Obesity is linked to many serious medical conditions. Yet many physicians refrain from talking about “the elephant in the room” for fear of offending patients.

The Archives of Internal Medicine published a study with the conclusion: “Patient reports of being told by a physician that they were overweight were associated with more realistic perceptions of the patients’ own weight, desire to lose weight, and recent attempts to lose weight.”

When in practice, I never hesitated to bring concerns about weight center stage. My approach reflected my unique role as expert guardian, guide, companion and/or cheerleader in patients’ efforts toward optimal health.

“This is not a social visit,” I’d begin. “I’m concerned about the ‘you’ inside your body; I care about your heart and joints and physical comfort, and not what size clothes you wear.”

I would focus on which specific activities of importance to the individual patient would likely be compromised if the patient developed which specific medical complications. Rather than try to frighten patients into adopting more healthful lifestyle, I tried to motivate patients positively by linking the measurable outcome (i.e., current weight) to meaningful endeavors (e.g., ability to sit on floor with small grandchildren or to work in the garden). I believe the best approach is one that addresses patients’ unique needs, desires, strengths, weaknesses and circumstances at each phase of recovery. It’s an approach that requires time, effort and caring about the life of each patient.

Conclusion: It takes time to deliver efficient care.

Wendy S. Harpham is an internal medicine physician who blogs at Dr. Wendy Harpham on Health Survivorship.

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