Roadmap to successful weight management: Guiding your patients in the right direction

By Soha Mahmoud, MS, CLS (ASCP) | Fact-checked by Anastasia Climan, RDN, CD-N
Published May 3, 2023

Key Takeaways

  • Two in three US adults are considered overweight, and one in three is considered obese.

  • Primary care physicians (PCPs) are in an ideal position to provide weight management guidance, as they see patients year after year and can detect trends in weight.

  • PCPs can utilize available tools to clinically assess weight dysfunction and to discuss and treat it in a nonjudgmental way.

Weight mismanagement and obesity are clear problems in the US. Significant proportions of the population are considered to be either overweight or obese. The costs of excessive weight include an increased risk for developing debilitating and potentially deadly diseases, combined with substantial related healthcare costs to the individual and at the national level.

PCPs, by virtue of the continuity of care they provide their patients, are uniquely positioned to help combat the problem of excess weight. PCPs can be effective in these efforts by using appropriate tools for assessing weight-related issues and honing their skills in communicating with patients.

The role of the PCP

In the United States, two in three adults are considered overweight, and one in three is considered obese.[]

Studies have presented clear data, as noted by the Harvard School of Public Health, that excessive weight reduces overall health and increases an individual’s risk of developing diabetes, heart disease, and even some malignancies.[]

A person’s weight at age 20 and again in midlife has a strong association with the development of atherosclerosis, according to authors of a study in Atherosclerosis, and there is a moderate association with an increase in weight between these two time points.[] Obesity diminishes the quality of life and the length of life, according to the authors.

PCPs typically see the same patients year after year and have access to their medical and physical history, including weight measurements from prior visits. Therefore, PCPs can be among the first healthcare professionals to detect changes in weight.

PCPs can play a pivotal role in helping their patients maintain good health and prevent future diseases through weight management.

With the opportunity to address unhealthy weight in adolescence, and monitoring for any weight gain through midlife, the PCP’s role is critical.

To manage weight in the primary care setting, PCPs need effective tools for both evaluating and communicating with their patients. A discussion in the American Journal of the Medical Sciences (AJMS) offers some guidance.[]

Clinical assessment and criteria for overweight

PCPs can access easy-to-use tools to assess and identify patients who are considered overweight. Currently, body mass index (BMI) is the most office-friendly means to identify and monitor overweight patients. A BMI of 25 to <30 kg/m2 is defined as overweight, and a BMI of ≥30 kg/m2 is considered obese.

While calculating BMI is relatively straightforward, there is no need to perform manual calculations, as most electronic medical records can auto-calculate BMI and plot weight trajectory. For patients who are overweight but otherwise “healthy,” utilizing waist circumference may be more appropriate, according to the AJMS discussion, as waist circumference is linked to increased weight-related health risks. 

A weight circumference ≥88 cm (35 inches) for women or ≥102 cm (40 inches) for men is indicative of excessive abdominal fat and a future risk of developing weight-related disease.

Nonjudgmental discussions about weight 

It can be tricky to start a dialogue about weight with patients, as it can be a very sensitive topic. The best approach is to structure the discussion around health, not size. Instead of saying, “Your weight is just going up and up,” try saying, “I’ve noticed your weight has increased since your last visit, and this could have an impact on your health.” Framing the discussion about health is the key to sparing patients from feeling judged or embarrassed. 

When it comes to providing solutions to weight management, shared decision making and patient involvement can produce positive results. 

Physicians should ask their patients about their thoughts in terms of current lifestyle obstacles or challenges that are contributing to their weight gain.

Physicians can also identify the patient’s goals and their openness to treatment options, including dietary changes, medication, or surgical procedures. This patient-centered approach allows patients to be more active participants in their weight management plans and may lead to better outcomes for weight loss. 

Personalized options for weight loss 

PCPs should have a general understanding of all currently available weight management options and be able to communicate with patients on the risks and benefits of each one. Weight management interventions are not one-size-fits-all and can range from simpler lifestyle or behavioral modifications to pharmacotherapy. 

PCPs should stay abreast of evidence-based weight management guidelines in order to appropriately treat patients based on their current weight and comorbidities. Not all patients are a good fit for certain treatment types. Weight management guidelines released by The Obesity Society, the American College of Cardiology, and the American Heart Association are good starting points for additional guidance on appropriate treatment. 

What this means for you

PCPs should remain up to date on current tools and guidelines for evaluation of weight dysfunction and on guidelines for treatment. Additionally, when discussing weight management with patients, a patient-centered nonjudgmental approach is best.

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