Ask an Equip Provider: What Do I Do if My Patient Says They Want to Lose Weight?

Nearly half of all New Year’s resolutions involve weight loss. This isn’t terribly surprising given the inundation of diet and fitness-related messaging at the beginning of January, but it can still be a challenging subject for healthcare professionals to navigate. As the new year marches on, providers may be hearing from patients who want to meet certain weight loss goals in the coming months, goals that—at least on the surface—are grounded in a desire for better health.

But, unfortunately, it’s not as simple as that. Not only do most diets fail, setting people up to feel a sense of shame and failure, but dieting is also a risk factor for the development of an eating disorder, and can be particularly dangerous for young people. What’s more, many people’s weight loss goals emerge from internalized weight bias, which has been linked to a range of psychological and physical issues.

That said, weight loss isn’t inherently bad in all circumstances. So as a practitioner, how can you best support patients who express a desire to lose weight? Dr. Lauren Hartman, Medical Director at Equip, answered some of the most common questions providers have on this complex topic.

If a patient tells me they want to lose weight, how can I know whether or not to advise them against it?

I usually don’t think it is beneficial to recommend weight loss, due to all of the potential negative outcomes that can result. However, weight loss is not always harmful—if it’s a means to another end, like cardiovascular or mobility goals. In these cases, it’s best to work toward the actual health goal rather than weight loss, though weight loss might be a “side effect” of these efforts. As practitioners, what we can do is aim to partner with our patients to better understand their concerns and goals.

If a patient says they want to lose weight without it being tied to another specific health goal, use it as an opportunity to dispel long-standing myths that equate “health” and “weight,” and share the harm being done by diet culture. It is also an opportunity to discuss behaviors and goals that are healthy but not weight-related, like joyful movement, eating regular and balanced meals, or sitting at a table for meals.

If I think it would be harmful for a patient to lose weight, how can I effectively change their intentions? Should I try?

Yes, it is important to try. I’d suggest starting from a place of curiosity and hearing from the patient about why they are interested in weight loss. Here, it can be helpful to acknowledge the years of mixed messages that someone may have received about weight loss, whether from social media, family members, friends, or the medical community.

It is also important to make the person feel that we are not judging or shaming their intention, but rather helping them to understand the medical and psychological harms of “weight loss” as a goal. Some of the medical harms of weight loss as a goal are lowering your heart rate, developing a heart arrhythmia, vomiting (which can lead to electrolyte imbalance and internal bleeding), lightheadedness and fainting, and osteopenia or osteoporosis, among others. Some of the psychological harms are stress, anxiety, depression, mood instability, lack of concentration, self-harm, and suicide.

In the case of children and adolescents, is it ever okay for weight loss to be a goal?

No. Childhood and adolescence is a critical time of growth and development. This is the time that a person’s brain, heart, bones, and all the organs in the body are developing. In order for this to happen in a safe way, they need to be adequately nourished. Losing weight at a time when the body has high metabolic needs and is requiring a lot of nutrition can result in significant medical consequences.

What can I do if a parent is insistent that their child lose weight?

If a patient insists that their child lose weight, I would use it as an educational opportunity. I would talk with parents and families about how research shows that adolescents whose parents talked with them about weight loss are more likely to engage in dieting, unhealthy weight-control behaviors, and binge eating.

I would try to shift the focus with the parent from their child losing weight to them developing a long-term healthy relationship with food and their body. I would encourage the things that we know help achieve that, such as having frequent family meals, avoiding diets, and doing joyful movement.

If a patient is going to go ahead with their weight loss goal, what guidelines or resources can I share with them to help them do so in a healthy way?

This is a tough question, since I wouldn’t recommend guidelines or resources for weight loss.

Given that someone can quickly move from weight loss to a place of medical instability, I would recommend that they check in regularly with their doctor for medical monitoring. I would discuss with them warning signs of medical compromise such as lightheadedness or fainting, fatigue, cold intolerance, abdominal bloating, and lack of a period in those with ovaries.

Citations:

  1. Daee, Allison, et al. "Psychologic and physiologic effects of dieting in adolescents. (Review Article)." Southern Medical Journal, vol. 95, no. 9, Sept. 2002, pp. 1032+. Gale Academic OneFile.
  2. Eric Stice, C. et al. Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study, Behaviour Research and Therapy, Volume 49, Issue 10, 2011, Pages 622-627, ISSN 0005-7967.
  3. Dianne Neumark-Sztainer, et al, Obesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later? Journal of the American Dietetic Association, Volume 106, Issue 4, 2006, Pages 559-568, ISSN 0002-8223.
  4. Marshall Rachel D., et al. Internalized Weight Bias and Disordered Eating: The Mediating Role of Body Image Avoidance and Drive for Thinness. Frontiers in Psychology, Volume 10, 2020.
  5. Berge JM, Maclehose R, et al. Parent conversations about healthful eating and weight: associations with adolescent disordered eating behaviors. JAMA Pediatr. 2013 Aug 1;167(8):746-53.
Randy Smith
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