Changing How We Talk About Obesity — A Conversation with Dr. Sowa

Conversations about obesity can be tricky for both healthcare providers (HCPs) and those seeking treatment for weight and obesity health concerns. Some women feel that their HCP uses language that implies judgment, while others may feel that their HCP doesn’t give them enough information to manage their weight.

We reached out to Alexandra Sowa, M.D. for her tips on how healthcare providers and their patients can have more productive conversations around obesity. Sowa is a board-certified physician of internal medicine specializing in preventive health, nutrition and obesity medicine. She is also clinical professor of medicine at NYU Langone Health and a member of HealthyWomen’s Women’s Health Advisory Council (WHAC).

This interview has been lightly edited for clarity and length.

HealthyWomen: How can we move toward a person-first vocabulary when discussing obesity? [Editor’s Note:People-first language puts the person before the disability or disease, and describes what a person has, not who a person is. It does not label someone with their disease.]

Alexandra Sowa: I think we can move toward a person-first vocabulary when discussing obesity by just remembering that the person in front of us is always a person and not a disease. So I don't talk about a person with hypertension as a hypertensive. I will say, Let's discuss your hypertension. And the same should be applied for excess weight. Excess weight/obesity is a disease. We should remember it's not a person, it's just a disease state.

HealthyWomen: How can we help others understand that obesity is a chronic condition?

Alexandra Sowa: Again, I love to come back to the comparison to hypertension. So, often in medicine, we are very comfortable prescribing someone a medication to help bring their blood pressure down to goal, and we really don't think twice about it. We will also counsel on lifestyle changes, increased physical activity, better diet, decreased salt, but we will always discuss a medication option if it helps them get to goal. And the same should be true of obesity. We should counsel in all aspects, but we should always consider medications if it's appropriate. And we shouldn't look at this as a lack of willpower or something that people have done to themselves. We shouldn't consider this an emotional state. This is a disease, like anything else we treat.

HealthyWomen: What are some ways we can help HCPs discuss treatment options for obesity?

Alexandra Sowa: One way to help people discuss treatment options for obesity is to be open to learning — and then open to having a discussion. So many healthcare providers and physicians just really didn't learn anything about this field in their education. And the willingness to listen to others, to reframe your beliefs and to engage in continuing medical education is really important. Then, once you have a foundation for knowledge in the field, you can actually discuss options with your patients or just feel comfortable broaching it, discussing it and then referring out to a specialist.

HealthyWomen: How can HCPs promote both body acceptance and treatment of obesity to their patients?

Alexandra Sowa: I do not believe that these two things are mutually exclusive. It's really important to treat people with respect and to realize that, again, this is a disease, not a lack of willpower — something that these patients have or haven't done in their lifetimes. And we should never talk about weight in terms of appearance or being skinny. We should always frame it in terms of being healthy so that we can still love our bodies, but we can be [in] a healthier body with weight loss.

HealthyWomen: What can HCPs ask their patients about their weight without stigma, judgment or bias?

Alexandra Sowa: By being open and honest, and by being very gentle when we have conversations about weight. For example, “Can we discuss your weight? I‘ve noticed that during our last visit two years ago prior to the pandemic, you were 20 pounds less. I really understand it. This has been a stressful time. Have you thought about how you would like to manage this?” Just asking open-ended questions, asking for permission. These are all very important in establishing a rapport with a patient so that they can even accept the knowledge or the referral that you might have.

HealthyWomen: What can HCPs do to help address the obesity epidemic?

Alexandra Sowa: I think that education is the foundation on both the provider side and on the patient side. We have so many new tools at our disposal, we should remember that there's no one size fits all when it comes to weight loss. It should never be a “my way or the highway” approach. It should always be shared decision-making between the patient and the provider.

This resource was created with support from Novo Nordisk.