Sensitive communication and giving patients space to voice their concerns are key to managing obesity – and nurses in primary care are well placed to do both, according to a senior obesity specialist nurse.
While nurses play a vital role in providing health education and supporting successful lifestyle changes, it can be challenging to broach the subject of weight with patients.
Speaking at a Nursing in Practice 365 virtual event on 11 February 2026, Wendie Smith, an advanced nurse practitioner, and senior obesity specialist nurse, offered hundreds of nurses practical advice on how to do exactly that.
‘Nurses play a crucial role in addressing obesity,’ said Ms Smith. But doing so effectively requires sensitive communication, a genuine understanding of patients’ individual circumstances, and awareness of the cultural and personal barriers that can shape a patient’s relationship with their weight.
Ms Smith’s talk covered the practical application of NICE guidance for weight management, the limitations of BMI, how to raise weight sensitively in clinical consultations using the “Three A’s” framework (ask, advise, assist), and the importance of empathetic, non-judgmental communication with patients. Moreover, there was a particular emphasis placed on managing weight in the context of type 2 diabetes.
Ms Smith highlighted that obesity is the single most significant risk factor for developing type 2 diabetes across all age groups. Given that nearly two-thirds of UK adults are now overweight or living with obesity, the scale of the challenge facing healthcare professionals continues to increase.
Despite this, multiple clinical studies have demonstrated that sustained weight loss – even just 5–10% – can improve blood glucose levels, improve insulin action, and reduce the need for diabetes medications.
Language and stigma
Ms Smith emphasised that language and communication approaches matter enormously when talking about weight.
She encouraged nurses to: ‘Provide support, communicate with empathy, [and] respect patients’ decisions – and that is key in managing obesity, because it is a very, very difficult subject for some people.’
Nurses were also advised to be ‘understanding of patients who may be reluctant to be measured or find discussion about weight triggering’, but to also try to provide patients with the tools and space to address any concerns.
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‘We do need to think about obesity as preventable and treatable, and that is really key here, whether we aim for 5% or 10% weight loss, what we need to be doing is encouraging our patients to consider it, because actually addressing it can open the door,’ said Ms Smith.
‘We also have to understand that support is needed to address this, what we need to do is give people the tools, give people the space to address their concerns about their weight, and actually give them the information about how weight can impact on their future and current health.’
Nurses were also urged to consider the language they used during conversations about weight and obesity.
‘I wouldn’t want to be called obese or weight challenged. So, the language we use is really key,’ she said.
Language frames the consultation, she added, and it is important that people do not feel targeted in any way.
The European Association for the Study of Obesity recommend using person-first, non-judgemental, and non-stigmatising language. For example, ‘person with obesity’ rather than ‘obese person’.
It says, person-first language avoids labelling people by their illness and defining a person’s identity by their health condition.
Alternatively, NICE suggests health professionals identify and explore the terms the patient would prefer.
Ms Smith added: ‘What is really key, is we need to be aware of our own stigma attached to obesity. I think as practitioners, we set the tone here.’
‘Ask, Advise and Assist’
During her talk, Ms Smith highlighted the ‘Ask, Advise, and Assist’ approach as a method that she finds helpful for opening a conversation about weight with patients.
The method, also called the ‘three A’s framework’, was recommended by Public Health England (now under the UKHSA and DHSC).
The three-step approach is as follows:
- Ask permission to discuss weight, being non-judgemental and exploring the patient’s readiness for change. Simple questions to initiate the conversation might be: ‘Before you leave, could I check your weight today?’; or ‘While you’re here, can I check your weight?’ If they agree, you can measure the person’s height, weight and waist circumference, to determine their obesity stage.
- Advise on the benefits of modest weight loss, and how this can be more achievable with support. Explain what specific services are available to them and offer referral. Try to keep this brief, to around 30 seconds to avoid lecturing. For example, ‘One of the best ways to lose weight is with support and [named local weight management service] is available free. I can refer you now if you want to give it a go?’
- Assist the patient to commit to action and leave with a plan in place, by making a referral to the service you have agreed on and offering ongoing support. If they are receptive, you can let them know the next steps – for example, ‘I will refer you to the service now. You’ll get an appointment through the post’ – and suggest a follow-up appointment – for example, ‘I’d like to see how you’re getting on, so next time you come to see me, I will weigh you again and we can talk some more’.
However, Ms Smith noted that if the patient is non-committal, or does not want to engage at all, accept their wishes and acknowledge their concerns but also re-offer support for a future time.
Alternatively, Ms Smith said nurses could ask patients what their weight was the last time they weighed themselves, or whether they had scales at home that they could use to provide a measurement.
Whatever the outcome, nurses are reminded to make a note in the patient’s records about the discussion and what follow up is needed.
Other factors to consider
‘Obesity is a complex condition with multi factorial causes,’ Ms Smith said. ‘Ethnicity and genetics play a role. And I think the most important thing is socioeconomic factors, because if we don’t take into account how much people can spend and how much people can earn, then actually we are not doing our job well.’
Ms Smith highlighted that for nurses working in deprived areas, it can be extremely helpful to be aware of local resources – such as cooking classes, exercise programmes, and health coaches – and tailor advice to what is realistic for each patient’s circumstances.
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NICE guidance urges practitioners to know the patient’s life:
- Think about family history and weight-related complications.
- Be aware of weight history (and for children and young people, growth history), and previous experiences of related problems (such as eating disorders).
- Think about family and personal context: daily life, ethnicity, culture, money worries, special needs and disabilities, mental health factors and stage in life.
Ms Smith added: ‘It’s important to understand each person’s potential causes and risks and help them to address it. I normally say, what birth weight were you. Or, how big are your family? Are they tall? Are they short? Because the genetics of that are unchangeable, so we have to acknowledge that.’
GLP-1 receptor agonists: not a substitute for support
Towards the end of her talk, Ms Smith acknowledged that injectable obesity drugs such as Wegovy and Mounjaro may be changing the treatment landscape. However, she was clear that she believes that these medications alone are not enough.
While GLP-1 receptor agonists are effective at suppressing appetite, they don’t address the behaviours that drive weight gain. Wraparound support – including dietary advice and behaviour change programmes – remains essential, and nurses are key to that, she said.
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