Qualitative assessments, conducted through conversations between patients


and providers, help to personalize treatment recommendations and are another way to address disadvantages caused by structural inequities. At times, particularly in weight-management care, it may be easy for clinicians to make broad recom- mendations. However, it is important to ensure that patients have access to the necessary resources and equipment to make behavioral or lifestyle changes. For example, suggesting that a patient increase consumption of nutrient-dense foods such as fruits and vegetables is not helpful if the patient has no access to transpor- tation, a local supermarket, a refrigerator to store foods safely, or a stove or other kitchen device to prepare the foods. Conversations about work, home life, and the patient’s priorities may provide insights into these structural inequities. For example, if a patient experiences interpersonal discrimination at work, a referral to a specialist for stress management may aid in weight-management efforts.119,120 Additional topics to assess qualitatively in conversations with patients include food insecurity, socioeconomic status, support systems, stress, sleep, community resources, and patient goals.78


Questions may include, “Is there anything about


your community or neighborhood that prevents you from participating in physical activity outside?” and, “Do you feel you have access to resources that will help you achieve your goals? How can we help?”78


Understand Patients’ Goals


When discussing weight management with patients, clinicians should strive to understand their patients’ goals in pursuing treatment, including their health- related and psychosocial-related motivations.121


Some patients may hope to


improve their quality of life by being able to keep up with their children, partici- pate in activities with friends and family, or improve other psychosocial factors.122 Whatever their motivations, it is possible that some patients will have unrealistic weight loss goals.123


can lead to disordered eating behaviors in Black and Asian patients.124-127


These may be driven by Western ideals about being “thin” and Part of


implementing evidence-based obesity treatment is ensuring that patients have realistic expectations for treatment outcomes and can make informed treatment decisions.128


rather than on aesthetic changes (eg, going down a dress size). For example, clini- cians may choose to focus on process goals, which can include the improvement of comorbidities or behavioral or lifestyle changes.129


In this vein, one can explain to


a patient that a weight loss of 5% to 10% of body weight may not result in notice- able aesthetic changes but can lead to cardiometabolic health improvements.130


If


a patient weighs 122 kg (269 lb), a reasonable goal weight could be in the range of 116 kg (256 lb) to 110 kg (243 lb)—a loss of 5.19% to 10%. Including a discus- sion of patient goals and motivations in clinical conversations about weight loss treatment helps patients avoid setting unattainable goals that may promote dis- ordered eating behaviors and promotes autonomy in the patient’s decision-making process.98-100,130,131


However, it is important to recognize the limitations of current


treatment options. As previously noted, treatment outcomes differ among various patient groups, and these differences are an important area of future study.


Provide Accessible Education Materials


An additional important step to equity is to ensure the readability and accuracy of all patient health-education materials. The majority of printed materials offered to patients are written at grade levels higher than the average American eighth-grade


CHAPTER 2: Health Inequities in the Development, Management, and Treatment of Obesity 35 Providers should encourage goals based on improvements in health


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