How Do Doctors Talk to Patients in the Age of Body Positivity?

April 14th 2017

Danielle DeCourcey

Body shaming is bad.

Everyone deserves to feel good about their bodies, and the recent anti-body shaming movement aims to support that message.

However, sometimes doctors need to talk to patients about their weight for health reasons — and given the newfound popularity of body positivity — it can get complicated.

A recent study published in March in the Journal of the American Medical Association, led by Dr. Jian Zhang, an associate professor at Georgia Southern University's College of Public Health, found that less people who are overweight or obese are actually trying to lose weight. In 1997, 55 percent of obese or overweight people studied were trying to lose weight, but in 2014 that number dropped to 49 percent.

A study published in 2014, which Zhang looked into, found another example of people taking obesity less seriously.

According to the study, parents of medically overweight and obese children are less likely to perceive their children as obese or overweight compared to parents studied 10 years earlier. The study authors wrote that this "may indicate a generational shift in social norms related to body weight."


This possible shift in perception comes at a time when Americans are more overweight and obese than ever.

More than 70 percent of adults older than 19 are overweight or obese, according to the Centers of Disease Control and Prevention. Overweight and obesity categories are generally determined by the Body Mass Index, a formula based on weight and height.

"We are stuck in a vicious cycle. More people are getting obese. More are fine with their weight. When they are looking around, they find more persons with even larger bodies, and more are getting less motivated to lose weight, and in turn, we are getting even heavier," Zhang told CNN. The CDC lists serious health risks associated with being overweight or obese, including Type 2 diabetes, stroke, sleep apnea, mental illness, and even "all-causes of death."

So how do doctors balance helping patients' maintain a positive body image, while stressing the dangers of obesity? ATTN: talked to Dr. Karen Kelly, a primary care provider at Fenway Health in Boston, to find out.


Kelly said that insensitive or poorly executed conversations about weight can damage the important relationships between doctors and patients.

"It is imperative that you consider a patient’s relationship with their body when beginning a conversation with them about their weight," she said. "I work very hard to establish a therapeutic relationship with my patients and how you address this topic can enhance or damage that relationship very quickly."

Some of Kelly's patients told her other doctors have made them feel ashamed of their bodies in the past.

"One common complaint that I hear from my new patients is that they have had providers in the past that have made them feel awful about their bodies and that they felt shamed and put off by those conversations, enough to leave that practice," she said. "And the last thing that we want is people who are not engaged in care, and therefore not being cared for [with] all of their other health problems."

Although she has had some patients flatly tell her they don't want to lose weight, Kelly said she tries to connect weight loss to an outcome that's specific to that patient, like trying to get off cholesterol medication, improving the chance of a healthy pregnancy, or improving the patient's ability to run a road race. She said she makes sure to address the patient's feelings while being as straightforward as possible.

"I usually ask my patients if there are ways to discuss things that feel better to them, that would make them more comfortable. I also make it very clear that I am only going to talk about lifestyle changes in the setting of improving their health and not because they need to lose weight because being overweight is bad," she said. "Anyone who has ever had a weight problem has been made to feel shame because of it in their past, and this often has happened in conversations with healthcare providers."

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