I struggle with how to discuss the topic of weight with patients. I also struggle with how to discuss it here on my blog. I have dozens of half written posts litering the notebook app on my iPhone. I decided finally to stop second guessing myself and just dive right into the deep end.

The thing about weight, as you already know, is that it is terribly emotional. People skip out on needed doctor visits, especially after the holidays, because I *might* bring up their weight. I have worked hard trying to find compassionate ways to discuss weight with patients because I struggle with my own weight, but even that fails all too often. I feel like I should be better at this. 

But I’m not.

As I was working my way through this yearly “open book test” thing for maintenance of my board certification last week, I realized that I was sorta hoping for my own eureka moment. Maybe there would be a holy grail somewhere in all of this research, the one thing that would help me know how to help patients…

The only thing they kept bringing up was motivational interviewing.


That is all we have to offer? That and surgery and meal replacement shakes and pharmaceuticals? 

There was a provocative article from JAMA in 2013 that looked at mortality and BMI. Being overweight (a BMI of 25-30) was associated with a lower risk of mortality. That’s right. You are less likely to die if you are classified as overweight. Class I obesity (a BMI of 30-35) was not associated with increased mortality. In fact, only at a BMI of greater than 35, classified as Class II and III obesity, did increased mortality kick in. This makes me particularly angry every time I am forced to complete a biometric screening for someone’s employer that makes me downgrade their insurance rebate because their BMI is not under 25. We are emphasizing the wrong thing here and missing the whole point, aren’t we? Except that maybe it IS all part of the plan… make sure the work force dies quickly after retirement so they cannot draw a pension.

Perhaps I am being too cynical.

Maybe it is simply because sedentary people are not out there taking risks. You can’t get eaten by a mountain lion if you are not out there hiking, can you? No, sir!

Generally when I talk to patients I don’t reference BMI unless they ask me to do so. I also don’t talk about weight except to mention trends. For instance: “You lost some weight, way to go!” or “You gained some weight since your last visit, what are you doing differently?”

But what if even this is wrong? 

What if everything I have been taught to do about weight is wrong? What if I should just take the focus off of weight and instead refocus attention on lifestyle exclusively? 

No one has done that research, at least not that I am aware of.

Quite honestly, I am not sure that me talking about the numbers has really helped anyone over the years I have been practicing. You can be skinny and not really healthy at all. We all have *those* friends that make us shake our heads as we well up with intense jealousy. Why does SHE get to eat extra cheesy cheeseburgers at every meal, watch Netflix all day, and STILL wear a size two at age forty-two?!?!???! Believe me, I’d like to know as much as you would.

So I have been toying with the idea of going weightless for my 2016 New Years Resolution. I would plan to talk to patients more about lifestyle, but would not speak to weight or BMI at all unless specifically requested. I will be looking at the numbers but I won’t be talking about them. Instead, I will be asking about diet and exercise and sleep habits.

Truthfully, talking numbers is easier. Lifestyle is much, much harder to pin down for people. It will be a significant time investment. Maybe I will try it out for a few weeks and see how it goes…

What do YOU think? How would you feel about YOUR doctor doing this sort of thing?


209 thoughts on “Weightless

  1. I’ve struggled with weight most of my life with long periods of success. But it’s been creeping up since I got married 3 years ago and my doctor says I’m approaching borderline diabetes. I never thought that would happen to me! But after talking to my dad, I learned he was diagnosed in his 40s and I’m 60, so I can’t beat myself up too much. I appreciate and expect my doctor to talk about my weight, diet, and activity level. I see it as part of her job to gently call me on it and encourage. But I can see how motivational interviewing might be better with some people. It’s complicated. Maybe you could have someone make a list of resources to hand out.

    Liked by 2 people

  2. I certainly dread it when the doctor mentions my weight, although, surprisingly, they don’t that often, I think talking about Lifestyle is much more productive, and certainly in my case, I would be more receptive to it than if I was told to lose weight.

