We are pleased to present the last article in a three-part series on weight management and diabetes sponsored by Lilly and written by Amy Hess Fischl, MS, RD, LDN, BC-ADM, CDCES. Content is provided for information only; please consult with your healthcare provider before making changes to your diabetes management.

In the first article in this series, we discussed weight management as a tool for diabetes management. The second article covered diabetes treatments and medications available to help with weight management. In this final article of the series, we'll focus on how to have an effective discussion with your healthcare providers about weight management as part of your diabetes management plan.

Let's face it. Weight management is difficult to discuss in our own social circles, let alone with healthcare providers. It is not anyone's fault if they don't always say the right things. In the case of healthcare providers, their jobs are predicated on the fact that they can affect positive outcomes for those in their care. The medical profession is based on numbers – A1C, blood pressure, cholesterol, and, of course, weight.

However, we know that words matter, and sometimes we must take the bull by the horns and be honest about how specific conversations make us feel. As a healthcare provider, I welcome that open discussion. Although I am mindful of my words, I learn from understanding how someone perceives those words. It leads to a more honest and trusting relationship. I had a conversation a few days ago with someone who mentioned how nervous she was about coming into the office because she gained weight and did not want the doctor to yell at her. I reminded her that we work for HER, and while it may not be comfortable, she might feel empowered by bringing the topic up first with the doctor. Candidly discuss how it makes you feel to talk about weight management and what you expect from the conversation. These conversations need to be based on mutual respect for there ever to be a chance of ongoing success. I have always been a strong proponent for everyone I see coming with questions of their own and an agenda of what to discuss. Your medical appointment is for you, and YOU should be in charge of the narrative. Your healthcare team's job is to answer questions and help create a plan of attack, set goals and problem-solve frustrations.

Conversation Tips:

• Remember that patient-centered care should be the driving force behind all treatment decisions. This is about YOU – and you should feel comfortable verbalizing what you want.
• Set the stage with YOUR short- and long-term goals. What are you expecting in 4-6 weeks versus 6 months to 1 year?
• Discuss the big picture – weight changes will affect diabetes medications, and you and your healthcare provider should create a plan to make adjustments to reduce the risk of hypoglycemia.
• Have a discussion about how these goals will improve your health specifically. Are you on medications for hypertension and/or dyslipidemia? How will these goals impact those medications and blood pressure and lipid levels, and what plans should be made to assess this more frequently?
• Remember that weight management is not always about food intake and physical activity. If your goals cannot be met solely with lifestyle changes, what other options exist for you?
• Address the emotional side. How we feel about ourselves and our weight loss journey also dictates our success. Talking with a mental health professional can be a valuable experience to tie everything together. Understanding self-compassion, positive and negative self-talk, and our emotions surrounding why we eat all contribute to successful progress. It's okay not to be perfect!
• Discuss the plan when “the wheels fall off .” That is not failure; it’s just being human. The ability to problem-solve and adjust if having difficulty meeting goals should also be a big part of this conversation. The most successful weight management journey includes a team. In addition to your provider and a mental health professional, meeting with a registered dietitian nutritionist (RDN) on an ongoing basis can help discuss changes and pitfalls and adjust goals to meet evolving needs.

Your healthcare team should be those you feel comfortable talking to without judgment. Weight management, when done right, is a long-term project. Realistic goal setting is essential to be successful. With your provider and diabetes team, focus on small changes to reach your long-term goal. Be sure you have a team that will cheer you on, listen to you, and help you formulate the goals necessary to get you closer to your long-term plans.

 

Amy Hess Fischl, MS, RD, LDN, BC-ADM, CDCES, is an advanced practice dietitian and diabetes care and education specialist at the University of Chicago within the departments of pediatric and adult endocrinology. She speaks internationally on all diabetes topics, especially meal plan options for type 1 diabetes, insulin pumps, and continuous glucose monitors. She is actively involved in the American Diabetes Association, the Academy of Diabetes Care and Education Specialists, and the Academy of Nutrition and Dietetics, as well as several international groups for diabetes and pre-diabetes. She was named 2018 IL AADE Diabetes Educator of the Year and also received the 2018 Pan Arab Congress on Diabetes Award of Excellence for her contributions to diabetes care and education. Her dream vacation always includes diving with sharks.