The first step in overcoming patient resistance to weight loss counseling is creating a judgement-free, safe space where they feel understood rather than criticized.

Even as a weight loss expert, counseling your patients can sometimes feel like you are climbing a steep hill — especially when they are resistant. They may have tried every diet, bought all of the products, and feel as if they have heard it all before. So, when they walk into your office, they might not be feeling particularly hopeful.

Sound familiar? Well, in all likelihood, their resistance isn’t about you. It’s usually about fear of failure, frustration, or simply feeling overwhelmed by it all. But here’s the good news—you have the power to transform that resistance into actions that can transform their beliefs and their health. You and your team can turn your hesitant patients into empowered partners in their own weight loss journey. Below are eight tried-and-true strategies to help you do just that.

1. Build Trust and Rapport

You have likely heard the phrase “people do business with those they know, like, and trust.” When it comes to receptiveness to counseling, the same applies. Building rapport is the foundation of everything else you will accomplish together. When a patient comes in, start by listening to their story — really listen. Seek to understand where they are coming from and what they have been through. Perhaps they have been on every diet out there, or perhaps they have faced judgement in other health care settings. Make it clear that this time is different. Be there to support them, not judge or shame them. Ask questions, acknowledge their past struggles, and make sure they really feel heard. When your patient believe you are on their team, they start to let their guard down, and that’s when the magic happens.

2. Help Them Discover Their Own “Why”

As you know, telling someone what to do doesn’t always work. If you really want to move a patient from resistance to readiness, motivational interviewing will be key to your success. Rather than giving them a list of “should” (you should avoid processed foods. or you should exercise more), flip the script and use motivational interviewing techniques. Instead, ask them questions like, “What would your life look like if you had more energy?” or “How would feeling healthier impact your day-to-day life?” Motivational interviewing is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own reasons for change.¹ It puts the power back in their hands. When patients find their own reasons for change, they are more likely to follow through. You guide them to their own “why” instead of trying to force change. Find the “why” behind your patients’ deeper, personal reason(s) for wanting to lose weight and resistance will start to dissipate.

3. Focus on Achievable Goals

Weight loss can feel very overwhelming. Particularly when your patient thinks about their need to lose 50 or 100+ pounds. They likely have no idea where to start. This is exactly why breaking things down into small, manageable goals is key. You are not asking them to overhaul their entire life overnight. Instead, you are asking them to take one step at a time. Perhaps something as simple as swapping sugar filled drinks for low-calorie or no-calorie drinks (including water). Or, focusing on getting at least 15 grams of quality protein at every meal. Be specific based upon your professional recommendations. These aren’t drastic changes; rather, they are steps in the right direction and these small wins will build greater momentum. Once a patient sees they can handle one change, they will be more open to the next. So, the next time you are counseling your patient, try saying, “Let’s focus on one thing this week. When you are ready, we will add another.” Keep it simple, keep it achievable, and notice their confidence grow.

4. Normalize Resistance as Part of the Process

Let your patients know that feeling resistant doesn’t mean they have failed. In fact, it is just part of the process. So many people beat themselves up when they hit a roadblock or slip up. This only leads to more resistance and can manifest itself as “no show” appointments. Forewarn them by letting them know that it is normal to feel hesitant or struggle at times. The important thing is to show up and be open to working through the resistance together. They are not alone with you and your team. This validation can ease their anxiety and allow for personal growth. When patients know it is okay to stumble, they are more likely to get back up and keep going, rather than giving up — perhaps, one more time.

5. Connect the Process to Their Values

One of the best ways to get patients to embrace weight loss counseling is by tying it to what they care about most. So, get to know what really drives them. Perhaps they want more energy and mobility to keep up with their grandkids, or they are worried about their health and want to avoid going on medication (or decrease the number of medications they take). They may also want to be a better example for their children or be able to shop in a regular clothing store. It varies for everyone. Once you know what is at the heart of their motivation, you can frame your conversations around it. For example, you can say “I know you have an active vacation with your kids coming up. Let’s work on strategies that will help you feel more energetic and mobile so you can fully enjoy your time together.” When patients see how weight loss fits into the bigger picture — especially things they deeply care about — they are more likely to stick with it.

6. Provide Education Without Overwhelming Them

As educated clinicians, sometimes we can provide information in the form of a fire hose, instead of a refreshing sip of water. We can easily cause information overload or provide information in a complicated way. Your patients are bombarded with conflicting advice every day. That is why your role is to provide clear, actionable, and simple information, counseling and guidance. There is no need to overwhelm them with every detail right at the beginning. Focus on just one or two key pieces of information/advice in each counseling session. For example, “This week, let’s focus on portion control. Next week, we will tackle meal planning.” You can also reinforce your education with easy to access written, audio, or video resources. It has never been as easy as it is today to create and provide such resources. Bottom line, keeping things simple will make the process feel more doable so your patients are more likely to follow-through. It keeps them engaged without burning them out.

7. Create a Safe, Non-Judgmental Environment (Exemplified by your Entire Team)

Many patients have feelings of shame or guilt when it comes to their weight loss journey. They may have been judged and/or judged themselves in a negative way. The last thing they need is another place where they feel criticized. With each interaction, they need to feel safe — from phone calls and check-in to their counseling sessions and check-out. It is important for your entire team to avoid language that feels punitive or solely focused on weight. Instead of saying “you need to lose 25 pounds,” you can say “let’s focus on a few pounds at a time with a goal of improving your mobility and energy.” In fact, in the publication Improving Patient-Provider Communication, the National Institutes of Health promotes the fact that a non-judgmental approach creates a safe space where patients feel respected and supported. This can significantly impact their willingness to engage in lifestyle changes.²

8. Inspire Hope

In a world that can often be judgmental and cruel, particularly when it comes to being overweight, you can make a huge difference by inspiring hope. Your patients may feel like they have tried everything and nothing works. They may be ready to give up on themselves. This is where they need to know that you believe in them. It is a time for them to understand what is possible. A great way to do this is to share your success stories and experiences of past patients who were in a similar situation and experienced success. You can do this through conversation and by having evidence of success stories throughout your office, on your website and highlighted each week on your social media and Google reviews. You can also share a patient story such as “I had a patient who felt as if she had tried everything and was skeptical as to whether our program and products could work for her. We focused on small, manageable changes that matched with her lifestyle and preferences. As she saw progress, she was motivated to keep going. Now she is feeling healthier and more confident than ever. She even ran her first 5K last month.” These stories aren’t just motivational. They are a reminder that change is possible, even when it feels out of reach or too overwhelming.

As you know, transforming patient resistance into results isn’t about convincing your patients to “just do it.” It is about building trust, focusing on small wins, and tapping into their own personal “why” When patients feel understood, supported, and empowered, their resistance  turns into motivation. As with everything, it is not about perfection, it is about progress. With the right approach, your patients can and will embrace weight loss counseling and even enjoy the journey along the way.

Source(s):

¹ Miller W., and Rollnick, S. (4^th Edition). Motivational Interviewing: Helping People Change and Grow. The Guilford Press, New York, NY.

² https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904301/