How to Advise Patients on Climate Without Turning Them Off

Eating less meat and more fruits and vegetables or walking and cycling more — these recommendations benefit both health and the climate. Yet, many patients reportedly do not want the environmental benefit highlighted explicitly. A study by the University and University Hospital of Heidelberg, Heidelberg, and the University Hospital of Halle, Halle, both in Germany, explored this phenomenon.

A team led by Alina Herrmann, MD, examined whether and how doctors should discuss environmental and climate protection with patients. Herrmann is head of the “Climate-Smart Health Systems” research group at the Heidelberg Institute of Global Health, first author of the study, and honorary spokesperson of the section “Climate Change and Health” at the German Society of General and Family Medicine. The study was published in The Lancet Planetary Health.

Environmental and climate protection remain key topics in the medical community. In 2022, Klaus Reinhardt, president of the German Medical Association, emphasized that protecting the climate is inherently protecting health. Rising global temperatures increase heat waves, infectious diseases, conflicts, and generally worsen living conditions — all of which directly harm human health.

Many doctors therefore aim to increase societal acceptance of climate measures, Herrmann told Medscape’s German edition. But there is a dilemma: “On one hand, we want to maintain a strong doctor-patient relationship. On the other, we see the importance of preserving the foundations of life and curbing climate change, which directly threatens human health. We are looking for the best ways to communicate climate protection,” she said.

Highest Acceptance for Health-Focused Advice 

The Heidelberg-Halle study included 1516 participants from five German federal states. Researchers used the “HeReCa” online panel from the University Hospital of Halle, which tracks health-related opinions nationwide.

Participants were presented with three counseling scenarios recommending more plant-based protein or greater daily activity, each framed differently:

• In the first scenario, the advice focused solely on personal health benefits.
• In the second, a positive impact on the climate was also mentioned.
• In the third, the doctor elaborated on the threats posed by climate change.

Researchers assessed which scenario was most accepted, participants’ attitudes toward climate change, and their political orientation.

The results showed that health-focused advice received the highest acceptance, with an average score of 4.09 out of 5. Advice that included climate benefits and risks scored 3.5 points, slightly lower than the scenario that mentioned only the positive climate effect. Whether the guidance related to nutrition or physical activity made no difference.

Differences were most pronounced among participants skeptical of anthropogenic climate change or identifying as politically right-leaning. In these groups, climate-focused messages significantly reduced acceptance of medical recommendations.

Framing Matters

Herrmann emphasized that the findings should not be interpreted as suggesting doctors avoid discussing climate protection entirely. The framing is crucial. Health-focused advice can also advance climate goals, she noted. A balanced, mostly plant-based diet and active mobility naturally support climate protection — regardless of whether these behaviors are adopted for health or environmental reasons.

“All three scenarios in the study were climate-conscious, highlighting a more plant-based diet and encouraging people to leave the car at home and walk or cycle. The climate aspect was present in all scenarios, but in our health-only framing, it was not explicitly mentioned — and this was well received,” Herrmann said.

“Interestingly, even climate skeptics and politically right-leaning participants responded positively to recommendations like eating more plant-based foods or leaving the car at home — especially when they were not told, ‘This is also good for the climate,’” she added. “In a way, that’s encouraging: Sustainability-focused recommendations appear acceptable across all groups when framed around health.”

Patients’ Interest in Sustainability

Why has climate protection become a sensitive topic for some? “In a medical setting, many people primarily focus on their health, and climate-related aspects may feel unfamiliar or uncomfortable in conversation,” Herrmann explained.

“In future studies, we plan to examine how explicitly addressing climate issues — or providing related informational materials in waiting rooms — affects patients’ attitudes and behaviors. This could help identify the most effective communication strategies.”

For now, Herrmann recommended tailoring discussions to individual patients. “This may mean initially focusing only on the health benefits. Then you can add: ‘For this topic, sustainability and climate factors also play a role. Would you like to learn more?’” Framed this way, advice is seen as an offer rather than a lecture. Patient responses also indicate that their autonomy is respected — they can choose whether to engage with guidance on the topic.

This story was translated from Medscape’s German edition.