    Liked by 1 person

  3. Many of us feel powerless when it comes to “weight.” Because we can feel like we are doing everything we have been taught to do, and still, somehow, it doesn’t equate with “healthy weight.” Meanwhile, we watch as others do everything “wrong” and still somehow the scale tips in their favor. I think what you are contemplating is FANTASTIC.

    We may not be able to control the ultimate outcome, but we can all control our actions and decisions. So, focusing on “have you moved today? How much? In what ways? What did you eat?” empowers your patients to take actions that they can control. We can all decide what to put in our mouths, though how our bodies react can vary from person to person.

    And I’ve decided that I’m not going to eat anything that brings me misery, like quinoa, or chia seeds. Broccoli is fine. Chia is disgusting, and quinoa is just depressing.

    Liked by 1 person

  4. If anyone knew the answers we wouldn’t have such a problem. Lifestyle is certainly part of the problem. Emotions also seem to be a big part, so your caution is certainly justified. Support systems, external influences (like advertising and friends), and things that get in our way like injuries. I look forward to your insites.

    Liked by 1 person

  5. I can see how this study is both correct and misleading. As it turns out, I was at a BMI of about 27 some 7 or 8 years ago and soon after became a 22. I feel better and am more energetic. I feel healthier. This effect alone makes the effort worthwhile to me. That aside, I can see a possible reason why all-cause mortality might not be affected by the overweight category. Simply put, heavier people are less active and therefore less likely to have accidents like falling off ladders or bicycles. Anyway, I think it’s dangerous to tell people that overweight is OK because it is then likely to get worse.

    Losing weight is likely quite different for different people. Genes do matter. However, I believe it can be done fairly simply for many. Avoid sugar, particularly juices and soft drinks. (Learn to like water.) Exercise regularly but moderately, making it a mandatory part of one’s routine. And finally, control portion size at meals. This last is especially difficult when eating out for obvious reasons. Fast food is bad. Use smaller plates at home. Eat slowly, go for quality over quantity. These are the things that worked for me.

    Liked by 2 people

    • Bravo for working on your lifestyle! No one would disagree that lifestyles need to change. But lifestyle is the issue more than the weight. Too many of my patients get caught up in the weight and loose sight of the lifestyle. THIS is what I want to fix.


      • But, doc, lifestyle is what I’m advocating as well. The weight loss will follow. Oh yes, I forgot one other thing. I make it a point not to check my weight daily – there’s too much variation. I check it once each weekend in the morning.

        Liked by 1 person

      • You are an unusual doc, Victo. Most physicians in my experience are content to limit their efforts to the soma and leave the psyche to the patient. This is bound to increase your stress so I hereby prescribe for you one hour of relaxation and meditation every day, including a nice cold glass of water with some lemon in it. 🙂

        Liked by 1 person

  6. My GP NEVER talks to me about my weight. And as you read from my post today, it’s not in what I consider a good place. So every time I visit her about my meds, my weight goes up and up and up. Maybe she’s waiting before I’m on the high end of overweight? Would I like her to mention it? Maybe. But she asks me other things like you alluded to: do you smoke? do you drink? if so, how much? what kind of exercise are you getting? etc…

    Liked by 1 person

  7. Hmm…I manage my weight and it is normal for my height, but I could get really fat, really fast. My doctor does do a lifestyle questionnaire on me, how much exercise, sleep, wine, etc. I do. He also asks about my emotional state, relationships and things that might be struggles in my life. The second part I think actually has more to do with weight issues than the first part about lifestyle. When I over eat or eat the wrong foods, I am usually trying to stuff my feelings down, dissociate, self soothe, because I feel they are unacceptable, making me, unacceptable. I do think everything comes back to loving ourselves unconditionally in this ‘not good enough’ society that rejects most emotions other than ‘happiness’ as undesirable. I will stay away from the topic of our food supply and how it has changed.

    Liked by 1 person

  8. Happy New Year. Hope you had a nice holiday.

    When I look at my beautiful bride and see how much weight she’s put on since we got married 16 years ago, it breaks my heart. It’s the third rail, though. The one that will get you electrocuted. I never talk about it. She knows. It’s all portion control. She eats like a longshoreman but what can I do about it? I’ve just returned from a cruise. My first. The only depressing part was watching people eat.

