‘Do you think I’m fat, doctor?’ Using empathy to help patients lose weight

By Kristen Fuller, MD | Fact-checked by MDLinx staff
Published January 6, 2023

Key Takeaways

One time during a regular checkup, I was caught off-guard as my longtime female patient asked if I thought she was fat. She had been struggling to lose weight for some time and had approached me about diet pills.

I believe in a stepwise approach to weight loss, searching for the underlying problem contributing to weight gain (or the inability to lose weight) before prescribing pills.

I did not know how to answer her question without potentially hurting her feelings, so I took the objective approach.

“As your doctor, it’s my duty to answer honestly,” I told the patient. “Yes, you are considered overweight.”

Sensitive topics

I asked the patient how this made her feel. We discussed how her body image and weight issues have affected her life so I could develop a deeper understanding of the approach we needed to take.

We talked about the importance of a balanced diet and healthy exercise and looked at any underlying medical conditions that could be contributing to her weight gain.

"As a patient, I refuse to be weighed on a scale at the doctor’s office as it is uncomfortable for me, even though I know I’m at a healthy weight."

Kristen Fuller, MD

Body image and weight issues are extremely sensitive topics that many patients struggle with, regardless of how much they weigh.

As a result, we need to take an objective yet empathetic approach when discussing these topics with patients and among ourselves.

Relationship between weight and chronic illness

We can talk to patients about how being overweight has a negative impact on overall health and can lead to many chronic diseases. But without humanizing this approach and providing a realistic picture in addition to bite-sized pieces of education, we’re just giving a lecture that will most likely not have any positive results.

Obesity, defined by the WHO as “abnormal or excessive fat accumulation that may impair health,” is the 5th most common cause of death worldwide, according to research published by Computers in Biology and Medicine.[]

It’s a health issue that cannot be ignored, as it’s the primary lifestyle illness that leads to further health concerns and contributes to numerous chronic diseases, such as cancers, diabetes, metabolic syndrome, and cardiovascular diseases.

"We must openly discuss the importance of maintaining a healthy weight with our patients, even if it’s challenging. But when we do, we must empathize with them—and lead by example."

Kristen Fuller, MD

Be an example for your patients

A perfect body does not exist. But we can help patients by sharing our personal struggles and successes with weight loss, if we've had them, to humanize their journey.

Ask yourself how you take care of your own body and mind. Which daily activities improve your overall physical health and fitness? Use your approaches to set an example for your patients with weight-loss goals.

Related: Are you incorporating the latest obesity-screening research?

Counsel patients on avoiding weight gain

Dieting is complex and frequently unsuccessful in the long run, as many individuals will regain their lost weight. Educating patients on adopting lifestyle changes that help them lose weight and keep it off is crucial.

How many calories does your patient consume on an average day? How are they getting them (ie, through whole or processed foods)? What times of day are they eating? Are they drinking (alcohol or soft drinks) or eating their calories? How often—and how intensely—are they exercising?

Adopting a regular exercise routine and viewing food as a way to nourish the body instead of a fast way to feel full is an extremely important part of adopting a healthy lifestyle.

We must educate patients on refined vs non-refined sugars and carbs, snacks, alcohol, soft drinks, fried foods, fast food vs whole foods, the importance of meal prepping and cooking, hydrating with water, and the benefits of fresh produce and lean meats.

"Many patients do not know how to react to and process different types of foods; it’s our job to educate them on nutrition."

Kristen Fuller, MD

Call in the experts

Patients may use food as a coping tool to deal with underlying problems such as stress, mental health disorders, past trauma, unhealthy relationships, low self-esteem, and substance use disorders.

Look for physical and metabolic issues contributing to weight gain (thyroid disease and PCOS, for example) as well as signs of depression, addiction, and low self-esteem that could benefit from therapy or a psychiatric consult.

Recognizing and treating the underlying triggers associated with unhealthy eating is extremely important. It may also be helpful to consult with a dietitian or nutritionist who can meet with the patient over a long-term period and check in with them regularly, as we may only see them once a year.

Your patients may benefit from regular guidance from these professionals, who can educate them on food choices, healthy thoughts around food, and their physical activity.

Read Next: Asking your patients to lose weight may do more harm than good. Here’s why.

Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.

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