Diabetes Distilled: Importance of language in engagement between healthcare professionals and people living with obesity

Worldwide, people with obesity describe stigma culturally, through the media and when engaging with health services, with significant misconceptions underlying this stigma, including among healthcare teams. Whether we regard obesity as a disease or as a risk factor for other diseases such as COVID-19 and type 2 diabetes, the prevalence is increasing in the UK, with nearly 30% living with obesity and an additional third of the adult population overweight. Even after brief conversations about weight, up to a fifth of people can lose 5% of their weight. However, to achieve this, healthcare professionals need to be willing to initiate conversations about weight in ways which are in an acceptable format.

The Language Matters: Diabetes initiative in 2018 brought together people living with diabetes and healthcare professionals to talk about how language can help build collaboration at all stages of the diabetes journey. The current consensus builds on this by exploring how people living with obesity wish to discuss their condition, and how professionals can improve their conversations and care to raise the issue of weight most effectively.

From a person living with obesity’s perspective, the very words used to describe the condition, such as “morbid obesity”, can cause offence; instead, group members preferred conversations about “being overweight” or “carrying too much weight”, but only once permission had been agreed. Openings of consultations or discussion around weight were identified as being important for engagement. Seeking permission to discuss weight allows the person to share their concerns or opt not to discuss weight at this time.

Open-ended questions provide an opportunity to raise concerns; giving positive feedback even if effort fails to achieve weight loss can help maintain confidence; and using the person’s own words can open up discussion (e.g. “As you said, your weight has crept up a little recently…”). Referring back to topics raised previously can demonstrate the healthcare professional has been listening. Strategies to use alongside conversations include knowing what resources are available locally and a willingness to signpost. Ensure that people know there are many different ways to lose weight and that they can return to talk more if that would be helpful in the future.

During the consensus development, healthcare professionals raised the need for guidance and education, particularly around how to raise the issue of weight and their concerns that initiating such conversations would damage their precious relationship with the individual. Improved understanding of the pathophysiology of obesity, combined with getting both verbal and non-verbal communication right and ensuring size-appropriate furnishings and equipment, can help allay concerns and improve consultations.

The consensus summarises the following principles for communication between healthcare professionals and people living with obesity:

• Be positive – focus on benefits and achievements of weight management rather than negative consequences of obesity and overweight.
• Be helpful and supportive – offer specific advice, signpost to local information and services, and acknowledge the multiple routes to weight loss.
• Be aware of non-verbal communication in consultations.
• Be collaborative – focus on helping develop meaningful person-centred outcomes rather than focusing on weight change goals, such as weight loss of 10 kg by 3 months, where possible.
• Be understanding – 80% of obesity variance may be genetic; acknowledge the challenges around achieving weight loss.
• Be environmentally aware – ensure suitable chairs, scales and blood pressure cuffs are available.

The pervasiveness of the stigma related to obesity across areas such as education, workplaces, healthcare and the media can result in these messages becoming internalised and development of physical and mental health problems and avoidance of healthcare. This consensus demonstrates simple but effective steps that healthcare professionals can take to reduce stigma and encourage weight-related discussions.

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