    Liked by 2 people

  9. The only reason I lost 25 lbs. in a year’s time was FEAR, Victo. I had been walking two miles a day for more than a year before I had a heart attack in 2007 and had been quite active all for years. Still, I HAD A HEART ATTACK! Now that’s scary… Thanks to a surgeon who did not condemn my diet, but merely suggested a few changes (yes, eating is a life style change) and to a cardiac rehab program, where great literature on easy to adjust to recipes. I did it (revised my diet) and will continue to stick with it for the rest of my life. I love eating and I love trying new healthy and delicious recipes. But, I don’t feel like I’m sacrificing a thing. I still enjoy a meal out once a week and holiday fare is always welcome on my plate. So, I offer readers this advice: DON’T WAIT UNTIL IT’S TOO LATE. I almost did. But DO weigh yourself every morning (after eliminating and before eating), so if you happened to gain a pound or so, you’ll take a easy before the next weigh-in. It works for me. 🙂

    Liked by 1 person

  10. Great photograph! I have fought the battle of the bulge my whole life and am still winning but I avoid the topic with others. They all think I am one of those people that can eat anything and stay thin. I count calories every day and exercise thirty minutes every day and also do some yoga stretching. If I didn’t do those things I would probably put on thirty pounds.

    Liked by 1 person

  11. I think I would link a talk about weight to how a person feels. Not how they feel about their weight, but do they feel crappy all the time… Perhaps an idea about what they eat could morph into a conversation about what they could eat to make them feel better in the long term. I find that when I don’t eat much and lose weight I feel worse than when I eat more in a balanced way. Maybe you’ve been there, done that…
    Best of luck… I hope you post it when you arrive at a successful strategy.

    Liked by 1 person

  12. I am not as sensitive, so my GP can talk weight with me, no problem. I know I have a couple of extra kg, and I know it is no good for me, and all my obese acquaintances except one who suffered a stroke, are dead before their sixties. I don’t say that I am going to live longer than them, but at least I won’t die from the reasons I could easy avoid.

    Liked by 1 person

    • Weight is not so much the issue at least until you get to the more extreme obesity ranges. Lifestyle is the thing I think that really makes the difference. My patients that maintain healthy weights are not focusing on the pounds. For decades we have emphasized losing weight to patients but given very little advice and support for healthy living and lifestyle or the advice we have given has been proven dead wrong. I really feel the need to change how I have been approaching it in my practice. I have gotten some funny looks this week but on the whole it has been very positive. For my part it feels like I am doing something more and that by itself is more rewarding. 🙂 It is too early to say if this is going to make a difference for patients long term but if I didn’t try something different I feel like I would be giving up. I am not ready for that. Not yet! If this doesn’t help, I will try something else….


  13. I would love for my doctor not to weigh me each time I visit. I hate the weigh-in as if I unknowingly joined Weight Watchers and it’s either Praise or Shame Time. Annually during a check-up, okay. But every time?

    When I’m real sick or real sad, I lose weight.

    Since I’ve been happy and my health is holding steady, guess what? I’ve gained some weight recently and it seems to be so much in love with me that it simply won’t let go (think psycho stalker).

    Plus, I think the older we get, the harder it is to lose weight. It’s our bodies way to protect us from dying too quickly if we develop a debilitating illness. We’ll hang in there much longer if we can’t eat because we have all these reserves, right? I call it the “Fat Chance” theory. Don’t laugh. It’s a thing. It has to be, right?

    Maybe I’ll do a blog about it. The new year is when we tend to focus on weight and fitness, right?

    Liked by 1 person

  14. After studying naturopathic medicine for 10 years of my life and attempting to make a career change I understood one thing. Weight is a very subjective thing that only can be broached when brought up by the person with issue. I managed several Nutritional stores for the largest supplement company in the world and dealt with this topic often with my customers. I think it boils down to one thing – if the individual has a desire to make a change then the conversation can be very fruitful, but if they are not then the timing just isn’t right. It seems it takes some kind of tragedy to occur or a doctor to finally get through to their patients. Either way doctors plays the most important role in pointing out the seriousness of being overweight. How it’s received isn’t your problem it’s the patients. Your the messenger, not the answer.

