How to have difficult conversations about weight 

Before you have a conversation about weight, it‘s important to understand the stigma surrounding it.  

The causes of obesity are complex and commonly misunderstood. Factors include an individual’s biology, psychology, environment, and financial situation. Alongside societal and cultural influences, such as the production, availability and consumption habits of unhealthy foods.   

This stigma can be internalised by people, which can create negative repercussions for their physical and mental wellbeing. They may feel discouraged from making positive changes to their lifestyle or avoid seeking preventive care.   

But there’s a possibility that difficult conversations with you about their weight could make a difference. 

Listen and approach with empathy

Remember, behind all the factors, you’re dealing with a person with their own story. Before and during your conversation, try to understand how the person will be feeling. Don’t make assumptions about their health on their behalf, instead try to understand their point of view.   

You can start by asking open questions. Give them the opportunity to speak openly first. Practice active listening, by understanding what they have said, reflecting and responding.  

You could use phrases like:  

• Sounds like…  

• I can hear that…   

• I can see by the expression on your face that… 

By showing that you have heard and understood what they are saying is a critical first step before touching on potential sensitive subjects.  

How do they describe their weight and body image? If you’re unsure of meaning behind one of the words – ask them about it. Try not to correct them if you think they misspoke. Focusing on the meaning of words used to describe their lifestyle choices can help you explore any internal bias your patient might have.   

It’s also important to know what matters most to your patient. You should be aware of their goals and what they would like to achieve, rather than focus on what you think they should do.  

Ask permission

Someone may raise concerns about their weight, and you can use this as a starting point. However, if they don’t bring it up themselves, it’s important that you ask for permission first.   

  You could do this by directly asking “Is it ok if I ask you about weight?”  

  Or approach the topic indirectly and ask,   

• “Do you have any concerns about your health at the moment?”  

• “Are there any areas of your general health I might be able to help with? Some of the most common things people talk to me about include sleep, eating…”  

• “Is your weight something you are worried about?”  

• “What does your lifestyle look like at the moment?” 

• “For some people, the things you have raised (i.e. not wanting to be active, always hungry etc.) can sometimes lead to being above a healthy weight. Is that something you are concerned about?”  

If you see this person regularly and use these broad openers frequently, make sure to modify your language to avoid repetition.   

Language matters

It’s worth looking at what kind of language you are using during these conversations. Remember, your language is not only about your words, but your tone and gestures too.   

 Language to avoid:  

• Negative consequences e.g. “’If you don’t lose weight, you will get diabetes.”  

• Shaming or blaming language e.g. “You are eating too much.” 

• Overly simplistic language e.g. “You just need to eat less and exercise more.” 

• Judgmental language and humour.  

Language to use:  

• Person-first language e.g. “person with obesity” rather than an obese person  

• “Above ideal weight” / “outside a healthy weight range”  

• Focus on moving towards a “healthy and happy way of life.”  

Make positive assumptions

Understanding that this person may have previously felt stigmatised, means that you can focus on making positive assumptions rather than negative.  

For instance, you can ask “What things do you do to keep healthy?”, to get an understanding of their lifestyle and what positive actions they currently take.  

If they open up about their weight it’s helpful to use positive and empowering language to begin to create a plan together with them to take action.   

  A few examples of language you could use here include:  

• “Thank you so much for sharing where you are at right now – would it be helpful to talk about some support?”  

• “So, it sounds like you are a bit worried about your weight – would it be useful if I gave you some information?”  

• “What do you think are the best next steps? How can I help?” 

• “That sounds really tough. It’s great you want to move towards a healthier way of life.”  

• “The good thing is by looking at this now we can begin to make some small changes that will make a big difference.”  

This approach can help you talk about goal setting with the person. You can ask questions like, “What are your targets and when would you like to achieve them?” This can help the two of you set SMART goals together. These are Specific, Measurable, Achievable, Realistic and Time-based.  

It can also be good to focus on the positives of making small changes. For instance, weight loss of 5% per year can be achievable and maintainable. More manageable goals can make the person feel like change is possible, rather than overwhelming them with a seemingly impossible target.  

Offer further support

Having a comfortable conversation with the person will ultimately enable them to get the support they need to take action towards a healthier and happier life.  

That’s where our team come in. We help people set and achieve goals that will last a lifetime, we don’t just offer a quick fix.   

Here are a few examples of language you can use to refer to our services:  

• “Can I tell you about a local service that I think would really support you?  

• “I can get one of the team to give you a call and explain the programme if that would be helpful?”  

• “Would you like to do a referral together now?  It’s quick and easy.” 

• “I have worked with patients that have used this service and they found it really useful.”  

Remember, conversations about weight can be difficult but they’re incredibly important. If you know someone who needs a nudge in the right direction, refer them to our free Beezee programmes today.

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