In part 5 of this Exclusive Interview, Dr. Scott Kahan talks with Diabetes in Control Associate Medical Editor Joy Pape during the AACE 2018 convention in Boston, MA about his preference to ask permission of the patient to talk about their weight and the importance of having a compassionate discussion.
Scott Kahan, MD, MPH is the Director of the National Center for Weight and Wellness in Washington, D.C.
Transcript of this video segment:
Pape: So, speaking of a self-talk and being compassionate, of the “5 A’s”, you started with “ask.” What does that mean?
Kahan: Yes, so my favorite of the “5 A’s” is that first one and by that, I mean ask permission about talking to a patient about his or her weight. This is a little different than other areas of medicine. If you have a patient that comes into your clinic and they have high blood sugar, you’re not going to ask permission if we can talk about their diabetes and things like that. But when it comes to weight, it’s a very unique and different area of medicine. Weight is a sensitive and personal issue. People who grew up carrying around excess weight probably have been teased throughout their childhood. In our society there is so much weight stigmatization that it hits almost anyone, even people who objectively aren’t heavy. And so, I think one of the most valuable and simple things that we can do as healthcare providers is, before talking about weight, ask the patient’s permission – “Would it be O.K. if we talked about weight today?” Let me expand on that a little bit. If you are a primary care doctor, for example, and you’re seeing a patient and you haven’t talked to them about weight before, you might say something like this: “You know, we have been seeing each other for a few years, and I’ve noticed that your weight has been climbing over the years, and it seems to be leading to your cholesterol going up and such. We know that there are lots and lots of diseases that are associated with weight, and I have some training in this, and I would love to be able to help and support you in addressing your weight and improving your health. Would it be O.K. if we worked together on weight management?” When you approach them in that compassionate way and that patient-centered way, and give them the autonomy to choose whether they are ready and open to talk about it, the vast majority are willing and even eager to have such a supportive partner in their care. And for those who aren’t right now interested, you’re still putting forth yourself as someone who cares about them who is going to treat them compassionately and has a skillset to help them. I bet that they’re going to come back to you, maybe next month or maybe next year, and then you’ll be able to take some steps forward with them.
Pape: Makes me think of your planting the seed if they’re not ready.
Kahan: Yes, I like that.