional dimensions that can affect weight management. Physicians should:

• Screen for depression, anxiety, and eating disorders, referring patients to mental health professionals as needed.
• Recognize the impact of stress on weight gain and recommend stress-reduction strategies.
• Foster positive body image and self-esteem to help patients stay motivated. 

Step 6:

Provide Ongoing Support and Follow-Up

Weight management is a lifelong journey, and ongoing support is crucial for maintaining progress. Physicians should:

• Schedule regular follow-up visits to monitor progress, celebrate successes, and address setbacks.
• Adjust the weight-loss plan as needed based on the patient’s response and preferences.
• Provide resources such as educational materials, support groups, or digital health tools (e.g., apps for tracking diet and exercise).
• Encourage patients to view setbacks as temporary and focus on long-term behavior change rather than perfection. 

Step 7:

Educate and Empower Patients

Education is a powerful tool for empowering patients to take charge of their health. Physicians should:

• Provide clear, evidence-based information about the benefits of weight loss and the risks of obesity.
• Debunk common weight-loss myths and emphasize the importance of sustainable changes over quick fixes.
• Encourage patients to take an active role in their care by asking questions and seeking support when needed.

Conclusion

Helping overweight patients lose weight is a complex but rewarding aspect of medical practice. By creating a supportive environment, conducting thorough assessments, setting realistic goals, and developing personalized weight management plans, physicians can empower their patients to achieve better health. Addressing psychological factors, providing ongoing support, and advocating for systemic change further enhance the likelihood of success. With compassion, patience, and a multidisciplinary approach, physicians can make a meaningful difference in the lives of their patients struggling with obesity.