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Welcome to the Quick Consult podcast, brought to you by Metall. Before starting this podcast, please review the faculty information, disclosure statements, and learning objectives using the link in the episode description. To claim your CME credit, complete the evaluation using the link in the episode description. This podcast is a continuing education activity managed and accredited by Affinity CE in collaboration with Metal. This activity is supported by an independent medical education grant from Lily. Welcome to our final episode, Episode 4 on addressing stigma and improving patient engagement. We know that weight bias and stigma have a profound impact on a patient's health journey and their willingness to seek care. I'm here once more with Doctor Forner. Let's start with the communication basics. Patients who have been told in the past to quote, eat less, move more, or who describe feeling lazy and ashamed, often internalize this as a personal failure. What are two practical biasawa communication tips for clinicians, focusing on respectful person first language? Absolutely, uh, when patients have been told to eat less and move more or have internalized feelings of laziness or shame, the language we use becomes incredibly important, and there are two practical biasware strategies that can make a meaningful difference. The first is to use non-judgemental person first language. We refer to the person before the condition and we simply use the word weight rather than labels. This helps to shift the conversation away from blame and makes the patient feel respected and understood. Second, avoid stigmatizing terms altogether. Phrases like obese patient, morbidly obese, or unhealthy weight. Reinforce negative stereotypes and can deepen a patient's sense of failure, eliminating these terms is a simple but powerful way to reduce harm, and finally, always ask permission before discussing weight. So a gentle, would it be OK if we talked about your weight today, shows compassion and builds trust. But for many patients that moment of respect can change the entire tone of the encounter and reduce the impact of past stigma. That's a powerful call for intentional language. To truly understand the impact of communication, we turn to the patient perspective. We asked Marion Rung Fribe from the German Obesity Association, what is the single most important action a healthcare professional can take in the first appointment to make patients feel respected, empowered, and confident in their treatment journey. There should always be a respectful approach to the patient and without stigmatization. So no derogatory comments or simplistic statements like, you simply have to eat less, or you simply have to move more. That is completely the wrong approach. You have to find a joint decision together with your clinician. What hasn't the patient done yet? How can we walk this path together? And what is right for the therapist, but also what is important for the patient. You spoke about confidence, and we know that managing this is a long term commitment. What is the biggest barrier that challenges patients? Ability to stick with their long term plan. Yes, the greatest impediment for many individuals suffering from obesity is not a deficit of knowledge or a lack of willpower. But rather a complex interplay of biological, psychological, and social factors, and that necessitates a long-term lifestyle modification, which is exceedingly challenging. So it's also very difficult for the patient to even begin to approach this. The shame, it's heavily stigmatized. The social judgment. How then can I possibly gain access to treatment? Who's going to pay for all of this? And if I actually have to go through my health insurance, perhaps for nutritional counseling, perhaps for medication, do I have to submit an application? This application is also very embarrassing again. What will this insurance company say and for how long will my health insurance pay for this access? Does it ever stop when I've lost a certain amount of weight, and then it's like, OK, weight loss, now we stop. But the patient knows it's a chronic illness that always comes back. So this lifestyle change, this treatment must continue for a lifetime. And the patients here are very uncertain for how long will they be supported, how long will they be able to participate in programs? How long can they also balance that again in their social environment with work and family life? What kind of support will they receive? How far will they actually get? So that plays a very, very significant role, and since a patient has very often experienced failures, and also shame because of that. And then of course, the motivation, yes, I'll start something now, is extremely burdensome for the patient to really get going and begin. Finally, clinicians aim for a patient's best weight. What is an example of a non-weight related health gain that can have a positive impact on a patient's life? For the patient, it's not the number of kilos lost that's important. Much, much more important is that the patient can again experience participation in life. Many patients also speak of being so restricted by obesity that they're just spectators of their own lives because they can't do anything any more. But then when life becomes a bit easier through weight loss, then participation in life is possible again. We have many mothers who report, Finally I can go to the playground with my child again. I can jump and slide with my child, walk much, much longer distances like getting on the bus. So mobility, physical resilience also plays a bigger role here. The quality of life is much higher. Just being able to get on a bus or a train, to go on a holiday, to go out on your own, that plays a truly, truly enormous role. The sense of self-efficacy, fewer symptoms of depression, simply because one cannot leave the house or can no longer take an active part in life. A very big part is also played by trust in your own body. I can go out by myself again. I can sit in a cafe. I can go to a supermarket without being stared at. That plays an extremely big role. So general participation in life. Marian, thank you for joining us and sharing your perspective. We now return to our clinician expert. Consider a 32 year old patient who has pre-diabetes, polycystic ovary syndrome, and reports a history of shame and disappointment over prior dieting failures. How can clinicians facilitate shared decision making and genuinely partner with this patient in co-creating the plan, ensuring the treatment goals and strategies are truly personalized and sustainable? This is a situation so many clinicians run into and it really shows how important it is to move beyond just handing someone a plan. When a patient comes in with pre-diabetes, PCOS, and a long history of feeling shamed, ashamed or unsuccessful with dieting, our job isn't to prescribe first, it's to rebuild that trust and not just trust in us, but trust in the whole process of care. With these patients, the shift from prescribing to partnering is absolutely critical, and shared decision making has to be front and center. We need to acknowledge what they've been through and validate how exhausting and demoralizing repeated dieting attempts can be. I'll often say something like, you know, you're in the driver's seat and I'm just here to support you, these are your options, and you can see people relax when they hear that. A big part of that partnership is really um getting clear on what matters to them. Instead of making the conversation all about weight, which is often where the shame lives, we broaden the lens. What health gains would actually improve their life. Maybe it's better glycemic control, having more energy, reducing pain, or just feeling mentally lighter. When goals are personally meaningful, motivation can look completely different. And we can't ignore the impact of weight stigma because it shows up everywhere in society, in healthcare, and often internally for patients. So a big part of our role is actively countering that. We need to frame obesity as the chronic biologically driven condition that it is. It's a combination of genetics, hormones, neurobiology, it's not a question of willpower. When patients hear that, it helps to dismantle the narrative of, you know, nothing has ever worked or I've failed every time. We reframe those experiences as understandable outcomes given the biology and the lack of proper support. And when you put all of this together, genuine shared decision making, patient-centered goals in a stigma-free science-based framework, you build trust and that trust becomes the foundation for the treatment plans that actually stick. Beyond verbal communication, what simple practical steps can clinicians take to make the physical clinic environment more welcoming and improve the likelihood of a patient engaging with long-term follow-up? This is another very important question because the physical environment of the clinic often sends a message long before we say anything and what's interesting. That's small, really intentional changes can make a huge difference in how safe and respected a patient feels, and that has a direct impact on whether they come back. Creating a genuinely welcoming space starts with the basics. So we need to think about the waiting room, what it looks and feels like, is it open, is it calm, does it feel non-judgemental? Equipment is another big one and it's often overlooked. Having a full range of BP cuff sizes, a sturdy exam table and chairs without armrests isn't just.