Discussing Weight Management With a Patient (aka How I Made a Patient Cry)

Today I'm going to talk to you about a patient that I made cry a few years ago. And not only that, the whole topic is a very sensitive one that's often difficult to talk about and that is weight and weight management. So I'll get into this patient in a moment. First of all, I want you to know why I'm deciding to talk about this today. Because there's a very recent reason for this. Last week, one of the main groups that I'm in online, the topic of weight came up and the topic of fat shaming came up. And just like all these conversations do, it rapidly went off the rails. Things got very polarized. You had these two sides going at each other. It got nasty, it got personal, it just, it was not a productive or constructive conversation at all. And I knew it was going to go that way because I've seen this happen a bunch of times. And this topic comes up and I really think that both sides could be doing much better with this because I get why these things occur. On the one side, you have people going, well, we're healthcare professionals, we have a duty to help our patients improve their health. Part of that for many of them is weight management. And we shouldn't be shying away from that. We shouldn't be pretending it's not an issue because we're worried about hurting their feelings. We just have to have a grown up conversation. If that upsets some people, well, tough. That's what we're gonna do. On the other hand, you have people going, well, yeah, but also things like fat shaming are real, very counterproductive. Fatphobia is real, very counterproductive. And very few people who are overweight are not already aware of the impact that's having. And actually all you're going to do is just reinforce the shame and negativity. And it's often done by people who are, you know, skinny, who've never had this sort of issue. They don't get it, frankly, they shouldn't be talking about this at all. So I get some where that side's coming from as well. Both sides have a point. But to illustrate this, I want to talk about this patient who I made cry. It's not quite what you think it was. We'll call this patient Jane. Jane is one of the biggest patients that I've ever seen, if I'm being honest. And Jane came in with chronic history of back pain. And straight away, you know, as Jane comes in and sits down, I'm thinking, okay, well, yes, Jane's weight is going to be a factor in her recovery. Like, you'd have to be an idiot not to have that thought at least. But I didn't think. Right, let's go into that. What I did was actually just let Jane talk and surprise, surprise, this was not brand new information for Jane. Shockingly, you know, within a few minutes, she said, look, I know if I just lost the weight, if I could lose the weight, my back would get better. You know, I know that's playing a big role. So I'm carrying all this extra weight, that's more work for my back. But the pain hurts so much, I can't do any exercise right now. And I know that when I exercise, I lose the weight, I feel better, I'm healthier, and if I'm honest, I. I am comfort eating, I am indulging in food too much because it's really getting me down. And I know that's bad and I know that's not an excuse, but that's just where I'm at right now. So I gave it a moment, I said, well, it sounds to me like, yes, you're already aware that weight is playing a role in your back pain, but it also sounds like focusing on the weight isn't really a productive thing for us to do right now. Sounds like if we were to park that for a minute and if we can get the pain calming down, you already know what you need to do and you're actually quite motivated to do that. So if we can just see if we can manage the pain a bit more. Sounds like you've got a good handle and you're already very keen to get going on handling the weight side of stuff. So why don't we just park that for now? It sounds like focusing on that isn't going to be helpful. And then went through restaurant history, did the examination, did some treatment. I then only found this out later. Jane walks out the room, sits down, a reception, bursts into tears. Now, these weren't tears of me having made her feel bad so much. These were tears of relief because it turned out she was telling the receptionist she had been dreading coming to see me all week because she thought I was just going to tell her, it's because you're fat, lose some weight. That's why you've got this and I can't help you if you're not going to lose the weight. And I'll be honest, I think part of that was probably exaggerated by the fact that I'm male and I'm not skinny skinny, but I'm not overweight. I am not someone who struggled with my weight before. And she had had many, many healthcare practitioners in her past blame her for her weight, blame her condition on her weight. Basically tell her, you need to lose the weight or we can't help you. And essentially all they've done is throwing the responsibility back to her. She said, I need some help with something. And they've gone, you've got to help yourself. That's not helpful. That's not useful. Ignoring it and pretending it's not an issue also isn't that helpful. But I think as healthcare practitioners, we need to be a little bit more sensitive when we come to these conversations, that very few people who are overweight don't already feel really bad about that. And the majority are aware that that's having an issue, not all of them. And we should check with them. Are you aware that being overweight can play a role in this? We should be asking that question. And if they say, no, I'm not, then we can give them a little bit of information. We can then ask, would you like some help in terms of weight management? Would you like some additional resources? Would you like some support in that? Just like we would if they were smoking, for example, we can offer them something and see what they say. If they say no, my opinion is leave it, because all you're going to do is damage the therapeutic relationship. All you're going to do is make them feel bad. Shame is a massive demotivator. It really is counterproductive when you're trying to help somebody and it actually pushes them further away from the place that you both probably would like them to go. But sometimes it's not the right time. We've got to remove the obstacles. Like I used to smoke, nagging me, my gp, calculating how much money I was spending every year on cigarettes didn't help. That actually made me go outside and have a cigarette because I was annoyed and stressed out. So it's a very similar thing. And when we're talking about behavior change, it has to be the right person, the right place, the right time. And we need to find that out and then decide. Right. Is it going to be fruitful to have more of a conversation about this, or should we leave it for now and let's maybe focus on some other things and potentially getting to the point later on when they're feeling a lot better, they can start to do some of those things and develop a healthier lifestyle, but we don't have to do all of it at once. So hope that's been helpful for some of you. Hopefully, no matter where you sit on this kind of like, divide or whether we talk about weight or not, it's giving you some food for thought. I do think it's an important thing to talk about with patients, but approaching it with sensitivity, a bit of understanding, a bit of empathy, and not being the one to try to have to fix the patient or try and get them to change. Now, I think that's really important for us to acknowledge. So, like I said, I hope that's been useful. And I'll see you soon for another video. Take care, everyone.