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Individualizing Obesity Treatment: Best Practices
Best Practices for Individualizing Obesity Treatment Through Shared Decision-Making

Released: June 21, 2023

Robert Kushner
Robert Kushner, MD, MS
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Key Takeaways
  • Healthcare professionals (HCPs) providing obesity care should use shared decision-making to help patients feel heard and acknowledged.
  • The SMART goals strategy stands for specific, measurable, actionable, realistic, and timely and can help people be more specific about achieving their goals.
  • HCPs who would like to incorporate shared decision-making strategies into their practice should initially plan to spend more time during their patient encounters to avoid feeling rushed.

Shared decision-making is a communication style that is commonly used for all medical encounters and in particular with patients whose condition requires a good deal of self-management. Examples include chronic conditions or diseases like diabetes, hypertension, asthma, and obesity, where a 20-minute encounter is insufficient to counsel on behavior change. Therefore, when setting targets or goals for someone, shared decision-making implies that you as the healthcare professional (HCP) in a primary care setting, are finding common ground with the patient regarding their goals and what the strategies will be used to achieve those goals. We want to get away from the paternalistic or maternalistic approach where the HCP tells the patient what to do. This approach conjures up terms like “compliance” or “noncompliant” and does not involve the patient in the decision-making process. Instead, we are trying to move toward a framework where we determine a mutually agreeable set of goals and strategies and have replaced compliance with adherence.

I think shared decision-making leads to a much more gratifying interaction between HCPs and patients because patients feel supported and acknowledged by having that conversation and, hopefully, feel empowered because they had some say in decision-making about their treatment plan.

SMART Goals
When you discuss treatment goals with a patient with obesity, you need to be as specific as possible about any additional strategies, methods, tactics, or goals so that there is common ground with the patient. For example, a reasonable goal would not be “I want to exercise more” because it is too vague and the meaning is unclear. In this case, employing a communication strategy called SMART goals is helpful. SMART stands for specific, measurable, actionable, realistic, and timely. Therefore, when using shared decision-making to discuss exercise, using SMART goals can help pinpoint the specifics of what the patients plan to do. You want to ask when they are going to exercise? How often will they exercise? Is the exercise plan realistic? These details should be decided upon and recorded in your notes so that when the patient leaves the encounter, you and the patient both agree on the goals. When the patient returns, you will have more specific information to review with the patient and can ask questions such as: Were you able to achieve the goal that we established together? What were the barriers? Did you need to modify the goal along the way? Also, do not forget to congratulate patients on what they accomplish and encourage them to continue on with their plans to achieve their health goals.

Patient Expectations
I think that shared decision-making with the patient is especially important when someone comes in with specific questions that they would like to talk about, such as a treatment they want to use (ie, incretin-based therapies or glucagon-like peptide-1 receptor agonists. This discussion becomes part of their education, making sure they understand how the medication works and whether they are a good candidate for the treatment. You want to know if they have realistic expectations on how the medication will work? Do they have insurance coverage for it? Do they know how to give themselves an injection? How do they feel about needles? What do they think about weekly use? A lot of shared decision-making involves information gathering and providing education prior to a decision about what treatment direction the person chooses to go in and calls for a deeper understanding on the patient’s part.

Recommendations for HCPs
When it comes to obesity care, I think many HCPs have minimal and, in some cases, insufficient training in obesity. They may use a knee-jerk response such as, “I want you to eat healthier. I want you to follow a Mediterranean diet. I want you to exercise 3 days per week.” When less is known about a field, HCPs often fall back on generic recommendations instead of taking a more thorough history and understanding where the patient is coming from. I recommend that HCPs not make assumptions, try to avoid oversimplified recommendations, and hear the patient’s perspective.

As with any new procedure or protocol, there will be a learning curve incorporating shared decision-making into a primary care practice, and it will initially take more time. It is similar to motivational interviewing, which is another counseling technique, and can take more time if not familiar with the language and the flow. Therefore, I recommend that HCPs be kind to themselves and become familiar with how to use shared decision-making. Plan for more time per encounter to avoid feeling rushed. Patients do not want to be lectured or told what to do. With shared decision-making, the encounter with the HCP and the patient is more rewarding if there is a mutually agreed upon goal that is more of a collaboration, with a realistic expectation of how the person will achieve that goal.

Your Thoughts?
In your practice, which counseling strategy do you use with patients when discussing individualized obesity treatment? Join the conversation by answering the polling question or leaving a comment below.

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In your practice, do you plan to implement shared decision-making with patients when discussing individualized obesity treatment?

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