A GP’s tips to other clinicians when speaking with people who want to lose weight

Adapted from BMJ 24-31 January 2026 Dr Ellen Fallows. British Society of Lifestyle Medicine.

Although the NICE guidelines say that clinicians should always ask permission before discussing obesity with patients, in my experience as a GP, this is still seen as a barrier to mutual understanding by patients.

Unless a patient has come to the surgery to discuss weight loss, I have not found it helpful for me to bring the subject up. Instead, I use the time to explore potentially modifiable drivers of symptoms that matter to the person in front of me. This means less time assessing the degree of obesity, and more time assessing its causes.

For instance, if a patient has knee pain or type two diabetes, I could ask: Do you ever have difficulty making ends meet at the end of the month? When did you last eat a green leafy vegetable? Are you a shift worker? What does your job involve?

Understanding a person’s life can avoid discussions about numbers on scales. Often fatigue, pain and low mood, matter more to the patient than body mass index.

New weight loss medications are seen as simple quick fixes, but weight tends to return once they are stopped. These treatments have their place, but need to be used alongside core interventions such as help to improve diet, relationships, and sleep, increasing physical activity, and reducing stress and harmful technology use.

GPs may be able to help their patients get adjustments made to shift work, or increase activity through discounts to council run gyms, or referrals to a social prescriber, health coach or dietician. Multiple symptoms can improve with these interventions without discussing weight.

The most important question is: What matters most to you right now about your health? This gets back to old style GP work rather than ticking off the QOF indicator markers that were often surrogate markers for poverty, food insecurity, sedentary and stressful jobs, shift work, social isolation, technology harm, and smoking and alcohol use.

Ultimately this approach can avoid adding to polypharmacy and overprescribing harms, when for many people the problem is food.