To overcome that and start building trust in the doctor’s office, Flanagan said she first asks people for permission to talk about their weight, eating habits and obesity-related health issues.
Even though some providers may bristle at this idea, she said it pays off.
“Whether or not we should or shouldn’t be asking permission, you get better buy-in from your patient if you do,” she said.
During a well visit, Flanagan may tell a patient that their weight could be contributing to specific health issues and concerns they’re having. She then asks them if they could have a conversation about it then, or if they’d be more comfortable scheduling a follow-up appointment to talk more in depth about it.
“And I would say I’ve almost never had a negative response to that,” she said. “The vast majority of patients say, ‘Yeah, I would love to talk about it, but I didn’t know how to bring it up.’”
It can be important to create that kind of opportunity, especially during someone’s primary care visit, Flanagan said. But she also knows it can be hard to do when doctors have to cram in all sorts of exams and discussions about other health issues in such a limited amount of time.
Concerns about obesity risk don’t always make the cut, she said.
“There can be some hesitation, because it is not a short conversation. Do you want to open that can of worms when you have three patients waiting for you? Do I really want to start talking about this now when I have 15 other things I need to do for this patient anyways?” Flanagan asked. “It’s usually not life or death that you have to address someone’s weight that second, but it’s something that if we just keep kicking the can down the road, eventually it does become that way, not necessarily from the weight itself, but from all of the consequences that come from that.”
In the pediatric setting, McDonald said she incorporates discussions about weight early on, especially while she’s educating new parents and growing families about the importance of healthy eating, nutrition and physical activity in childhood.
It also involves creating a safe space for families to open up and tell her about challenges they face in finding fresh produce, being able to afford the costs of healthy eating, traveling to a food store and having an area for kids to run around and play, all while trying to take care of their own health.
“Sometimes as physicians, we have the ideal way it should be done, but then we’re in the real world,” McDonald said. “You have to understand the community that you are servicing and you have to understand their barriers to meet them where they are.”