How to Discuss Weight With Your Doctor — Without It Being Awkward
In the weeks before and after the holiday season, there’s often a lot of conversation about weight. And while the topic is discussed relatively easily amongst family and friends, it’s usually not the same case when discussing weight with your physician. The logic behind it seems oddly flawed. After all, doctors are medical professionals; they deal with uncomfortable health-related discussions all day long. Nevertheless, many people find themselves tongue-tied when it comes to relaying weight-related concerns.
To get to the bottom of this conundrum, we enlisted Penn Medicine bariatric surgeon, Noel D. Williams, MD. Here, he explains how to tactfully and thoughtfully discuss weight with your doctor.
Whose job is it to discuss weight at the doctor’s office? Should patients heed this responsibility?
Even before you get to the possibility of bariatric surgery, a doctor should notice over time if your body mass index (BMI) is going above 30, nearing 35, 40, etc. He or she will hopefully try to intervene before you get over 30.
This means if you see your physician and your BMI is nearing 30, you should try and address it now. Nowadays, part of wellness is obesity management with the primary care physician.
If your physician doesn’t address your weight and you have questions or concerns, how can the patient bring this up tactfully without feeling awkward?
From my standpoint [as a bariatric surgeon], patients are upfront when they come to see me, but that’s different. In the office when you go to see your doctor, you should be direct about it. Whether you’re younger, middle aged or older, there’s no question that a rising BMI in the long term is associated with higher mortality rates. In other words, as your BMI goes up, the bad things happen: high blood pressure, sleep apnea, cardiovascular disease and so forth.
While we’re on that topic, when exactly does excess weight become a concern?
BMI is the body mass index, a calculation that combines a person’s weight and height. A normal BMI is between 19 and 25. If you’re between 25 and 30, you’re considered overweight. 30 to 35 signifies class I obesity, while a BMI greater than 40 means you’ve hit the class II, III or IV mark. Super obese is greater than 55 or 60. This information is available on most websites.
Years ago, the National Institute of Health (NIH) came up with criteria for whether a person can undergo weight-loss surgery. Essentially, bearing in mind what I just told you, if your BMI is 35 to 40 and you have comorbidities (e.g., high blood pressure, diabetes, sleep apnea, etc.), or if your BMI is over 40 and you do not have comorbidities or complications, you’re eligible for surgery. Insurance companies also take this into account.
What kinds of interventions exist for obesity?
By and large, if your BMI is between 26 and 34 and surgery is not really indicated, your doctor will probably recommend that you undergo an active weight loss regimen. Exercise is very important. Diet is important. It’s intense.
I know: Our morbidly obese patients have to undergo the same kind of medical weight management in post-op for three months before they can have surgery.
What are the short-term and long-term benefits of bariatric surgery?
The most important thing from our standpoint is better health. It is pretty amazing. Someone will come in with Type 2 diabetes, for example. I do the surgery and oftentimes before they leave the hospital or certainly by the time they come back for their first post-op visit they’re already off their insulin. So our goal for those patients who are on insulin, hypertension medication or other medications is that six months into this they’re off of them.
Additionally, their joints will feel a lot better. That sort of thing is very tangible; we document it during follow-up. We stay in very close contact with patients’ primary care physicians and include them in post-surgery management.
Last and most obviously, these patients lose weight. We strive for 70 percent of that excess weight to come off.
If someone thinks bariatric surgery might be a solution for them, what should they do next?
There’s a number of different ways that people will come into the system for bariatric surgery. You might go to your primary care physician or endocrine or orthopaedic specialist, and they could send you. We find that a lot of our patients come because of a referral from a friend.
At Penn Medicine, we offer information sessions at the Hospital of the University of Pennsylvania (HUP), as well as our satellite locations in and around Philadelphia. At info sessions, I talk about the criteria, comorbidities and different surgeries. I also go into detail about the potential complications, but I make sure, in my practice, that they do not happen. There’s ease for our patients once they hear from us.
Any parting words or wisdom about discussing weight with your physician?
If you meet the criteria, you should certainly speak with your primary physician. Your doctor may say it’s not suitable or to try [something else] first, but a lot of them now are going ahead and referring their patients. The surgeries we do are macroscopic, meaning small incision. The recovery time is short.
Learn more about Penn Metabolic & Bariatric Surgery Program or sign up for an information session.
This interview has been condensed and edited for length.