How to Talk to Your Doctor About Weight

The short version

• It's reasonable to ask for a specific appointment about your weight and your goals.
• Bring your history: what you've tried, your medications, and how you've been eating and sleeping.
• Ask about causes, blood tests, medications that affect weight, and your treatment options.
• If you feel dismissed or shamed, you can ask for a different clinician or a referral.

Before you go

Tell the office that you'd like to discuss weight management, so enough time can be set aside. Then write down a few things:

• Your weight history. When you started gaining, your highest and lowest adult weights, and any major life events around those times.
• What you've tried. Which diets, programs, medications, and what happened.
• Your medications and supplements. Bring the list or the bottles.
• Your daily life. Eating patterns, activity, sleep, stress and work schedule.
• Family history. Diabetes, heart disease, thyroid problems, and any history of medullary thyroid cancer, which affects some medication decisions.
• Your goals. "I want to get off blood pressure medication," or "I want to be able to climb stairs without pain."

Also mention any past or current eating disorder symptoms, even if you find it hard to do. It changes what's safe to recommend.

Questions worth asking

Understanding what's going on

• Does anything in my history or medications explain my weight gain?
• Which blood tests make sense? (This might include A1C, cholesterol, liver enzymes, thyroid, and kidney function.)
• Should I be checked for sleep apnea, PCOS or fatty liver?
• What are the health risks for me, specifically? And which of them would weight loss improve?

Making a plan

• What's a realistic goal for me, and by when?
• Do any of my medications need to change as I lose weight?
• Is there a weight-neutral alternative to any medication I'm taking?
• Can you refer me to a registered dietitian, a behavioral program or an obesity medicine specialist?
• Am I a candidate for medication or surgery? What would each mean for me?
• How often should we follow up, and what do we check?

Costs

• What does my insurance cover?
• Are there lower-cost options?

If the visit goes badly

Weight stigma in healthcare is real, and it can lead people to avoid getting care. You can push back:

• If every problem gets blamed on your weight: "What would you do for a thinner patient with this same symptom?"
• If you're told to "just eat less and move more": "I've already tried that for X years. What else can we look at?"
• If you want to skip the scale: You can ask not to be weighed unless it's medically necessary, or you can ask not to be told the number.
• If you need equipment that fits: It's fine to ask for a larger blood pressure cuff or gown. A cuff that's too small gives false high readings.

Sometimes the best thing you can do is to find someone else. You can also bring a friend or family member along for support.

Who can help

• Primary care clinician: Your first stop and your coordinator.
• Registered dietitian (RD or RDN): A credentialed nutrition expert. Many insurance plans cover visits for conditions like diabetes and kidney disease. The title "nutritionist" isn't regulated in many states.
• Obesity medicine specialist: A doctor with extra training in weight treatment. The American Board of Obesity Medicine has a directory.
• Therapist or psychologist: Especially for emotional eating and behavior change.
• Physical therapist: For pain or mobility problems.
• Bariatric surgery program: For surgical options.

Sources

1. NIDDK: Weight Management Resources for Health Professionals
2. NIDDK: Treatment for Overweight and Obesity
3. Jensen et al., Circulation (2014): AHA/ACC/TOS obesity guideline

This guide is general information, not medical advice. Please check with a clinician before making big changes, especially if you have a health condition, take medication, or are pregnant. Read the full disclaimer.