How to talk to your patients about being overweight or obese

Being overweight or obese is associated with increased risk of many disease entities, including cardiovascular disease, cancer, hypertension and diabetes1. In addition, being overweight or obese is implicated in a number of ocular diseases, including cataract, age-related macular degeneration, glaucoma, hypertensive retinopathy, diabetic retinopathy, ischemic optic neuropathy and pseudotumor cerebri2. Accordingly, it is important for eye care practitioners to educate patients about these associations, as well as how to prevent and remedy excess body weight through dietary modification and increased physical activity, and/or refer patients to qualified health care personnel for assistance with weight loss.

 Simple Tips for Discussing Weight Loss with Patients:

1. Ask for permission to discuss patients' weight status.

2. Patients prefer terms such as "excess body weight" or "above ideal body weight."

  • Avoid words such as "fat" and "obese."
  • Let patients know excess body weight is directly linked to several serious eye diseases and that losing weight may lessen these risks.

3. Ask open-ended questions about current lifestyle habits:

  • "Tell me about your diet."
  • "What kinds of physical activity do you enjoy?"
  • "How often and how long do you engage in these activities?"
  • "Are you interested in losing weight?"
  • "What kinds of support do you think you need in order to help you lose weight?"

4. Educate patients about the Diabetes Prevention Program (DPP):

  • 30 minutes of exercise (walking) five days each week combined with 5 to 7 percent weight loss reduces the risk of developing type 2 diabetes by nearly 60 percent in patients at high risk3

5. Give clear and specific advice about achieving weight loss.

  • Keep a food diary to determine about how many calories are consumed each day.
  • To lose weight, one must use up more calories than are taken in. As one pound equals 3,500 calories, one would need to reduce caloric intake by 500 to 1000 calories per day to lose about one to two pounds per week4

6. Ask about symptoms/signs of obstructive sleep apnea syndrome (OSAS), which is highly associated with obesity and several eye diseases:

  • Daytime sleepiness, snoring and neck circumference great than 17 inches5

7. Give names and contact information for excellent bariatric specialists, registered dieticians, exercise specialists and  mental health professionals in your area.

8. Use patient handouts that include simple dietary guidelines (e.g., low glycemic index, Mediterranean-type diet).

9. Criticize behaviors, not people. Explicitly tell patients: "I am on your side."

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1 Ann Epidemiol. 2005 Feb;15(2):87-97
2 Surv Ophthalmol. 2007 Mar-Apr;52(2):180-95
3 N Engl J Med. 2002 Feb 7;346(6):393-403
4 DHHS, AIM for a Healthy Weight, page 5,
5 Mayo Clin Proc. 2008 Nov;83(11):1251-61
®A. Paul Chous, MA, OD, FAAO, 2008, 2009, 2010