Today is World Obesity Day and the theme for this year is “Changing Perspectives: Lets Talk about Obesity.”

There has been a dramatic rise in the prevalence of obesity over the past few years. According to the World Obesity Atlas 2023, the number of people with overweight and obesity (BMI ≥25kg/m²) is projected to increase from over 2.6 billion in 2020 to over 4 billion by 2035. About 2 billion people (adults, children, and adolescents) are expected to have obesity alone (BMI ≥30kg/m²) by 2035, showing a rise from 14% to 24%. The greatest increase is expected in childhood obesity. It is no walkover for India either. The predictions for India too are dire. The annual increase in obesity from 2020 to 2035 is anticipated to be very high among adults (5.2%) and children (9.1%).

The consequences of obesity on health are well-established. High BP, heart disease, stroke, dyslipidemia, type 2 diabetes, asthma, sleep apnea, osteoarthritis including some cancers are a few of the recognised associations of obesity. Also, obesity during childhood is likely to persist into adulthood. Not just physical health, obesity has a significant social and emotional effects. It is a disease with huge societal impact.

There is therefore an unquestioned urgent need to talk about obesity. But if we are to tackle this public health crisis, to know how to talk about obesity assumes possibly even more importance because obesity comes with lot of stigmas attached to it. People may therefore be reluctant to talk about their obesity as it may be emotionally upsetting and may further erode their self-esteem. Being judgemental runs the risk of nonadherence and noncompliance to treatment.

Published in 2018, the ACTION (Awareness, Care, and Treatment in Obesity maNagement) study carried out in the United States, found that 67% of health care providers are comfortable discussing weight management with people with obesity, many reported facing challenges in initiating a discussion about weight loss; time constraint was the most common reason cited by the healthcare providers; patients’ lack of motivation or interest in losing weight or their emotional states were cited by nearly 75%. Among people with obesity who discussed their weight with the healthcare providers, only 24% reported taking a follow up appointment for the same.^1,2 These results point out the poor communication between the two about weight management and the need to use obesity friendly language to ensure appropriate dialogue.

The WATER (Warm welcome; Ask and assess; Tell the truth; Express empathy; Reassurance and regular follow up) approach to motivational interviewing used for diabetes can also be applied to obesity management.³

Mutual trust and respect are the foundations of a healthy doctor-patient relationship with patient autonomy being the key driver of this relationship. A doctor must be not only competent but also compassionate and empathetic. Hence, the need to focus on the language used during a conversation with the patient. The choice of words and dialect should be appropriate for the age, gender, and social status of the patient so that the patient not only comprehends the matter at hand, but it should also not have any negative emotional impact. Hence, a patient-centered approach to communication is of the essence.

We have created a list of five Dos and Don’ts for an obesity-friendly language.¹

• Do: Enquire, Engage, Empathize, Encourage, Energize
• Don’t: Delay, Distract, Demean, Discourage, Demonize

As healthcare providers, it is upon us to also educate parents about how to have a conversation with their children about the need to maintain a healthy body weight.

About the Author

Dr Sanjay Kalra, DM (AIIMS); President-elect, SAFES, Bharti Hospital, Karnal, India; Dr Nitin Kapoor, Professor of Endocrinology, Dept. of Endocrinology, Christian Medical College, Vellore; and and Dr Suneet Kumar Verma, MD (Med), Dept. of Internal Medicine, Alchemist Hospital, Panchkula, and Sparsh Clinic, Zirakpur, India

Reference

1. Kalra S, Kapoor N, Deshpande N. Obesity-friendly language. J Pak Med Assoc. 2022 Jun;72(6):1237-1238. doi: 10.47391/JPMA.22-73.
2. Kaplan LM, et al. Perceptions of barriers to effective obesity care: results from the National ACTION Study. Obesity (Silver Spring). 2018; 26:61-69.
3. Kalra S, Kalra B, Sharma A, Sirka M. Motivational interviewing: the WATER approach. Endocr J 2010; 57(Suppl 2): S391.