Doctors avoided two common words when talking about weight with patients

By Dr. Sanchari Sinha Dutta, Ph.D.Reviewed by Lauren HardakerOct 13 2026

When weight becomes part of a diabetes consultation, who leads the conversation, what language do clinicians choose, and how does this influence the advice patients receive?

Study: Examining clinicians’ approaches to discussing weight during routine diabetes care: an observational study. Image Credit: Studio Romantic / Shutterstock

A new study published in the journal BMC Primary Care found that weight was mentioned in fewer than half of recorded primary care visits involving adults with type 2 diabetes and elevated BMI, with clinicians avoiding potentially stigmatizing terms.

Background

Obesity is a chronic disease characterized by excess body fat that can adversely affect health. It is a major public health concern worldwide.

Excess fat accumulation in obesity can worsen insulin resistance and impair glycemic control, increasing the risk of type 2 diabetes. Because weight loss can improve insulin sensitivity, weight management strategies are becoming increasingly important in diabetes care.

However, discussing body weight and its management with patients remains challenging for clinicians. Discussions using carefully chosen words to introduce the subject of weight can support constructive conversations, whereas discussions using stigmatizing language can negatively affect patients.

Recent advances in weight loss therapies, especially glucagon-like peptide-1">GLP-1 receptor agonists, may have made it easier for clinicians to discuss weight management with patients. These medications have shown promising outcomes in weight management among people with type 2 diabetes, providing clinicians with more effective treatment options for weight loss.

Researchers at Yale School of Medicine examined how clinicians and patients discuss weight during routine primary care visits, as effective weight-loss treatments become more widely available.

Study design

The researchers analyzed 123 video recordings of patient-clinician encounters during primary care visits at a community health center in New Haven, Connecticut. The recordings came from a randomized trial evaluating an agenda-setting intervention during diabetes care. The intervention did not explicitly address weight management. Eligible patients were adults with clinically diagnosed type 2 diabetes, an HbA1c of at least 8%, fluency in English or Spanish, and a body mass index (BMI) of at least 25 kg/m². Most participants identified as Hispanic or Latino, and most with available income data reported incomes at or below 150% of the federal poverty level.

The researchers examined how often patients and clinicians discussed weight, the words used to describe it, the nature of those discussions, and recommendations for interventions. Any mention of a patient's weight counted as a weight-related discussion, even without weight-loss advice.

Key findings

The analysis revealed that weight was mentioned in 48 out of 123 patient-clinician encounters (39%). The frequency of weight discussions did not differ significantly by patient gender or BMI category. Weight was discussed more frequently with patients taking GLP-1 receptor agonists.

Of weight-related discussions, clinicians initiated 56%. Clinicians recommended specific physical activity during 44% of conversations they initiated, compared with 14% of those initiated by patients. Overall, 44% of conversations were clinician-directed, 38% collaborative, 15% patient-directed, and 4% confrontational. All patient-directed conversations began with the patient, raising questions about opportunities for patient-led decision-making when clinicians introduce weight.

During weight-related discussions, clinicians frequently recommended dietary changes and diabetes medications associated with weight loss. Bariatric surgery was never discussed in these encounters. Clinicians rarely explored social determinants of health (17%) or recommended referral to a dietitian (13%).

Clinicians most frequently used the word “weight” to refer to the topic at hand. They also used “pounds” and “kilograms” to describe weight in some discussions. The researchers never used the terms “overweight” or “obesity.”

Study significance

During recorded weight conversations, clinicians primarily focused on medication use and lifestyle changes and avoided the potentially stigmatizing terms “overweight” and “obesity” when speaking with patients. The authors suggest that socioeconomic barriers may already have been discussed or addressed outside these encounters.

There are no widely accepted guidelines for discussing weight with patients, and existing evidence regarding style and content of discussion does not favor a single approach. Some patients dislike direct diagnostic terms, while others object to euphemisms. Other research has associated clinicians' acknowledgment of overweight or obesity with greater recognition of weight status and more attempts to lose weight.

Weight conversations were also more common among patients already receiving a GLP-1 receptor agonist. These medications have contributed to greater recognition of obesity as a chronic disease that can be treated with medication. The researchers suggest that this changing perception may encourage weight-related conversations, but their findings cannot establish why these discussions occurred more frequently.

The researchers call for further studies to determine the best way to encourage more frequent and more in-depth discussions in primary care clinics.

Because of the observational design, the study could not determine the impact of specific discussion style and content on patient health or behavior. The analysis involved a small number of video recordings collected from a single clinic, which may restrict the generalizability of the findings. Classifying conversations also required subjective judgments, though the researchers calibrated their coding before the analysis.

Even with these limitations, the study provides valuable information to clinicians who seek to review and improve their practice and to understand possible shortcomings in current approaches to weight management in diabetes.