How Can Doctors Tell Patients to Lose Weight?

In a cheerful, 1,000-square-foot modern kitchen painted in hues of bright orange, blue, and green, you can hear blenders whirring and the sounds of children laughing. Recipes are taped to the walls of rooms named Sweet Pea and Carrots. In a garden out back, cucumbers and tomatoes are ready to be picked, and kitchen scraps are being turned into compost.

It looks like an ordinary house, but it’s a pediatric practice in Spotsylvania, Virginia, where Dr. Nimali Fernando counsels children and their families about the importance of weight management.

“It’s not uncommon to see adult diseases in kids. In the 1980s it was almost unheard of to see a child with type 2 diabetes,” said Fernando. 

Food preparation

In 2012, Fernando started a nonprofit called The Doctor Yum Project, where in a large church kitchen she taught children how to cook healthy foods. Then, last January, Fernando left the medical practice where she was employed and opened Yum Pediatrics.

Fernando, whose patients call her Dr. Yum, believes the best way to tackle obesity is to teach children and their parents how to prepare healthy meals. She takes them into the kitchen to work on preparing healthy recipes, and has them pick veggies from her "teaching" garden.

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Don't Harp on the Numbers on the Scale

“I try not to mention weight. And I don’t discuss the numbers on the scale. It isn't productive,” Fernando told Healthline.

I want to make sure the kids’ life expectancies aren't earlier than their parents' generation. A lot of patients who are obese have parents who are obese. It’s a ripple effect. The whole family has to change.
Dr. Nimali Fernando

Fernando does look at how much the patient weighs, but she said, "It is not as important as talking about habits and how the children feel. We’re working to make sure they are eating good foods. If, over the years, you talk about numbers, the child will obsess over them. It becomes all about losing weight. I want to make sure the kids’ life expectancies aren't earlier than their parents' generation. A lot of patients who are obese have parents who are obese. It’s a ripple effect. The whole family has to change,” said Fernando. 

Fernando also motivates patients by having them work each week with a nutrition education coordinator to learn how to create healthy meals and snacks. Four patients are currently participating in the "model" program: a morbidly obese middle schooler who has elevated blood pressure and is prediabetic; two elementary school age children who are obese (one who is prediabetic); and an obese patient who is in high school.

Teaching Garden

The counselor familiarizes the patients with new ingredients, such as flaxseed. "We will show them what it looks like when they buy it, how to grind it, and how they can use it to add fiber and omega 3 fatty acids to their diet. One important part of the sessions is letting families try some of these foods and showing them that, contrary to popular belief, healthy food can be absolutely delicious ... The kids are given a journal to write down what they are eating and how they are feeling, so they can start to connect healthy food with feeling good," said Fernando.

Social media is also an effective tool for influencing patients. Fernando posts new recipes and wellness ideas on Facebook, Twitter, and Pinterest, and says that 90 percent of her patients' moms visit her Facebook page. When she first started her website, Fernando said, “I noticed a lot of moms didn't know how to cook or what to stock in a kitchen."

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Get Connected with Patients Online

Another strategy doctors can use to sway patients to lose weight is to send personalized phone, email, and text messages using software integrated with their electronic medical records (EMR). Doctors can send healthy recipes, exercise tips, and reminders about appointments, health screenings, and medication refills.

TeleVox, an Alabama-based company that provides patient engagement software, recently conducted a study on how doctors can best communicate with their diabetes patients.

The study, which included 1,130 adults ages 18 and older, found the following:

  • 63 percent of patients feel their weight has negatively affected their health.
  • 96 percent have tried to lose weight in the past.
  • 78 percent have been unsuccessful or only somewhat successful at losing weight.
  • 42 percent said they would be more likely to stay on prescribed treatment plans if they received encouragement from their doctor between visits.
  • 38 percent of patients with diabetes were interested in receiving communications and tips from their doctor to manage their own weight between appointments.
  • At least 43 percent felt the same way about receiving tips to manage their child’s weight.

Allison Hart, director of TeleVox’s Healthy World Research Initiative, told Healthline that more than half of those surveyed who are receiving these messages say the messages make them feel more valued as a patient. The messages also improve their opinion of their doctor, and patients feel more certain about visiting that doctor again.

