close up of a runners' sneakers

Well this is awkward – we think our patients are unmotivated [Commentary]

I’ll admit to being a little blind-sided by the leading paragraphs in this article published in the Sydney Morning Herald (and similar pieces published on other platforms, for example here), that 71% of health professionals believe their patients with obesity do NOT want to lose weight (while this is reportedly the case for only 7% of those patients). Certainly among the GPs and other health practitioners I interact with, this figure would be much lower. My own experience is that patients who are overweight or obese have typically experienced years, if not decades, of self loathing, frustrated attempts at weight loss, confusion over what the “right” diet is and a growing sense of hopelessness and helplessness.

The research, conducted in Australia by Professor Ian Caterson, Director of the Boden Institute at the University of Sydney, was reported at the recent European Congress on Obesity and is due for publication.

There seems to be a Catch-22 identified, with half of the surveyed patients saying they had eventually been able to discuss obesity with their GP, but after an average six year wait! More than two-thirds of respondents said they wanted their GP to raise the issue with them.

The reported findings point to an awkwardness on the part of health practitioners and patients in raising issues of body weight, weight management, overweight and obesity. This in turn points to the shame and stigma still strongly attached to overweight and obesity that simply doesn’t occur with most other health conditions. If a person had an enormous skin cancer on their nose, I’m pretty confident that neither patient not practitioner would feel any awkwardness in raising it as a concern.

As a Psychologist, Fitness Trainer and Health Coach, I have conversations with clients on a daily basis about weight management and overweight/obesity, even when it’s not a presenting issue. So given the apparent awkwardness, concern about giving offence and shame that often attaches to obesity, what’s the best way to do this?

The starting point for me is always to understand what’s important to my clients. In this context, that could involve inquiries like:

“What are your health goals?”; “What (other) health concerns do you have at the moment?”; “What other health issues would you like to raise with me?”; “What risk factors are you aware of for your health later in life?”; “Tell me about the efforts you’ve made to manage weight.”; “What’s your three year vision for your own health?”.

Of course a large number of other presentations can also lead to discussions about weight and its management. These can include, hypertension, hypercholesterolaemia, insulin resistance, reflux, movement restriction, joint pain, mood disturbance and many more.

The truth is that all health practitioners – whether we be GPs, Psychologists, Dieticians, Exercise Physiologists, Dentists, Optometrists or whatever – have a responsibility to think broadly about the health of our patients and clients and need to be prepared to initiate what may be a difficult discussion. Regardless of the type of Practitioner, we should all follow the Hippocratic principle of “primum non nocere” (remembering that harm can be caused by omissionas well as commission) and the guidance of the World Medical Association Declaration of Geneva “The Health and Well-being of my patient will be my first consideration”.


This commentary has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.

Interested in learning more about Lifestyle Medicine?