    Liked by 1 person

    • As you say, weight is subjective and is an emotional land mine for many people which makes it tricky, but I do think physicians need to help more on the answer bit by focusing on lifestyles with patients. I am two weeks into approaching things differently with patients and so far it has been really positive. 🙂

      Liked by 1 person

  15. Actually my doctor is all about life style…if you eat healthier, live healthier then if there is any extra weight is will normally just melt away….I can pass on the scale if I wish, but since I have been loosing I like to keep a record of how much….she is always very encouraging and very gracious….but normally it all comes back to living a healthy life style that fits your life where your at….like age, diseases…etc…I say go for it….we can’t hear it enough in my opinion…..kat.

    Liked by 1 person

      • New Journey’s doctor is right. At the risk of giving the horse another blow, I would like, based on my own experience, to emphasize what I believe to be a critical point in loosing weight. Weighing daily means that you are searching every day for evidence that whatever lifestyle changes you’ve made can be discarded. That is the road to failure. Lifestyle changes must be psychologically accepted as permanent, which is why they must be reasonable. Smaller portions, smaller plates, quality not quantity, less meat, less sugar. It’s not rocket science.

        Liked by 1 person

  16. An interesting train of thoughts. I come from a skinny family from a skinny people (the French).
    My BMI is 24, and I feel I could lose 4-5 pounds! So overweight is somewhat remote. The condition has increased dramatically in the last 30 years. In the US, the UK, in Mexico… Junk food, snacking all the time. I remember in my family, there was no snacking. NO eating between meals. I also noticed in Grad school in the US, the huge servings one got at a restaurant or an american friend’s house.
    Sooooo. I think overweight patients know. Smokers know. More figures and stats won’t change that. Lifestyles? Yes. Walk. Don’t drive unless you absolutely have to. Absolutely no eating between meals…
    Smaller portions. There are many angles you can cover. But aren’t you getting yourself into a somewhat “lost” fight?

    Liked by 2 people

  17. Really interesting post. I’m very overweight (BMI close to 50) and I’ve had bad and good experiences with doctors regarding weight. The worst was a doctor who saw my fat self or the number on the scale or both, and immediately started berating me about eating too much fried food and not getting enough exercise (I guess he neglected to notice in my chart that I had been working on diet and exercise and lost 30lb since the last time I saw him.)

    The best is the doctor I have now, who won’t shut up about getting enough exercise and enough veggies, but won’t talk weight unless I bring it up. And most importantly, if I’m having a problem, he actually investigates it and doesn just dismiss it as being due to my weight and curable by weight loss, like so many doctors have done to me in the past.

    Good luck with your resolution, and wish me luck with mine: more vegetables and more activity!

    Liked by 1 person

  18. Reblogged this on Hot Chick Gone Fat and commented:
    I came across this post. Its an interesting view from a doctor about weight. My last doctor never mentioned my weight. I’d get a print out with a visit summary and in small type there would be a mention of healthy eating. I wish she had mentioned something about it. Although I do think lifestyle may be a good way to ioen discussion. It may seem much less embarrassing to some of us chunkers 🙂 what are your thoughts?

    Liked by 1 person

  19. I would love a doctor who would do this!!! It seems like most problems can be fixed with a pill nowadays, unfortunately the pill typically creates some side effects.

    Liked by 1 person

  20. I really enjoyed this post – thank you so much for sharing.
    I have a doctor right now who NEVER comments on my weight, and I find it a little frustrating. I have a BMI of 35. I’m 65 inches short and my last weight at the doctor on Monday was 206. That’s not right!
    I would love it if she would say ANYTHING about it, even if she asked me about my lifestyle and not weight specifically.
    I think your approach would work, as long as you explained to your patients what you’re doing. Transparency in medical professionals is awesome to me – just tell them what you’re doing and maybe their response will be a little more positive as well.
    I noticed that you posted this almost a year ago – I’m curious to find out what your year has brought with this new idea.

    Liked by 1 person

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