Top patient education strategies for managing obesity

Communication skills

Like any good patient engagement strategy, obesity care management requires strong patient-provider communication. This includes clinician empathy, motivational interviewing and shared decision-making.

By employing these communication skills, healthcare providers can build trusting relationships with their patients while eliciting the goals and treatment plans that are most important to them. Ideally, this improves patient activation and, ultimately, outcomes.

Clinician empathy

All patient-provider communication must be clear, informative and, perhaps most importantly, empathic, most experts agree. This is because obesity is an extremely stigmatized chronic illness, with many patients with obesity reporting fears of judgment not just from their peers but from their providers, too.

In fact, per the Mayo Clinic Proceedings article, patients cite fear of stigma, prior negative healthcare experiences and fear of receiving a formal obesity diagnosis as key barriers to obesity care.

The report authors recommended healthcare providers use more neutral language to describe weight, such as "unhealthy weight" versus "obese." They also recommended using person-first language, such as "patient with obesity" instead of "obese patient." Importantly, these semantic choices should be reflected in the medical record.

Other experts suggest using the five As for obesity management:

• Ask permission to discuss weight.
• Assess relevant clinical metrics.
• Advise on health risks.
• Agree on realistic weight loss goals.
• Assist in identifying and overcoming barriers to resources.

Overall, healthcare providers should use the empathy skills for obesity management as they'd use for other disease states. Active listening, offering comfort, expressions of cultural competence and shows of respect will be beneficial to the patient-provider relationship.

By displaying empathy and avoiding judgmental language, providers might better connect with and engage their patients. Patients, regardless of the illness they manage, want to feel seen, listened to and respected by their healthcare providers. When managing a highly stigmatized illness like obesity, these factors could sway how -- and whether -- patients engage with care at all.

Motivational interviewing

While empathy should be infused in all patient-provider communication, motivational interviewing is a key chronic disease management skill that can be especially effective when managing obesity.

That is because motivational interviewing helps get at the heart of patient goal-setting. Patients are not always motivated by a number on the scale or a specific pants size. Rather, they might be motivated to feel well enough to do a certain activity or to improve a certain health metric, like A1C.

"Motivational interviewing teaches that although external influences incite inspiration, only the patient's intrinsic strength creates sustainable motivation," per the Obesity Medicine Association (OMA).

Clinicians can ask questions that address a patient's ambivalence about weight, importance or values, and readiness for change, the OMA adds on its website. Such questions might include the following:

• What factors make you feel more ready to take action toward weight management?
• How does your weight impact your daily life?
• What challenges do you foresee in making changes?
• What reasons might make you want to make changes to your eating habits? What do you like about your current lifestyle?
• What changes do you want to work on?
• How will you handle times when you are tempted to make unhealthy food choices?
• What tools do you have access to in making these changes? What community or support do you have to make these changes?

However, although motivational interviewing has been lauded for its patient-centered approach, and it might support a better healthcare experience, the data on efficacy is mixed. In 2022, a study of college students showed that motivational interviewing improved body composition compared to typical patient education approaches to weight management.

But a separate 2022 literature review showed that motivational interviewing does not add much to weight management programs. The researchers reported no statistically significant benefit to adding motivational interviewing to obesity management programs.

Still, motivational interviewing can improve the collaborative nature of obesity management. When supplemented with other patient engagement strategies, it could foster a better, more trusting patient-provider relationship.

Shared decision-making

Like motivational interviewing, shared decision-making acknowledges the role patients must play in their own obesity care management.

Healthcare providers can employ shared decision-making in obesity care similarly to how they'd use it in other types of chronic disease management. Key steps of shared decision-making include the following:

• Inviting patient participation.
• Sharing treatment options.
• Assessing patient values and goals.
• Evaluating treatment options, including side effects and cost, in the context of patient values.
• Making a decision.

Healthcare providers are responsible for educating patients about their health status, certain intervention options and the pros and cons of each intervention. In turn, patients can share their lifestyle needs and preferences. Together, patients and providers can determine a course of action that will be realistic for the patient to maintain.

Data has indicated that shared decision-making can improve obesity care outcomes. For example, one study in the journal Diabetes Care showed that shared decision-making yielded weight loss 36 months after a diabetes prevention program.

Other studies have looked at preferred weight loss levels among a diverse group of patients with obesity, indicating various levels of motivation and preference and a need to better understand patients on a personal level.

Care management strategies

In addition to patient-provider communication and collaboration, healthcare providers might consider how they frame the care and treatment they use to manage obesity. Patient education and treatment should be designed to make it easy and engaging for patients to manage their obesity.

By designing treatments with factors like health literacy, extrinsic motivation and social determinants of health in mind, healthcare providers can create a care plan that is manageable for patients.

Health education, counseling

As with many chronic illnesses, patient education is an integral part of managing obesity care. Healthcare providers can employ verbal, written and technology materials to educate patients about obesity. They should always consider patient health literacy levels and limited English proficiency.

Patient education materials outlining obesity and obesity care management need to first explain the disease, how it works, how it affects patient health, how the patient is diagnosed and various treatment options.

Educational tools and materials might also prompt patients to ask questions or have discussions with their healthcare providers.

A patient education handout from the American College of Physicians outlines what obesity is, how it affects patient health, how the patient is diagnosed and various treatment options. It also provides potential questions patients might ask their doctors about obesity or overweight.

Financial incentives

Most experts agree on a handful of medicinal and lifestyle interventions that can help address obesity, ranging from weight loss medications like GLP-1s to diet and exercise programs. But losing weight is often easier said than done.

