QUICK GUIDE
Sensitively discussing weight and health
Raising the topic
Weight can be a personal and sensitive topic. Positive interactions with health professionals regarding weight and health can help people understand the science and complexity of obesity, the risks, and the opportunities to improve their health and wellbeing. Negative interactions can impact a patient’s health and wellbeing, motivation for behaviour change, and trust in the health system. Some people will avoid healthcare as a result of a negative interaction, so it is important that we manage these conversations with care.
Consider the following questions before raising weight and health behaviour change as a topic with a patient.
Are you the right person to raise the topic?
A trusted relationship is a good foundation for the sensitive conversation and ongoing support needed. It may not be helpful to raise the topic in one off consultations or interactions unless you can refer on for further support to their GP or another health professional such as a dietitian, exercise physiologist and/or psychologist.
Is this the right time?
Is weight relevant to why someone is seeking care today? Do you both have time for the conversation? This helps to raise the topic in a neutral and relaxed manner. Quickly mentioning weight without further tailored support during a consultation can be harmful.
Does the patient want to discuss the topic?
Asking for permission to talk about weight lets the patient know that you will be there to support them if and when they are ready, on their terms. If the patient declines, respect their decision. If the patient is not interested, ready, or in the right headspace at that moment, it can be counterproductive to discuss weight or health behaviour change.
What language will you use?
Language is important and preferences vary. Person-first language is best practice (‘person living with obesity’). Some people prefer terms such as ‘living in a larger body’ or ‘person with higher weight’. You can ask how someone prefers to talk about weight and health. Or alternatively you could gauge from their body language or the words they use for the topic. Labelling a person as ‘obese’ or ‘overweight’ is to be avoided.
Have you considered their situation and past experiences with health behaviour change and weight?
People’s ability to manage their weight will vary depending on individual genetics, situation, physiology and factors such as previous experiences or attempts at health behaviour changes or weight loss. There is no one ‘diet’ or obesity management approach that is appropriate and effective for everyone. Asking open questions can help to identify important factors such as attitudes and motivators to achieve someone’s health goals.
What is an appropriate health goal?
Focus on functional improvements or health-related behaviour changes as primary goals, in a SMART (specific, measurable, actionable, relevant and time-bound) goal format. Weight loss should not be the sole or primary goal; rather it can be used as one way to help track progress for overall health along with other factors such as nutrition, movement, functional capacity, metabolic markers, psychological wellbeing and sleep.
Have you considered the negative impacts of shame?
Pressure, shame, or disapproval can negatively impact people’s motivation for health goals and behaviour change, and willingness to return for appointments or follow up healthcare. If an individual is finding health behaviour change challenging, encourage achievable steps to support them reach their goals and celebrate small positive changes along the way.
Are you the right person to raise the topic?
A trusted relationship is a good foundation for the sensitive conversation and ongoing support needed. It may not be helpful to raise the topic in one off consultations or interactions unless you can refer on for further support to their GP or another health professional such as a dietitian, exercise physiologist and/or psychologist.
Is this the right time?
Is weight relevant to why someone is seeking care today? Do you both have time for the conversation? This helps to raise the topic in a neutral and relaxed manner. Quickly mentioning weight without further tailored support during a consultation can be harmful.
Does the patient want to discuss the topic?
Asking for permission to talk about weight lets the patient know that you will be there to support them if and when they are ready, on their terms. If the patient declines, respect their decision. If the patient is not interested, ready, or in the right headspace at that moment, it can be counterproductive to discuss weight or health behaviour change.
What language will you use?
Language is important and preferences vary. Person-first language is best practice (‘person living with obesity’). Some people prefer terms such as ‘living in a larger body’ or ‘person with higher weight’. You can ask how someone prefers to talk about weight and health. Or alternatively you could gauge from their body language or the words they use for the topic. Labelling a person as ‘obese’ or ‘overweight’ is to be avoided.
Have you considered their situation and past experiences with health behaviour change and weight?
People’s ability to manage their weight will vary depending on individual genetics, situation, physiology and factors such as previous experiences or attempts at health behaviour changes or weight loss. There is no one ‘diet’ or obesity management approach that is appropriate and effective for everyone. Asking open questions can help to identify important factors such as attitudes and motivators to achieve someone’s health goals.
What is an appropriate health goal?
Focus on functional improvements or health-related behaviour changes as primary goals, in a SMART (specific, measurable, actionable, relevant and time-bound) goal format. Weight loss should not be the sole or primary goal; rather it can be used as one way to help track progress for overall health along with other factors such as nutrition, movement, functional capacity, metabolic markers, psychological wellbeing and sleep.
Have you considered the negative impacts of shame?
Pressure, shame, or disapproval can negatively impact people’s motivation for health goals and behaviour change, and willingness to return for appointments or follow up healthcare. If an individual is finding health behaviour change challenging, encourage achievable steps to support them reach their goals and celebrate small positive changes along the way.
Weight and health behaviour change advice
People with the lived experience of obesity have said they prefer tailored guidance from health professionals when talking about weight and health. They reported that it was beneficial when health professionals discussed:
Information about obesity
- The science and complexity of obesity
- Why obesity management and maintenance can be difficult
- The evidence related to current obesity management options
- Recognition that obesity is a long-term condition, and weight regain can be a normal part of a health journey
- Costs of treatment/care options and what is feasible based on individual circumstances
Personal goals and experiences
- Personal health goals related to weight
- Previous experiences with changes to their weight
- The importance of avoiding harsh self-judgement as this is not productive for long-term health behaviour change
- Options for shorter term, realistic goals that may not include weight loss
Ongoing support
- Plans for ongoing, longer-term support (noting that many programs are short term)
- Other available support services (e.g. mental health or social supports)
The BRAVE Framework
The BRAVE Framework is a practical guide for health professionals to support having a brief intervention conversation. It aims to create a safe, trusted and empowering space for initiating sensitive conversations about growth (for children and young people), weight and health behaviours during routine consultations. The Framework aims to overcome common barriers to having these conversations, such as lack of time, self-efficacy, and fear of causing harm. The Framework is not intended to be a prescriptive script that replaces clinical judgement; rather, the examples are designed as flexible, evidence-informed suggestions to assist in guiding conversations.
SUBSCRIBE TO OUR NEWSLETTER