Addressing the issue of obesity with a loved one

Weight is an extremely important issue in western society with the rates of obesity ever growing. Being overweight is linked to numerous health problems including high blood pressure, heart disease and even cancer. From a medical point of view, this means that weight is a big issue. Our views on body image mean that weight is often a very personal and sensitive issue. As such, addressing the issue of weight can often be very tricky.

How common is being overweight or obese?

Weight issues are often described by the media as an obesity epidemic. Recent  Australian Bureau of Statistics figures would support this. Figures from 2005 were quite alarming showing 62% of men and 45% of women were overweight or obese. In 2005, 54% of the population was overweight, compared to 44% in 1995. 

Why is weight such an important issue?

There are many risks of being overweight. Many of these are well known such as high blood pressure (about a third of people have high blood pressure due to weight), high cholesterol, heart disease and diabetes (about 95% of type 2 diabetes is weight related). While these risks are well known in the health community, it is important to realise that being overweight also increases the risk of:

• Sleep disturbances. Obstructive Sleep Apnoea results in people getting very poor quality sleep and then becoming drowsy throughout the day. This can lead to poor performance at work, poor memory, higher risk of motor vehicle accidents and even increases the risk of heart disease.
• Arthritis. Being overweight is a major cause of knee arthritis and plays a big part in arthritis of other joints, including those of the lower back.
• Cancer. Being overweight is strongly linked to many cancers. This includes breast cancer, uterine (endometrial) cancer, bowel (colon) cancer, kidney cancer and oesophageus and stomach cancer. For some cancers (especially uterine and kidney) the risk is up to four times higher in overweight and obese people. It is believed that being overweight may account for up to 30% of the most common cancers like breast and bowel. It now seems that weight loss (and especially an increase in exercise) can significantly reduce cancer risk (especially bowel cancer risk).
• Gallbladder disease
• Reflux / heartburn
• Gout
• Reduced fertility
• Urinary incontinence

Being overweight or obese is second only to smoking as a leading cause of lifestyle preventable death.

Apart from the physical health problems associated with being overweight there are also emotional and social problems that can arise from being overweight. These can include discrimination, low self-esteem and even depression.

Talking about weight to a friend or loved one

As mentioned before weight is often a sensitive issue and it can be very difficult to bring up the issue with a friend or loved one.

The first thing to realise is that most people who are overweight or obese already know this. Therefore, you should not take the approach that you are somehow giving the person some great insight. Overweight people often already have low self-esteem and the last thing they need is a friend or loved one telling them they are overweight and must lose weight. A better approach may be to encourage them to join you in making healthier lifestyle choices. For example instead of telling your friend that they are fat and should sort themselves out, have a discussion about how we (you and your friend) should start eating healthy lunches or that we should start going on walks together or join a gym. Even if you are already a member of the gym don’t try to show that you are superior but rather try to be as supportive and inclusive as possible.

Another school of thought is that you should not confront people about their weight. It is argued that as most people who are overweight already know and have often tried dieting, exercise, etc with limited success. Therefore there is no real benefit in directly telling them they have a weight problem. This is especially true of friends who you are not particularly close to as it is not really your responsibility.

If you are concerned about the person’s health another possibility is to begin a discussion about the importance of regular health checks with their doctor. The doctor can then assess the person and should broach the issue of weight with the person if they think that it is becoming a health risk. If you are worried about your spouse then the same can apply, however, the plan can be modified. Book yourself and your spouse to have a regular health check-up with your doctor. Book a separate appointment for your spouse so that they will have the privacy to talk about what may be a sensitive issue. Another approach (although more involved) is to go and see your spouse’s doctor beforehand and tell them your concerns and that you would appreciate it if the doctor could discuss the topic of weight, including the importance of having a healthy weight and ways of reducing weight.

Some tips to consider if you decide to broach the issue of weight:

• Never use the word fat.
• Take out all your frustrations before hand (by taking a walk, etc) so that you do not sound angry, frustrated or condescending.
• Pick the right time and place. Do not start the discussion when you (or the other person) are tired, angry or short of time.
• Write down the key points that you want to make beforehand, this allows you to carefully think about what you want to say.
• Never shout at the other person or threaten them, for example with a break-up of the relationship.
• Offers lots of support, including making healthy changes to your own lifestyle at the same time. For example you can both start eating more healthy foods or doing exercise together.
• Be prepared for a poor response. Often people will immediately think that you don’t find them attractive and therefore don’t love them anymore. Be sure to sound reassuring and tell them that you still love them.
• Support their weight loss attempts. If they go on a diet, you should too. When they start to become more active, be sure to do the exercise with them (for example if they go for a walk, you should go with them). Even if frustrating at first, because they are too slow or cannot match your level of fitness, it is important to stick with them as (with your motivation and support) they will improve with time.
• Do not be the ‘food police’ or continually nag the person every time they stumble in their diet. If you do this the person will only start to hide their eating habits and will eventually isolate themselves from you.

As a final note remember that you are an adult and are going to be talking to another adult. As such if you do choose to discuss weight with another person do so in an open, direct and truthful manner. Do not drop ‘subtle hints’ about the person’s weight or nag the person. The person will either ignore this or will be irritated or offended.

References:

1. Australian Bureau of Statistics. Overweight and Obesity in Adults, Australia 2004-05. Australian Bureau of Statistics 2008; Pub. No. 4719.0.
2. Kritchevsky D. Diet and cancer: What’s next? Journal of Nutrition 2003; 133(11): 3827S–29S.
3. Parker E, Folsom A. Intentional weight loss and incidence of obesity-related cancers: The Iowa Women’s Health Study. International Journal of Obesity and Related Metabolic Disorders 2003; 27(12):1447–52.
4. Potter M, Vu J, Croughan-Minihane M. Weight Management: What Patients Want from Their Primary Care Physicians. J Fam Prac 2001; 50(6): 513-20.
5. Salazar-Martinez E, Lazcano-Ponce E, Lira-Lira G, et al. Case-control study of diabetes, obesity, physical activity and risk of endometrial cancer among Mexican women. Cancer Causes and Control 2000; 11(8):707–11.
6. Vainio H, Bianchini F. IARC handbooks of cancer prevention. Volume 6: Weight control and physical activity. Lyon, France: IARC Press, 2002.
7. van den Brandt P, Spiegelman D, Yuan S, et al. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. American Journal of Epidemiology 2000; 152(6):514–27.
8. Weight Control Information Network. Talking With Patients About Weight Loss: Tips for Primary Care Professionals. National Institutes of Health. 2007.