Some experts have posited that certain extrinsic motivators, like financial incentives, could help support weight loss. But data has shown that these financial incentive programs need to be carefully designed. For example, one 2022 study showed that designing incentives around healthy behaviors can be just as effective as designing incentives around outcomes.

However, many studies have indicated that financial incentive programs aren't effective in the long term. Although they can help initiate weight loss, many incentive program participants do not effectively achieve long-term weight loss.

More evidence is necessary to determine the effectiveness of financial incentives. However, they remain a common practice, particularly for wellness programs and rewards hosted by payers and employers.

Food is medicine

Food is medicine is an emerging concept in healthcare that focuses on the nutritional value of and access to food. Built on the conceit that food can influence an individual's health and well-being, providers who integrate food is medicine philosophies work to educate patients about and connect them to nutrition resources.

This philosophy is particularly salient when managing obesity, one of the four pillars of which includes nutrition counseling.

Healthcare providers should focus on key elements of nutrition counseling and refer patients to registered dieticians when applicable. Moreover, clinicians should consider individualized elements of diet and nutrition, including residing in a food desert or food swamp, cultural preference and grocery affordability.

Under the food is medicine umbrella are medically tailored meals, which Tufts Food Is Medicine says can help address obesity. In particular, the organization has cited medically tailored meals, medically tailored groceries, produce prescription programs, nutrition security programs, such as SNAP, and population-level healthy food policies, like sugar taxes, to be effective at addressing obesity.

Indeed, the data shows nutrition and food are linked to health outcomes. One study, cited by Tufts Food Is Medicine, showed that a produce prescription program yielded a BMI decrease of 0.6 kg/m2 because participants had a 22% increase in food and vegetable consumption.

A separate study found that BMI fell by 0.36 kg/m2 for adults with obesity in a produce prescription program, again, because of the increase in fruit and vegetable intake.

Improving access to care

Good obesity care management is not possible without access to healthcare. Although access to primary care might be paramount, there is a litany of other related healthcare concerns that warrant care from other specialists.

Behavioral health access

Many experts agree that obesity and weight management extend beyond the physical symptoms, shining a spotlight on mental and behavioral health interventions.

"While both mental health and obesity have been explored separately, it is important to acknowledge the complex relationship between the two," OMA says on its website. "Obesity often correlates with an increased risk of developing various mental health challenges, including depression, anxiety, and reduced overall psychological well-being."

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), patients might need a referral to mental health specialists who can more specifically treat conditions that contribute to weight gain, including anxiety, depression and eating disorders.

Healthcare providers managing weight with patients should look for behavioral changes, emotional expressions of sadness or hopelessness and physical symptoms of mental health concerns, OMA added.

Using nonjudgmental language, clinicians should ask open-ended questions to continue to assess a patient's mental health during a weight management program. When patients' symptoms become severe, do not improve or when a particularly complex case arises, clinicians should refer patients to mental health professionals. They should also make a referral when a patient requests access to mental health professionals.

Team-based care models

Obesity care management is often centered around the primary care provider, but patients working to manage their weight often need to meet with a multidisciplinary care team to make effective, long-lasting changes.

Many patients will want to meet with obesity medicine specialists, registered dieticians or exercise specialists. Providers might also consider referring patients to a more structured weight loss program, including hospital-based programs, according to the NIDDK.

Team-based care for obesity management should also include the mental and behavioral health specialists outlined above.

Personalized care management

Obesity care is not one-size-fits-all. Employing many of the strategies outlined above, including shared decision-making and motivational interviewing, will be integral to ensuring a personalized care approach.

Experts also recommend outlining other specific care needs or preferences. For example, examining social determinants of health will help a provider tailor obesity care plans for patients based on health-related social needs. Healthcare providers should also engage patients in conversations about their culture to ensure culturally relevant interventions.

Personalizing the obesity care plan is important for ensuring the patient can adhere to the care plan. Discussing culturally relevant meals helps patients make sustainable choices about healthy eating without banning or prohibiting foods that are commonly served at the family dinner table, for example.

Remote patient monitoring

RPM tools can help patients stay engaged in their own health while also updating providers with progress and outcome data. RPM tools allow patients to track and stay involved in their weight loss even outside of the clinic and could help support building healthy habits and lifestyles.

RPM tools commonly used for obesity management include fitness trackers/smart watches, continuous glucose monitors, connected scales and some behavioral support apps. Telehealth is often commonly used to enable health coaching and patient-provider communication.

Like most RPM use cases, the evidence base is only just being established, but some data have indicated promise.

For example, one study in Current Obesity Reports showed that eHealth solutions -- mostly behavioral support apps -- are better than usual types of care management. However, they are best when combined with personal counseling or coaching. The most effective eHealth features include individual feedback, personalized content, self-monitoring capabilities and different types of interventions.

But others aren't so hopeful. One study showed that smart scales, which have been proven to increase self-weighing, aren't always accurate. Moreover, there's limited evidence indicating long-term adoption of these tools.

Still, the RPM space is still nascent. As reimbursement models enable more widespread adoption, healthcare researchers and policymakers might be able to draw more definitive conclusions about efficacy and best practices.

Moreover, health IT and connected health technologies are only a part of a larger patient engagement puzzle. With strong, empathic communication, tailored and engaging care plans and improved patient access to specialty care, patients and their providers can better manage obesity.

Sara Heath has been covering news related to patient engagement and health equity since 2015.