Having an existing strong therapeutic relationship with patients. Being non-judgmental. Empathising that weight loss is hard. Discussing that there is a strong genetic component to weight gain to help reduce their guilt and shame.
I avoid the phrase ‘going on a diet’ as it may have past negative connotations and it also sounds like a temporary change. I emphasise ‘healthy eating’ or ‘lifestyle change’ which sound more like ongoing changes.
I listen to what they have tried in the past - what has worked for them and what led to relapses. There are many successful approaches to weight loss, excluding crazy fad diets, so it is helpful to be familiar with some of these to discuss. They usually have an idea of an approach that will work for them best in their current situation. I say that the plan they can best stick to is the best one for them.
Whatever approach they use, trying to reduce rebound hunger is key. I suggest increasing their protein to help increase satiety. I suggest they aim to have at least five serves of vegies a day, particularly vegetables with lower calorie density. These will make them feel fuller due to the volume of food and fibre. I suggest looking at the Mediterranean diet as it has additional benefits of reducing cardiovascular risk and involves a high vegetable intake.
We discuss mindful eating. I ask them if they are emotional eaters and suggest they try to become aware of their cues and develop other ways of responding.
I suggest they make goals of what they can do rather than a number on a scale, for example, start with three thirty-minute walks this week.
I celebrate small successes and lifestyle changes with them. I think GPs are well placed to offer helpful advice around weight loss and to act as a coach.