You get about fifteen minutes with your doctor, and weight may be the hardest thing in the room to bring up. Either it gets mentioned in passing (“you might want to lose a few pounds”) or you want to raise it yourself and don’t know how.

Michael is joined by Loreen Wales, CEO of My Viva and Registered Dietitian, and first-time guest Dr. Cora Spaulding, a physician board certified in lifestyle medicine, obesity medicine and family medicine. They explain why this conversation is hard for patients and clinicians alike, then lay out what to do before, during and after an appointment so you walk out heard. Three listener mailbag questions close the episode.

In this episode

• Why it’s so hard. Appointments are short and neither side is practised at the conversation. Dr. Cora cites an Italian study where doctors held back because they assumed patients didn’t want to be asked, when most did.
• Shame in the room. Loreen says weight is the most sensitive topic she discusses with patients. In 28 years, she has never found motivation to be what’s missing.
• “Obesity is an inside job.” Dr. Cora explains that weight has been reduced to appearance and “calories in, calories out.” The visceral fat around the organs does the most harm, and it releases hormones that affect the whole body, including the brain.
• The visit starts before you arrive. “The most important part of the visit is outside the exam room.” Decide on your top two or three concerns and write them down.
• Bring your own data. Loreen explains why My Viva Plan includes daily reflections: a few data points on movement, sleep, food and mood let patients spot their own patterns. Dr. Cora, who has used My Viva with patients, says a summary of trends can save five minutes of a visit.
• What we think we do. Loreen’s example: the patient who reported exercising four to five times a week and one beer a week, then tracked it and found one workout and ten beers in two weeks.
• Time, agenda, teach-back. Ask how much time you have, set a shared agenda with your doctor, then repeat the plan back to confirm you both agree.
• You are not a passenger. Loreen: “You’re the pilot. I will only ever be your co-pilot.”
• If you feel judged, say so. Dr. Cora encourages patients to name language they don’t like, and to rehearse it beforehand. People living with obesity often avoid preventive visits because of past experiences.
• After the visit. Book follow-ups, referrals and labs before you leave, and ask whether your next appointment can be longer.

From the mailbag

“If my doctor brings up my weight, does that mean they’ve decided everything else is my fault?” No. Weight is one of several factors that affect health, and raising it isn’t an indictment. Dr. Cora notes that guidelines suggest doctors ask permission first: “Do you mind if I talk to you about your weight?”

“Can I tell my doctor that talking about this is hard for me, or is that overstepping?” Tell them, and tell them why. Some doctors have never dealt with obesity themselves and may not know how it lands. Holding it back makes their job harder.

“Is it weird or rude to record my appointment or bring someone with me?” Neither, as long as you ask first. Dr. Cora sometimes has family members call in. Loreen often asks for whoever buys the groceries and does the cooking to join. Many clinics now use AI scribes, so you can also ask for a copy of the visit summary.

The numbers

• Doctors raised weight with only 36% of patients with clinical obesity, while 80% of those patients wanted to be asked (Italian study cited by Dr. Cora)
• Doctors interrupt patients 67% of the time, after about 11 seconds
• Patients forget 40 to 80% of what was discussed once they leave the room

Your appointment game plan

Before:

• Write down your top two or three questions or concerns
• Summarize your own data as trends, such as a blood pressure range
• Bring your medications and supplements
• Consider bringing a support person, or plan to record

During:

• Ask how much time you have
• Share your list and ask what your doctor wants to cover
• Repeat the plan back before you leave
• Ask how to follow up on anything you didn’t get to

After:

• Book follow-ups, referrals and labs on your way out
• Ask for a longer appointment next time if you want to discuss weight in depth
• Ask your doctor which data points would be useful to track

Chapters

00:00 Introduction and disclaimer 00:52 Welcome, and meet Dr. Cora Spaulding 01:54 “How do I bring up my weight?” 02:28 Why the conversation is hard for both sides 05:02 Shame, judgment and the motivation myth 06:48 Obesity is an inside job 08:07 Before the visit: how to prepare 10:51 Daily reflections and bringing your own data 14:36 Telling your story with trends 16:39 During the visit: time, agenda and teach-back 18:59 Patient, not passenger 23:45 What to do if you feel judged 25:37 After the visit 30:20 Mailbag: “Is everything my fault?” 31:53 Mailbag: “Can I say this is hard for me?” 32:49 Mailbag: “Is it rude to record?” 37:00 One thing to do before your next appointment 38:50 Dr. Cora’s Inside Out course

Links and resources

• My Viva Plan: https://myvivaplan.com
• Dr. Cora Spaulding, Shared Clarity Health: https://sharedclarityhealth.com
• Free doctor visit guide: available at sharedclarityhealth.com
• Inside Out: an eight-week, small-group virtual course on understanding your weight, starting January 18. Join the wait-list at sharedclarityhealth.com/cohort

Your hosts

Michael Dargie, host Loreen Wales, CEO of My Viva and Registered Dietitian Guest: Dr. Cora Spaulding, board-certified physician in lifestyle medicine, obesity medicine and family medicine

This podcast is for informational and educational purposes only and is not a substitute for professional medical advice. Always consult your treating physician or a qualified health-care provider before making changes to your diet, exercise or lifestyle.

My Viva Plan: Lifestyle Medicine for Real Life. myvivaplan.com