“Technology eliminates the embarrassment many overweight and obese patients may feel. They can just interact with the device and not have to look someone in the eye and say, ‘I haven’t been eating the way I was supposed to,' or ‘I forgot to go for a walk yesterday,’” said Hart. 

Focus on the Positives

The TeleVox survey also found that 43 percent of patients want to receive specific advice that is positive in nature. “If you have the first conversation in a doctor's office, you can set the goal of taking a certain amount of steps every day. Doctors can tell patients to get a pedometer and then they can check in with them, asking, 'Did you get your steps in today?' This gives them the tools they need between visits to try new things and to stay on track,” said Hart.

Technology eliminates the embarrassment many overweight and obese patients may feel. They can just interact with the device and not have to look someone in the eye and say, ‘I haven’t been eating the way I was supposed to,’ or ‘I forgot to go for a walk yesterday.’
Allison Hart, TeleVox

In a separate study, TeleVox found that 34 percent of consumers said they would be more honest when talking about their medical needs through an automated call, email, or text message than in person with a healthcare provider. Also, 28 percent would talk more honestly about their nutritional habits.

“There’s such a stigma around weight. When you are talking about chronic conditions like diabetes and obesity, it’s a hard pill to swallow when you are told you need to make a change in the way you've always lived your life. There will automatically be a resistance and ‘this doesn't apply to me’ mentality,” said Hart.

According to Hart, patients want doctors to help them achieve positive goals one step at a time, such as eating less fat, reducing sugar intake, and walking a certain number of minutes a day, instead of a more difficult to obtain goal, such as being told they need to lose 100 pounds.

Weight Loss Perspectives

Patients also prefer being told by doctors that losing weight will give them more energy and make them look better in clothing, rather than receiving threats that their eating habits will lead to other health conditions and an early death, said Hart.

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Try One-On-One Support and Peer Counseling

DPS Health of Los Angeles, California offers year-long lifestyle intervention programs as well as self-management support interventions, sponsored by healthcare provider organizations and health insurance plans. These programs provide online as well as in-person support.

"We identify people who are on the path to adding more chronic conditions every few years if they don’t change their behaviors, improve their lifestyle, eat better, be more active, and understand and implement effective self-management support," Dr. Neal Kaufman, DPS Health's chief medical officer, told Healthline.

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Patients learn how to overcome barriers, set goals, and monitor and track performance. They can also communicate with a professional health coach through secure messaging and email, as well as get help from their peers.

"They get social support and accountability over time in an intervention that has proven to work in person and that has been transformed for use online. The idea is to allow patients to guide the health system to provide the information the way they want that information provided,” said Kaufman.

Patients can enter information into the software app, such as how much fat and calories they ate and how many steps they took in a given week. They can indicate to the coach that they want to be reminded to weigh themselves once a week, or that they want to learn a fact every day to help them understand diabetes.

"The coach sees the same dashboard as the patient and can say, 'Hey, you had a great week. Can I help you with anything? I see you had trouble here. How can I help you?'" said Kaufman.

Let Patients Lead the Way

Kaufman advised that the doctor-patient relationship should start with a respectful relationship-building conversation that helps patients discover what is important to them.

It’s more about where they are on that journey, and are they ready to hear the conversation. Listen to what the patient is saying and have them self-discover that they’re concerned about their weight.
Dr. Neal Kaufman, DPS Health

"Rather than jumping to how I think you should do this to solve your problem, it’s helping that individual identify the problem, what they might want to try to do today or tomorrow in a small step, and what you as a clinician might be able to do to help them become more confident," said Kaufman. "Ask questions, such as, 'What have you tried in the past that worked? What are the issues that are keeping you from being successful?'"

Kaufman concluded that doctors should not force their views on patients. "It’s more about where they are on that journey, and are they ready to hear the conversation. Listen to what the patient is saying and have them self-discover that they’re concerned about their weight," he said. "You may have to give them some information, but let them absorb that.

"If they say they are not ready, say, 'Okay, fine let’s talk about it next week, or next month.' This is a lifelong pattern based on environment, genetics, and behavior. Changing your behavior takes a long time. The clinician who just says, 'Here is what you need to do,' is not going to succeed," Kaufman said.

Photos courtesy of Dr. Nimali Fernando. Infographic courtesy of TeleVox.

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