Conversation Counseling

Talking to your obese patients about weight loss and bariatric surgery

Obese patients are not all alike. Some are actively trying to lose weight; others may be in denial. However, they all know that obesity is unhealthy, and they have probably been obese for many years, if not most of their lives.

Patience is critical. Patients will rarely decide to have weight loss surgery based on a single recommendation or conversation. The process may take some time as they discuss the matter with friends and family. You can facilitate the process by encouraging patients to research surgical weight loss options on the SWLC website (www.swlc.ca). Reassure patients that if they select surgery, you will continue to supervise their medical care before, during and after the procedure.

Here are some types of patients you may encounter and some ideas for talking with them.

1. Obese patients who are actively trying to lose weight, but who have been unsuccessful with traditional approaches

Support of patients as they explore weight loss options is critical to their commitment to the process. Most patients have tried many different non surgical weight loss options and generally become frustrated and disappointed with the inability to sustain weight loss with these methods. It is helpful to discuss why the attempts were unsuccessful. It is best to avoid making the patient feel that it is their “fault”. Studies have shown that very few individuals are able to stay with the rigors of dietary reduction for years on end. It is well known that the pattern of “yo-yo” dieting usually results in progressive weight gain and can make it harder to lose weight in the future.

Ideas to consider:

• Suggest the idea of making it a partnership as you work with your patient to achieve sustained weight loss. Many patients may not have heard of the Gastric Band procedure and may not be aware of its safety and effect of sustained weight loss.
• Point out that weight loss surgery is a proven option for obese patients who have tried other options. It is not a question of them not having willpower but that they have not yet found a tool that works for them. The Gastric Band procedure might be the answer.
• Give patients a brochure from the Surgical Weight Loss Centre and suggest they visit the website at {www.swlc.ca) to obtain more information. This will empower them to explore this option in their own way and in their own timeframe.
• Discuss the health benefits of sustained weight in the ability to treat and prevent a number of obesity related co morbidities such as diabetes, hypertension and sleep apnea. Many patients are not aware that they can reduce or eliminate their need for medications or other treatments for these chronic obesity related conditions.

2. Obese patients who have not yet confronted their need to lose weight, or who are afraid of weight loss surgery

Although sensitivity is important, at the same time it is important to be direct. Physicians are generally comfortable dealing with the health risks of anorexia. While dangers of obesity are not as acute, they are serious and potentially life threatening.

Ideas to consider:

• Locate the patient’s BMI on a chart. Use this as a tool to point out that health risks can be reduced just by moving from the “obese” section to the “overweight” section
• For patients with comorbidities such as Diabetes Type 2 or sleep apnea, you can point out that these conditions are more threatening to their health than the minimal risks associated with Gastric Band surgery.
• Patients who are concerned about the risks of weight loss surgery should know that its safety has improved dramatically in recent years. Today, virtually all Gastric Band procedures are done laparoscopically. Although a variety of surgical procedures are available, the least invasive and safest is the Gastric Band procedure because it does not involve cutting or stapling the stomach or rerouting the intestines.

3. Patients who ask you about weight loss surgery or who ask for a referral for the Gastric Band procedure

Be supportive. Recognize that these patients are taking the initiative to address their problem.

At the same time, try to understand the reasons or thinking behind each request. Does the patient understand what is involved?

Also consider if the patient is an appropriate candidate for weight loss surgery. Patients who are overweight or only mildly obese may not realize that their condition is sufficiently severe to achieve significant benefit from bariatric surgery or the Gastric Balloon.

Ideas to consider

• Ask the patient where he or she heard about the Gastric Band procedure. If the source of information is an advertisement or a magazine article, the patient may not fully understand the commitment that the procedure entails. Provide the patient with a SWLC brochure to learn more and suggest a visit to swlc.ca.
• If the patient does not meet the medical indications for the Gastric Band procedure or other surgery, suggest other weight loss methods such as the Gastric Balloon.
• If the patient meets the indication for the Gastric Band procedure and also appears to understand the procedure, recommend to the patient to have a consultation with an SWLC surgeon for an assessment.

In discussing weight loss surgery, make a point of reassuring patients that they are not being abandoned and that you will continue to play a central role in their treatment. Let them know that you do not think of them as having “failed” because they have been unable to lose weight on their own. In contrast, you are proud of them because they are acting to take control of their condition.

• If surgery is selected, the SWLC surgeons will work with you before and after the procedure. One area of interaction between us is the patient’s medication regimen. Some formulations, such as bulky tablets, can create difficulties for patients who have had weight loss surgery. We can help suggest alternatives if necessary.
• If the patient is being treated for comorbidities, we will work with you to monitor and manage these as before. Often, as the comorbidities improve, you may need to reduce medication doses or even discontinue medications all together.
• Express support for the decision that patient is making. Acknowledge that weight loss surgery is an important decision with inherent risks including complications and, rarely, death.

Commonly Asked Questions from Patients