Why is it so hard to talk to your doctor about weight?

scale weight

Ever sat – naked – in a gown while a doctor says to lose weight before your check up next year? And then had the same, guilt-riddled conversation for the next three years?

Us too.

Having a meaningful medical conversation about weight isn’t just hard – it can be down-right excruciating. Food, weight, health and physical activity are deeply personal and can pack an emotionally laden punch.

Silvana Pannain, MD, has seen the ramifications of that guilt spiral first hand. An endocrinologist and obesity medicine specialist who runs Chicago Weight, UChicago Medicine’s comprehensive medical weight loss program in downtown Chicago, she and her team of physicians, dietitians and health psychologists craft personalized, long-term weight loss plans for patients. Her biggest challenge? Sometimes it’s just getting patients in the door.

“People are so reluctant to seek help because weight is complicated and attached to a lot of emotions,” she said. “They’re carrying a lot of self-blame because they think they’ve failed or that they don’t have sufficient will power. Losing weight is a struggle and maintaining that loss is even harder due to biology. It’s not just about will power. And it’s not as simple as eating less and exercising more.”

We asked Pannain to talk about comprehensive weight loss programs, how they can help patients manage obesity in new ways and why there’s no such thing as a one-size-fits-all diet.


Q: People seem willing to try a new diet or a new fitness trend, but when it comes to weight loss it’s a one-sided conversation with a primary care doctor telling them to try to lose weight. Why are people so reluctant to seek out meaningful medical help to lose weight?

A: Doctors are warning patients to lose weight, but they’re not providing patients with the right tools and they’re not expressing appropriate empathy around a patient’s lifetime struggle to lose weight. That leaves people with the wrong message: that they don’t have enough will power or that they’re lazy if they can’t do this on their own. Every day we’re learning more about obesity and the mechanisms behind weight gain, which include underlying medical conditions, genetics or even medications. We’re learning that the struggle to lose weight or maintain a weight loss is due to biology, not to lack of will power.


Q: Why are weight loss conversations with doctors so uncomfortable?

A: Weight is complicated and attached to a lot of emotions. At the same time, doctors’ visits are shorter than ever. So people feel reluctant to address weight with their doctor because they only have limited time during a typical visit. It’s not something they want to bring up if they’re feeling hurried or if they think they’re being brushed off. That’s part of the reason why our first meeting with Chicago Weight patients can take 2.5 hours. We want time and space to really talk things through, to make sure we’re on the same page as our patient and to understand their journey.


Q: Why is it so hard to lose weight?

A: It’s biology. A large proportion of patients don’t achieve meaningful or long-lasting weight loss simply by dieting and exercising on their own. And even that is really hard to do. Once we’ve gained weight there are proven biological forces opposing our weight loss and promoting weight regain. If anyone tells you that weight loss is all on you, that it is easy, that it is just a question to “eat less and move more,” you should walk the other way.


Q: What’s different about how weight loss physicians work with patients?

A: One of the biggest issues for patients is determining if they’re ready to make lifelong changes surrounding eating habits and activity. We have a multidisciplinary team that helps people explore and resolve fears that sometimes comes with initiating change, especially after multiple attempts at weight loss. We work on setting manageable goals and we celebrate every success along the way – no matter how small. Finally, we make sure every patient hears two clear messages: that this should not be all on them and that this is not just a simple question of eating less and exercising more.


Q: Why should someone consider a medical weight loss program rather than a standard mainstream diet program?

A: At Chicago Weight we offer all possible tools to lose weight. It’s a comprehensive approach where experts in weight management work as a team to support patients along their weight loss journey. We start with a 2.5-hour evaluation with a team of physicians, dietitians and health psychologists. That helps us build an individualized plan that takes in account lifestyle factors, personal goals, family circumstances and any barriers that may be affecting people. But we build more than just a dietary plan. We add on layers of behavioral support, we assist with formulating goals, we propose strategies for problems and then we partner with the patient on a weight loss plan. We also pay a specific attention to eating behaviors and eating disorders, which affect as many as 20 percent of our patients. We work on balance: We don’t ever approach things in an-all-or-nothing manner. Finally, we know that our patients have a lot of questions and concerns about weight loss medication, so we only explore that route after a careful evaluation of risks and benefits.


Q: Are these programs just a gateway toward bariatric surgery?

A: Not necessarily. While we do work with UChicago Medicine’s weight loss surgery team as well as those who perform non-surgical weight loss procedures, we make sure to talk to our patients about all treatment options. The ultimate goal is for them to be successful no matter what it takes. At any time, we’re ready to redesign the treatment plan until patients reach their goal.


Q: What’s the best advice you have for someone who wants to pursue a program like yours?

A: Take the first step, even if you’re worried that it will feel awkward of uncomfortable. Learn about a program and ask all your questions. Make sure you’re working with a team you’re comfortable with. Be patient, because this is a process that takes trial and error. And keep coming back, even if it’s been a rough couple of months where you haven’t seen the results you’ve wanted. Many of our patients have never participated in a comprehensive weight management program before, but they say it’s a lot different from what commercial diets or plans at the gym. We like to think that’s in large part because we also take on part of the responsibility of their struggle and really make sure we’re partnering with them.

Chicago Weight: A Weight Management Program for Adults

UChicago Medicine's Weight Management Program is designed to help patients manage excess weight, as well as any associated medical conditions. Our team works with each patient to create an individualized care plan. We offer a full spectrum of services and, depending on your needs, may recommend nutritional and physical activity counseling, psychological and lifestyle counseling, medications, endoscopic bariatric procedures and/or surgery.

Learn more about our weight loss program
Silvana Pannain, MD

Silvana Pannain, MD

Dr. Silvana Pannain is a skilled endocrinologist. She provides advanced endocrinology care for patients who have weight problems or endocrine disorders. Dr. Pannain also serves as director of Chicago Weight, a weight loss program and support group at the University of Chicago Medicine.

Read Dr. Pannain's physician profile