How do adults with type 2 diabetes want to talk about weight with their doctor?

Our qualitative research shows five key preferred approaches

By Ralph Geerling

People with type 2 diabetes are often weighed and/or asked by their doctor to talk about their weight. With around 90% of people with type 2 diabetes living with overweight or obesity, managing weight can be important. Yet, when, and how, the topic of weight is raised, can be stressful. For the person with diabetes, this can have a harmful effect on their relationship with their doctor, and on their emotional well-being and self-care. Talking about weight can also be stressful for doctors who say they are often unsure of how to raise the topic.

To find out how adults with type 2 diabetes want to talk about weight with their doctors, we invited them to complete an online survey. A total of 254 adults with type 2 diabetes shared their experiences. We organised their responses into five themes:

(1) Collaborative, person-centred careWorking together to make decisions and achieve outcomes, taking personal context into consideration
(2) Balanced communicationOpen, clear messages encouraging action, empathy and kindness
(3) Quality adviceKnowledgeable health professionals, providing specific details or instructions
(4) Personalised weight management strategiesSuitable options to address weight management
(5) System-wide supportReferral and access to appropriate care from all relevant health professionals

1. Collaborative, person-centred care

This theme brought all the other themes together. It’s asking about, and understanding, all the things a person has been through and realising the important role that plays in how they deal with diabetes. As one person in the study said:

“Ask about my lifestyle, ask about who I live with and their lifestyle, give options to fit with mine and my partners lifestyle which also takes into account income and work life balance environment and other physical impairments.” Woman 50-59 years

2. Balanced communication

In this theme, words such as “understanding”, “kindness” and “empathy” were important. This was still the case for those people who found it motivating for weight to be discussed directly. When this didn’t happen, it could have a devastating effect:

“My previous GP had me in tears and feeling like my life was not worth anything because I hadn’t lost any weight. I had lost a small amount (3 kilos) and he was not satisfied that I hadn’t lost more. I felt useless and unworthy”, Woman 40– 49 years.

3. Quality advice

People want their doctor to be experts, but they also want advice they can put into action. That is, not only what to do, but how to do it:

“[My health professional would say] ‘I have a group walking around these [names] streets in the morning… walk at your own pace… and go around as often as you feel like… be sure to record your times and results at the starting pace (sic) before you leave. We start at 5.30am…’”, Man 60–69 years.

4. Personalised weight management strategies

The advice also needs to be tailored just for the individual, rather than a “one size fits all” approach. This needs to be based on understanding their personal situation, what they have been through, and what they can and can’t do:

“I would like to address the issue of my sore knees, but doctors usually dismiss that as an option ‘until you lose some weight’. The sore knees impair the ability to actually be as active as I want to be. Doctors don’t seem to realise this as an issue.”, Man 60– 69 years.

5. System-wide support

People were open to the idea that, if their doctor didn’t have all the answers, they could be referred to someone who did:

“[My health professional would say] I would like to suggest you visit an endocrinologist to see if there is some way of finding out about your specific hormones and auto-immune issues that may provide some keys to improving your weight management” Woman 60– 69 years.

Although, there were also concerns about wait times to see other doctors.

Our study was important because it is the first to ask people with type 2 diabetes how they want to discuss their weight. Most importantly, their experiences and preferences show they want to feel that they matter, and to be treated with respect.

Reference: Geerling R, Gray SM, Holmes-Truscott E, Speight J. ‘I need someone to believe in me and walk the journey with me’: A qualitative analysis of preferred approaches to weight management discussions in clinical care among adults with type 2 diabetes. Diabetic

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