Color & Control:

Weighty conversations: more than just a number on the scale

Overweight. Underweight. Heavy. Light. Fat. Thin. Healthy. Unhealthy. These words are loaded with emotions, assumptions, expectations and biases.

By Ashleigh Townley, Christine Provvidenza and Amy McPherson

Research tells us that lifestyle behaviours, such as being physically active and eating well, can contribute to someone having what is considered a “healthy life.” A healthy life can include the best weight for a person—in other words, whatever weight a person achieves while living the healthiest lifestyle that they truly enjoy. However, for many people, achieving or maintaining their best weight can be challenging for a wide range of reasons, including medications, access to healthy food and recreation, genetics, medical issues and time.

For clinicians, discussing weight with a patient or the family can be fraught with anxiety, leading to uncomfortable conversations or no conversations at all. How, then, do we have these potentially difficult conversations in a thoughtful, informed and respectful way that supports better outcomes?

Initiating a discussion about weight may seem daunting at first. But there are steps you can take before approaching patients to help foster positive conversations about health behaviours and weight.

1 Understand that obesity is not a personal choice

Weight bias refers to negative weight-related attitudes, beliefs, assumptions and judgements toward individuals who live with obesity. Such bias is common in today’s society, even in health care. Recognizing and addressing our own biases are important first steps in avoiding discriminating against people living with obesity. Research shows that shaming, blaming, teasing and stigmatizing do not motivate positive behaviour change; rather, they promote the opposite.

2 Ensure the environment is private, quiet and comfortable

Key considerations include providing comfortable seating for all body sizes, privacy and appropriate equipment (e.g. gowns in a range of sizes, larger blood pressure cuffs) and clothing.

3 Allow for dedicated time to have discussions

Set aside specific time (across several visits if necessary) to ensure that these conversations are not rushed, and that there is time for questions and discussion.

4 Be mindful of the words you choose and how the patient (and their family) responds to your phrasing

The same terminology can be received differently by different patients and families. Be prepared to explore each individual’s acceptable terms, and the subjects they are comfortable addressing.

5 Prepare resources to support the patient (and family)

Provide useful information tailored to different ages, family circumstances, cultural beliefs and values.

When you are ready to move forward, here are some dos and don’ts to consider when getting conversations started.


  • Always ask permission to have the conversation.
  • Explore what terminology the patient and their family feel comfortable using.
  • Ask patients and families what is important to them to feel healthy and well.
  • Talk about health and growth, rather than weight and size.
  • Affirm and acknowledge the patient’s and family’s responses, even if you do not agree with them. Seek common ground to move forward.
  • Make growth and healthy lifestyles a part of every consultation (as appropriate). This can help to destigmatize the topics.
  • Talk about the benefits of healthy lifestyles and healthy home environments for the entire family.



  • Oversimplify the problem or solution (e.g. just move more, eat less, it is just a matter of willpower).
  • Assume the reasons for weight-related issues (e.g. they are not taking their health seriously).
  • Assume that families are not already engaged in healthy behaviours.
  • Be judgmental or use shame, blame or scare tactics.
  • Leave a patient and family without resources and next steps.
  • Assume that patients and families are ready, willing and able to make changes right away.

These recommendations have been modified from the Fostering Positive Weight Related Conversations knowledge translation casebook from Holland Bloorview Kids Rehabilitation Hospital. Although this casebook directly addresses the experiences of clinicians working with children, many other nurses, dieticians, physicians, occupational therapists, physiotherapists, psychologists, social workers and clinicians may find the casebook useful.v

Amy McPherson, PhD, CPsychol, AFBPsS. Amy is a senior scientist at Bloorview Research Institute and an associate professor at the University of Toronto. Her program of research focuses on health and wellness promotion in children with long-term conditions. Also from Bloorview, Ashleigh Townley, MA. is a knowledge broker, and Christine Provvidenza, MSc, RKin. is a knowledge translation specialist.

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