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Collaboration Is Key for Weight Loss
Collaboration Is Key: Practical Strategies for Achieving and Maintaining Weight Loss

Released: November 02, 2022

Expiration: December 31, 2023

Carol Hatch Wysham
Carol Hatch Wysham, MD
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Key Takeaways
  • Collaboration is key between persons living with obesity and healthcare professionals when setting realistic weight loss goals.
  • Use person-centered language to build trust with persons living with obesity.
  • Use a structured approach for the assessment and treatment of persons living with obesity to improve care and minimize bias.

Collaboration in Person-Centered Care
The definition of collaboration is “to work jointly with others or together, especially in an intellectual endeavor.” Reflecting on this definition is essential when discussing person‑centered care, which can be applied to weight management.

Person-centered care consists of elements related to the understanding of an individual's preferences, as well as showing empathy and using shared decision‑making. In addition, it is important to use active listening and motivational interviewing when determining person-specific goals.

Guideline Recommendations for Collaboration and Person-Centered Care
With collaboration and person‑centered care in mind, it is helpful to consider organizational recommendations on collaboration for weight management. In the most recent Standards of Medical Care–2022, the American Diabetes Association shares evidence‑based recommendations on weight management. It provides a Level E recommendation to use person-centered, nonjudgmental language to foster collaboration between healthcare professionals (HCPs) and patients, including people‑first language. An example of this is to identify someone as a person living with obesity vs an obese person.

Other guidelines are lacking in recommendations in collaboration and person-centered care. The Obesity Medicine Association only mentioned collaboration when providing guidance on motivational interviewing. The American Association of Clinical Endocrinology published comprehensive clinical practice guidelines in 2016 on medical care for those living with obesity, but there are no recommendations or language in this clinical practice guideline on collaboration or person‑centered care.

There is guidance in a collaborative publication from 24 work-group organizations in June 2017, titled Provider Competencies for the Prevention and Management of Obesity. If we take away “provider,” these are competencies that we all can use as HCPs when focusing on a person‑centered approach for weight management, and all of these are applicable to clinical practice.

Let’s consider each of these recommendations and how they can be used for all HCPs in collaborating with people on weight management:

      1. It is important to demonstrate a working knowledge of obesity as a disease state. When discussing obesity, it has been recognized as a disease state and it goes beyond energy equaling intake, meaning the pathophysiology of this disease state is very complex. There are many factors that play into why an individual may be living with obesity.
      2. HCPs also need to understand obesity as an epidemic. For example, where you practice, you may need to understand the prevalence within your county and state, as well as the prevalence on a national level. It is projected that by the year 2030, 1 in 2 adults will have obesity and 1 in 4 adults will be living with severe obesity.
      3. You should be able to describe the disparate burden of obesity and address strategies related to mitigation. To me, this particular statement really focuses on the social determinants of health, or what you may call the “social drivers of health.”

        We know that the social determinants of health are related to education access and quality, healthcare access and quality, neighborhood and the environment, social and community context, as well as economic stability. All of these may play a role in why an individual may be living with obesity, and they should be addressed by providing person-centered strategies related to weight management.

      4. There are benefits of team‑based care for obesity to achieve desired and individualized outcomes. In a team‑based environment, we all have roles and responsibilities based on our discipline. Together, we can achieve improved outcomes by focusing on the person first, providing individualized care plans to help them achieve their weight management goals.
      5. It is important to apply the skills necessary for effective interprofessional collaboration and integration in any setting. This is key when it comes to the preparation and training of HCPs. After obtaining foundational knowledge on this topic, HCPs should obtain experiential or real‑world training through hands‑on experience in different clinical practice settings. Beyond initial training, HCPs should continue to seek professional development on this topic due to the growing need for HCPs who are well versed in weight management.
      6. Use patient‑centered, or more appropriately, person-centered language, toward people with obesity. Person-centered is preferred as it is a better representation of people‑first language, which should be used throughout any oral or written communication when addressing obesity. We should not say that the individual or person is obese as this is stigmatizing. Instead, we need to make individuals front and center in the conversation by describing them as a person living with obesity.
      7. Strategies should be used to minimize bias toward this patient population. In addition to using person‑centered language, other strategies should be considered to minimize bias and include promoting policy and advocacy work for this patient population. We also need to think about community‑based strategies that can assist these patients, especially in underrepresented or underserved areas.

        One relatively easy way to minimize bias is to be consistent in our clinical approach in practice when working with persons with obesity. An example of this approach is to   incorporate the 5 “A’s” into clinical assessment that have been recommended by Obesity Canada:

        • Ask for permission to discuss weight and explore readiness.
        • Assess obesity‑related risk and root causes of obesity.
        • Advise on health risk and treatment options.
        • Agree on health outcomes and behavioral goals.
        • Assist in accessing appropriate resources and HCPs.
      8. Implement a weight‑friendly environment for people with obesity. This is key, in terms of improving the experience when coming to a clinic, for example. When a person walks in, we need to have an appropriate setting in the waiting room as well as in the clinical area, so that they feel comfortable. An example of this would be to ensure that the chairs are comfortable and able to accommodate people at increased weights. The goal is to improve their satisfaction by making them feel welcomed in that environment so that they can develop a trusting relationship with the HCP.
      9. Evidence‑based practices should be used for people with obesity or at risk for obesity. This means we need to reflect on the recommendations from multiple organizations and maintain continuous professional development so that we are able to educate people living with obesity and provide the best care possible.
      10. Finally, evidence‑based practices should be provided to people with obesity‑related conditions. As pharmacists, we have a consistent way to follow best practices that can address weight as well as chronic disease states. This process, known as the Pharmacist–Patient Care Process, attempts to standardize the way we collect subjective and objective information; assess the condition; and, if the patient is meeting therapeutic goals, develop a person‑centered plan, implement the plan, and follow up with monitoring and evaluating.

        This process can be applied by other HCPs, but depending on your discipline, you may have a consistent approach that can be used to address an individual’s weight as well as their chronic conditions that would work well in your practice.

Conclusion
In conclusion, obesity is a complicated and multifactorial disease with multiple associated comorbidities. It is essential to collaborate with patients and other HCPs to achieve goals in weight management. We should be using a person-centered approach and person-centered language to build trust with persons living with obesity. And finally, implementing a structured approach for the assessment and treatment of persons living with obesity can improve care and minimize bias.

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How often do you incorporate a structured approach to weight management in your patients living with obesity?
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