Main description:

This practical book provides effective, time-efficient strategies for initiating and continuing productive conversations about weight that can be incorporated into any practice setting. It will benefit all clinicians-advanced practice nurses, physician assistants, physicians-from students to experienced providers, whether they provide obesity treatment or refer to those who do.

This guide addresses the numerous barriers that clinicians encounter when they contemplate or attempt conversations about weight and provides strategies to reduce and overcome these barriers. It guides clinicians step-by-step through the concepts and skills needed to have conversations that lead to improved health. Each chapter provides useful tools and information about how to move the conversation forward in a respectful, skillful manner. Real life clinical scenarios provide examples of short, productive conversations that incorporate the tools into clinical practice.

Many clinicians recognize the importance of discussing weight with their patients yet feel unprepared to do so. Most did not learn about obesity or how to talk about it in their clinical educational programs and have little access to continuing education. Without the knowledge and skills to start a productive conversation, many avoid the topic. This avoidance has a negative impact on the health of those with obesity and pre-obesity. Given that obesity treatment improves outcomes, it is imperative that clinicians are skilled at discussing weight with knowledge and sensitivity. This book meets that gap.

Contents:

Preface
An introduction that provides the rationale as to why it is important to initiate and continue conversations about weight and obesity. It will begin with a brief overview of the scope of obesity, with emphasis that it is a chronic, progressive, relapsing disease that is treatable, and that treatment improves health outcomes. Effective discussion between clinician and patient is needed to facilitate treatment. Whether the clinician treats the condition or refers to other clinicians, it is imperative that they approach these conversations with knowledge and sensitivity.
1) Understanding Obesity as a Disease
This chapter will educate clinicians about obesity by providing a brief overview of the disease and the complications that result from excess weight. It will also discuss the goals of treatment and the five comprehensive treatment modalities. This provides core knowledge that many clinicians are lacking.
2) Identifying & Reducing Weight Bias
This chapter will provide data on the prevalence and negative health effects of weight bias, with emphasis on weight bias in healthcare settings. Strategies will be provided to assist clinicians in recognizing and reducing weight bias in themselves and their patients.
This chapter will include 2-4 clinical scenarios that demonstrate:
* Clinical conversations during which a clinician conveys weight bias* Clinical conversations during which a patient conveys weight bias* A clinician recognizing and reducing his/her weight bias* A clinician recognizing and addressing the weight bias of the patient towards him/herself or others

3) Barriers to Discussing Weight
This chapter will introduce the barriers encountered by both clinicians and patients.
Clinician barriers include:
i) Lack of knowledge about weight and obesityii) Weight biasiii) Lack of knowledge about effective strategies for initiating and continuing productive discussions about weightiv) Concern that they will embarrass their patientsv) Misconceptions about patients' comfort discussing weightvi) Concerns about credibility if clinician carries extra weight (yes there is literature to support this.)vii) Timeviii) Reimbursement concerns
Patient barriers include:
ix) Lack of knowledge about weight and obesityx) Fear of being blamed and judgedxi) Fear of being given simplistic solutionsxii) Internalized weight bias and stigmaxiii) Patients want clinicians to initiate discussionsxiv) Results from the ACTION study. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22054

4) Creating An Environment for Effective Conversations to Take Place
The clinical environment sets the stage for effective conversations. The physical environment, as well as communication from the office and clinical staff, contribute to the experiences that patients with obesity have in healthcare settings.
This chapter will provide clinicians with information on how to provide a physical environment that is:
a) Safeb) Accessiblec) Accommodatingd) Comfortablee) Welcomingf) Non-shaming Recommendations for furniture, equipment, and patient gowns that accommodate larger bodies will be provided. Readers will learn about the importance of having health promoting, non-shaming literature in waiting rooms and treatment rooms, and using appropriate images and language on websites and promotional materials.
This chapter will address the importance of educating all office and clinical staff as to how to interact with patients in a manner that is sensitive and non-shaming.
Guidance will be provided about the importance of weighing in a private area and other practices that prevent patients from feeling physically or emotionally uncomfortable when vital signs are measured or tests are being performed.
This chapter will include 2-4 clinical scenarios that demonstrate:
* Office staff interactions with patients that are insensitive or shaming* Clinical staff interactions with patients that are insensitive or shaming* Office staff interactions with patients that are sensitive and non-shaming* Clinical staff interactions with patients that are sensitive and non-shaming

5) Creating a Framework for Effective Conversations (was Tools for Productive Discussion & Getting Started)
This chapter will provide guidance on how clinicians can select patients who will be most receptive and the importance of starting with just a few patients so as not to become overwhelmed. Strategies will be given for how to structure the conversation such that it can be done in five minutes or less. The importance of setting the stage for further discussion will be emphasized.
Motivational Interviewing (MI) will provide the framework for effective conversations. MI is a counseling technique that was derived from social cognitive theory. It focuses on creating a relationship within which MI techniques can be utilized. The relationship is founded on the concepts of collaboration, evocation, and autonomy. It is the technique that is utilized most frequently in the obesity literature and by obesity clinicians.
When discussing weight and obesity with patients, clinicians will utilize Motivational Interviewing techniques to: a) Focus the conversation on health, rather than weightb) Assess readiness using Prochaska's Transtheoretical Model of Change c) Determine the patient's perception of his/hera. Weight b. Healthc. Motivating factorsd. Previous weight reduction strategiese. Family and social support d) The value of connecting current concerns, symptoms, and function to weight and lifestyle choices
Within the context of MI, clinicians will learn conversational tools that are specific to obesity:
i) The importance of asking the patient's permission to discuss weight before entering into the conversationii) The importance of focusing the conversation on health, rather than primarily on weightiii) The need to use People-First Language for obesity, which is focused on putting the person before the disease. https://www.obesityaction.org/action-through-advocacy/weight-bias/people-first-language/
6) Clinical Scenarios
This chapter will demonstrate actual clinician conversations with patients. It will include 3-5 patient scenarios, with accompanying dialogue. At the end of each scenario, there will be a discussion about the techniques that were used and the rationale, as well as how the information gleaned from the conversation will guide the treatment plan and lead to the next conversation.
7) What We've Learned
This chapter will summarize the learning and bring the reader back to the original purpose of the book, which is recognizing the importance of discussing weight with patients and how doing so improves health and facilitates treatment.
A basic structure of the sequencing of obesity treatment will be provided. Given the chronic nature of obesity, readers will learn that long-term follow-up is needed to keep the disease under control, just as it is for other chronic conditions such as diabetes. The frequency of appointments will differ from person to person, but appointments are generally more frequent until the condition is under control. They become less frequent when it is well-controlled and more frequent when relapses occur.
Guidance will be provided as to what can be managed in primary care, as well as when to refer to obesity specialists, bariatric surgeons, and/or specialists to address obesity complications such as diabetes, osteoarthritis, obstructive sleep apnea, etc.