VIDEO: 'Approach ... with empathy,' check your biases when treating obesity

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So the advice I would give to new residents who are seeing patients with obesity is to one, first, check your own self in terms of your own perspectives and bias that you may not necessarily expect is there, but may often be manifest in terms of how you interact with that patient, or how you propose treatment strategies when you talk to that patient. It's important to approach the patient with empathy and to have an understanding that this is a physiology that is beyond the patient's control. We do understand that health behaviors are part of the process of self-care and, you know, do have an impact on the expression of obesity, but that patient's obesity is not their fault. And so when we understand that biology and we have that empathy, then it changes how we interact with people. It even impacts how we think about treatment strategies. What we might propose historically, if we thought, yes, this is this person's fault, then the only recommendation that we make is to say, well, you need to fix your faulty behaviors, and that's just you eating less and moving more. And that will solve the problem. And you know, we've gone through a number of decades of that as the primary focus, and we know that that hasn't worked. So that would be the first bit of advice is to just check your own assumptions and make sure that you're not bringing any internal or any, you know, I should say, implicit or explicit bias into the conversation.

The second thing I would say is just be willing to listen and hear the patient and their experience and their story. And also understand that if that patient's not there for a visit to address their obesity, if that's not their chief concern on that day, they may not be ready to address that. And so even though you see that as a main concern and a main medical problem that you are ready to address that patient's not ready to address it, then that's going to lead to a, what I call a cul-de-sac, right? I mean, it's a conversation that goes nowhere. So what you wanna be able to do is to ask permission for a conversation about obesity. And you want to ensure that that patient is receptive to that conversation. They may not be ready to proceed with the treatment recommendations or even a full evaluation, but at least ask that question, "Is it okay that we address this issue today?" And if they say, No, you have to be okay with that and say, Well, perhaps, we can come back and talk about that later because here are my concerns and this is why I want to address that with you."

So I think those are two really important considerations when a resident is approaching that patient with obesity. There are plenty other things that one can think about, but those two, if those two things go poorly, then there's nothing else that's gonna happen in that encounter that will be of any benefit to the patient.