Weight Loss

Christopher Still, DO, on Common Obstacles to Weight Loss

Cardiovascular disease, stroke, type 2 diabetes, and certain cancers are among the leading causes of preventable, premature death among patients with obesity, according to the CDC.1 Although these health risks can be mitigated in part with weight loss, many patients find it challenging to lose weight, especially on their own.                    

Consultant360 spoke with Christopher Still, DO, director of Geisinger Obesity Institute, who shed light on common obstacles patients encounter when it comes to changing their eating habits, and how providers can positively engage patients to ensure a successful weight loss strategy.

Consultant360: What are the most common obstacles that patients encounter when it comes to changing their eating habits, and how can providers help patients overcome these obstacles?

Dr Still: I think oftentimes, patients initially attempt to make changes that are too drastic, unrealistic, or unsustainable in the long-term. For instance, many patients attempt to completely eliminate certain foods from their diet cold-turkey after having consumed those foods for a long time, which can be difficult to maintain in the long-run. It is important for primary care providers to help patients set realistic expectations. A good approach to take is setting simple goals and trying to achieve those first, and then moving onto additional goals.

For example, one small change providers can help patients make is avoiding the consumption of sodas, fruit juices, or any caloric beverages. This could save hundreds, if not thousands, of calories per day within 1 week.

C360: In your experience, what is the best way to approach discussions involving weight loss or dietary changes with patients that allow them to feel in-control of these decisions?

Dr Still: Patients struggling with obesity have often tried many diets and related methods of weight loss. I usually ask my patients, “what has worked for you in the past?” If there was a certain diet or program that worked for them in the past, I advise them to revisit that approach, with the help of their primary care physician, and identify and overcome the barriers that made the approach non-successful in the long-term. I find that this approach helps give patients a sense of control.

C360: Can you describe challenging scenarios that patients with obesity often encounter while attempting a lifestyle change?

Dr Still: There are 2 common and challenging scenarios I tend to see in my patients. The first scenario is when patients go out to eat or travel. While they can make healthier choices at restaurants, they are not physically preparing the food themselves and, thus, have very little control over what they are consuming. In this case, I help my patients identify “safe” restaurants or places where they know they can eat somewhat healthily.

The second scenario I tend to see is when patients who are attempting to lose weight cook meals for their family. This can create some challenges because not all members of the family may need to be on the same weight loss plan, or taste palates may be different among family members. In this scenario, many patients often have to prepare 2 different dinners for themselves and their family members. It is much easier to tell your patient, “fix your family members what they want, and prepare yourself a healthy frozen meal,” but the solution is often not that simple. It is important to work with the patient, meet them where they are, and take their individual circumstances into account when forming a weight loss strategy.

C360: What key takeaways would you like to leave with health care providers?

Dr Still: The best way to approach weight loss and lifestyle change with your patients is to make your approach patient-centered. Ask your patients open-ended questions like, “do you travel?” or “if your kids and family do not always like the healthy food you prepare for yourself, what are some strategies you can utilize to overcome that?” Taking each patient’s circumstances into consideration, making suggestions, setting realistic goals, and building on their successes are all very important.

Patient engagement is also key. Providers should guide their patients in forming a weight loss plan that is right for them, but should also remind patients that they are just the shepherds in a patient’s weight loss journey, so to speak.

Christopher D. Still, DO, is the medical director of the Center for Nutrition and Weight Management, director of Geisinger Obesity Institute, and editor of the 2014 American Society for Metabolic & Bariatric Surgery Textbook of Bariatric Surgery, Volume 1.

—Christina Vogt

Published in partnership with ASMBS


1. Adult obesity facts. Overweight & obesity. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/adult.html. Page last reviewed August 13, 2018. Accessed May 15, 2019.