Provide the option to patients of facing away from the scale if they would prefer · Record weight and waist circumference without judgment (e.g., no negative comments or facial expressions) Before procedure: · Ask if they would like to know their weight and waist circumference today · Ask if they wish to discuss or have questions about their measurements or health After procedure: 7 · Dislike of discussing weight loss · Frustration · Belief that treatment is often ineffective · Pessimism about patient success Research14,31 shows that increased knowledge about obesity treatment can For Providers Part 4: Treatment Knowledge Despite encountering many patients with obesity, diagnosis and treatment of obesity remains lower than it should be.25-27 Subsequently, research indicates that few patients receive counseling about weight, diet, and exercise from their primary care providers.18,19,26,28-30 However, with greater knowledge about effective approaches for weight management, it is possible to integrate more behavioral counseling during office visits and better support patients’ efforts to make lifestyle changes.18 Did you know… Some research reported a between 1995 and 2008, particularly among patients with co-existing chronic conditions who may benefit from weight loss28 How might greater knowledge and competency in providing obesity care help? · Providing effective counseling for behavioral changes can help motivate and instill confidence for patients to make diet- and exercise-related changes18,32 · Having discussions about weight can improve your patients’ likelihood of achieving clinically significant weight loss 33 Decrease For Patients 8 Research Highlight Part 4: Realistic Expectations for Achievable, Sustainable Weight Loss Significant, long-term weight loss is not easily achieved, despite messages by the media and weight-loss industry that suggest otherwise. To make recommendations about weight loss and goals that are achievable and sustainable, consider the following information: 1. Expert medical panels concur that a weight loss of 5 to 10% of body weight should be considered a success34,35 · Weight loss greater than 10% is not sustainable in most conventional weight loss treatments.36 · Modest weight loss can result in clinically significant health improvements,37-41 even if patients remain ‘overweight’ or ‘obese.’42 typically occur in Glycemic measures Triglycerides High-density lipoprotein cholesterol Systolic blood pressure All of which lead to reduced risk for comorbidities such as, cardiovascular diseases, type 2 diabetes, and sleep apnea. Possible improvements In a recent experiment of 59 adults,43 the impact of a popular weight-loss reality TV show (“The Biggest Loser”) on weight bias was evaluated. Findings indicated that compared to those watching neutral content, adults who viewed 40 minutes of The Biggest Loser expressed: · Dislike of people with overweight · Belief in personal controllability of body weight Research Highlight 9 2. “Healthy” BMI may not always mean “Ideal” BMI Part 4: Realistic Expectations for Achievable, Sustainable Weight Loss Did you know… · Patients may have an ideal weight that they want to achieve, which may be significantly more than what is realistic to expect. When a goal is unrealistic, patients can feel discouraged and unsuccessful in their efforts for to make lifestyle changes. · Instead of focusing only on weight loss, encourage goals focused on behavioral changes and improvements in health indices, such as blood pressure. 3. Recognize the difficulty of weight loss management · Although weight loss is difficult, maintaining weight loss may be even harder,44,45 with only one in six adults with overweight or obesity maintaining weight loss of at least 10% for 1 year.46 However, with appropriate strategies and support, patients are more likely to maintain weight loss or have a similar extent of success after re-gaining weight.44,47,48 4. Even after weight loss (through behavioral or surgical interventions), weight stigmatization can occur (called “residual stigma”) 49-52 · Regardless of current weight, individuals with any history of obesity can still experience weight stigma that harms their psychological health, including increased suicide attempts and likelihood of anxiety and depressive disorders. Weight loss of approximately 10% is a typical and realistic outcome of the best behavioral and/or pharmacological treatments for weight loss. 34,35 Following weight loss, patients may experience ongoing stigma and still be negatively stereotyped by others. 49-52 10 Part 4: Key Strategies: Reducing Bias in Clinical Practice Strategies to help you deliver more sensitive are to your patients Consider that patients may have previous experienced weight bias from providers Recognize that obesity is a product of many factors, many of which are outside of person’s control53-55 Recognize that many patients have tried to lose weight repeatedly - Be careful not to assume that body weight is at the root of a patient’s symptoms, and consider his or her complaints independent of body weight Providers may not be aware of the ways in which they communicate weight bias to their patients. Explore all causes of the patient’s presenting problems Provide continuous feedback on progress in a nonjudgmental way Ask and discuss matters that help identify goals that may be