Patient Weight: Is Bluntness Better?

I came across a story last week from Time-The Obesity Pregnancy Dilemma-that urged physicians to have difficult conversations with their overweight/obese patients regarding weight loss. This particular article focused on the importance of losing weight before becoming pregnant in the very obese patient to help reduce the risk of pregnancy complications and increase the chances of becoming pregnant in patients having difficulty.

However, reading it brought to mind my own experience with one of the ob/gyns at the group practice where I received obstetrical care during my first pregnancy. Although I was pretty fit when I became pregnant, I was considered overweight based on BMI. When I was about 9 weeks pregnant, I had my first appointment with the sonographer to confirm the pregnancy and a meeting with the practice’s NP for a brief counseling session. My pregnancy was confirmed, along with the shocking news that I was having fraternal twins, and I was advised to limit my gestational weight gain to 40 lbs or less.

Fast forward to my first appointment at 12 weeks’ gestation, which was with a doctor from the practice whom I’d never met before and had only heard wonderful things about: The first words out of her mouth when she came into the exam room were these: “You’ve gained too much weight.” From 0 to 12 weeks’ gestation, I had gained a total of 3 lbs.

I instantly disliked her and couldn’t believe that friends of mine praised her on her bedside manner. I avoided appointments with her throughout the rest of my pregnancy and kept any body part I could cross crossed that she wouldn’t be the one on call when I went into labor. I was so angry with her about how she just breezed in and before even introducing herself “criticized” me.

But you know what? Her comment motivated me in a way that nothing else could have to keep my weight in check. I thought about her comment every single time I went to the doctor and stepped on that scale, and I thought about it in those moments when I felt like having Ben & Jerry's instead of yogurt. When I went into labor at 38 weeks, I had gained exactly 40 lbs, and at my 6-week postdelivery follow-up, I weighed less than I did before becoming pregnant. Looking back, I begrudgingly admit that her utter bluntness was exactly what I needed to hear at the time. 

So, my questions to all of you are these:
- How blunt are you when addressing weight gain or loss with your patients?
- Although patients may prefer kid-glove handling, are tough-love tactics more effective?

Share your thoughts in the comments section below.