Obesity May Bring Intimacy Concerns: How to Help Patients

Research has shown that obesity can be an underlying cause of both psychosocial and physical functioning and can be a consequence of disorders, comorbidities, and negative social attitudes that influence self-image, according to a new study published in Sexuality & Culture.

The study analyzed the “relationship between sexual satisfaction and a variable describing preferences, expectations,” and needs of people with or without obesity. The results demonstrated a more complex connection between “satisfaction, preferences, expectations, and needs” in people with vs without obesity.

If you are treating patients with obesity and they share feelings of self-doubt and concern regarding their personal relationships and intimacy, as a primary care doctor you can use these conversations as teachable opportunities. To begin with, you can validate their concerns, and you can reassure your patients they can remain close with their partner. During your discussions, it can also be helpful to discuss a healthier lifestyle. Here is how to share guidance with your patients.

Take a Nonjudgmental Approach

A candid and honest discussion with your patients with obesity is the way to build trust because their concerns can be personal. As you listen, assure them that intimacy remains attainable, and keep the discussions nonjudgmental.

After trust is established between you and your patient, you can then offer guidance to interact with their partner if you believe they are seeking such guidance.

If your patients express intimacy concerns, providing self-expression language to share with their partner could help.

“It sounds so cliché, but it will help to use ‘I’ language and the ‘share back’ approach,” said Mark Loafman, MD, a family physician with Cook County Health in Chicago. Advise your patients to start by sharing “I” statements that describe their inner struggles such as self-image/doubt, judgment from others, etc. and then suggest they ask their partner to share back what they heard them say, he stated.

This is a process known as reflective listening.

Another way to enhance connections is to take some protected time without distractions, Loafman said. “Make sure you are both clear on and agree to stick with the process,” he said.

Suggest Counseling for Further Support

Although your guidance in providing communication skills and strategies to build connections for your patients is a helpful strategy, if you determine it’s necessary, consider suggesting therapy.

“Counseling can be helpful in reframing self-talk, drawing healthy boundaries, and formalizing individual health goals,” said Brintha Vasagar, MD, a family physician and chief medical officer of Progressive Community Health Centers in Milwaukee. “It’s so important to guide patients in making decisions about their health based on how they feel and help them put less emphasis on what they may believe other people in their life think.”

Also, she noted that counseling can bridge partners in other ways.

“Couples counseling can be helpful in better understanding the complexities of relationship and finding a healthy path forward,” Vasagar said. In addition, patients need to continue to work with their partner on the entire relationship. “Patients often feel they need to change to meet expectations of a partner or family member. While we have many ways of addressing obesity, I caution patients that physical changes may not improve relationship concerns.”

Using the Opportunity to Pivot to Health Improvements

Loafman cited that family doctors routinely address and treat depression and related mood disorders, so patients should never shy away from bringing these topics up. “However, we do struggle when discussing obesity and lifestyle in medical encounters in large part due to of all the associated societal judgment and shame, further hampered by the time constraints associated with office visits,” he cited.

To that point, his discussions with patients regarding their feelings and concerns about self-image and their health could be a springboard to a healthier mindset. “Evidence shows that patients are more likely to engage in lifestyle and behavior changes when their family doctor is candid about the associated health concerns and risks,” Loafman continued. “So on the one hand we don’t want to miss an opportunity to facilitate a healthy change, while on the other hand we are all well-aware of how easily those conversations can cause harm.” For all these reasons, it’s best to follow the lead of your patient. “It really helps when the patient starts the conversation expressing interest in addressing either weight itself or the associated negative impact it is having on mood and well-being,” he summarized.

In fact, a study cited by the National Library of Medicine noted how primary health professionals can be resources for patients to encourage and facilitate patient self-management for healthy-life objectives. Once patients are on board with healthier life practices, they can be instrumental in success.

“The practice of tracking and the knowledge that the data tracked may provide can bring awareness and support health behaviors, thus helping in improving quality of life,” the authors wrote.

The research outlines how self-management may improve patient engagement in their own care by taking on an active role in their disease management by better understanding their health conditions, coping with treatment, and communicating with providers. Be sure to encourage patients toward self-monitoring because it can be a valuable tool for patient success.