- Try to understand what the patient wants, and tailor your approach to that. Some want help with diet and exercise, others just want to take medication. Tell the patient his/her options are to either accept his/her current weight, to diet, to take drugs, or to have surgery. Also share the success rates of these approaches. Weight loss from diet/exercise is usually about 3-5% of current weight, drugs is 5-8%, and surgery is 3%,
- Consider how heavy the person is in considering whether a modest (like diet) or more serious (like surgery) approach is best. Also consider co-morbidities.
- If the patient decides to opt for changing his/her diet, send to a nutritionist if possible. Other options are meal replacement programs (like Slim Fast or Lean Cuisine), commercial programs like Weight Watchers, and Internet diet programs. There isn't much data on Internet programs yet, but there is quite a bit of data supporting the effectiveness of meal replacements.
- Keep circling through the patient's four options if he or she is resistant to your ideas. If, for example, a patient says she hates her weight but doesn't want to diet, then says she doesn't have time to exercise and that medications and surgery are too expensive, say "Well, it sounds like you want to accept your weight, then?" If she says no, then bring up the option of changing her diet again. This tactic works.
...and that concludes our on-site coverage of Endo '08. Hope you enjoyed it half as much as I did!