Conversations about obesity can be difficult for both healthcare providers (HCPs) and those seeking treatment for weight and obesity issues. Some women may feel that their HCP is using language that implies judgment, while others may feel that their HCP is not giving them enough information to control their weight.
We asked Alexandra Sowa, MD, for her tips on how healthcare providers and their patients can have more productive conversations about obesity. Sowa is a specialist in internal medicine with a focus on health prevention, nutrition and obesity medicine. She is also a clinical professor of medicine at NYU Langone Health and a member of HealthyWomen’s Women’s Health Advisory Council (WHAC).
This interview has been edited slightly for clarity and length.
HealthyWomen: How can we move towards a person-centric vocabulary when talking about obesity? [Editor’s Note:People-first language puts the person before the disability or disease, and describes what a person has, not who a person is. It does not label someone with their disease.]
Alexandra Sowa: I think we can move to a person-first vocabulary when discussing obesity simply by remembering that the person in front of us is always a person and not a disease. So I’m not talking about a person with hypertension as hypertension. I’m going to say let’s talk about your high blood pressure. And the same should apply to being overweight. Overweight/obesity is a disease. We should remember that it’s not a person, it’s just a disease state.
HealthyWomen: How can we help others understand that obesity is a chronic condition?
Alexandra Sowa: Here, too, I would like to come back to the comparison with high blood pressure. So in medicine, we often feel very comfortable prescribing someone a drug to get their blood pressure down to target, and we really don’t think twice about it. We also advise on lifestyle changes, increased physical activity, better diet, less salt, but we will always discuss a drug option if it helps you achieve your goal. And the same should apply to obesity. We should advise on all aspects, but we should always consider medication when appropriate. And we shouldn’t see this as a lack of willpower or something people have done to themselves. We should not think of this as an emotional state. This is a disease like anything else we treat.
HealthyWomen: How can we help HCPs discuss obesity treatment options?
Alexandra Sowa: One way to help people discuss treatment options for obesity is to be open to learning—and then open to discussion. So many healthcare providers and doctors simply didn’t learn anything about this area in their education. And a willingness to listen to others, restate your beliefs, and engage in medical education is really important. Once you have a base of knowledge in this area, you can actually discuss the options with your patients, or just feel comfortable approaching them, discussing them, and then referring them to a specialist.
HealthyWomen: How Can HCPs Promote Both Body Acceptance and Management of Obesity in Their Patients?
Alexandra Sowa: I don’t think these two things are mutually exclusive. It’s really important to treat people with respect and to recognize that this is again an illness, not a lack of willpower – something these patients may or may not have done in their lives. And we should never talk about weight in terms of looks or being thin. We should always design it with being healthy in mind so we can still love our bodies, but we can be [in] a healthier body with weight loss.
HealthyWomen: Without stigma, judgment or bias, what can HCPs ask their patients about their weight?
Alexandra Sowa: By being open and honest and very gentle when we talk about weight. For example: “Can we talk about your weight? I noticed that on our last visit two years ago before the pandemic you were down £20. I really get it. This was a stressful time. Have you already thought about how you want to handle this?” Just ask open-ended questions, ask for permission. All of this is very important in building a relationship with a patient so that they can even accept whatever knowledge or referral you may have.
HealthyWomen: What Can HCPs Do to Fight the Obesity Epidemic?
Alexandra Sowa: I think that education is the foundation both on the provider side and on the patient side. We have so many new tools at our disposal that we should remember that there is no one-size-fits-all solution when it comes to losing weight. It should never be a “my way or the highway” approach. There should always be joint decision-making between the patient and the provider.
This resource was created with the support of Novo Nordisk.