Clinicians addressed weight in less than half of routine primary care visits with patients managing type 2 diabetes, according to an observational study published in BMC Primary Care. In an analysis of recorded clinical visits, discussions centered on weight occurred in 39 percent of encounters, highlighting ongoing challenges in integrating weight management conversations into standard outpatient diabetes appointments.

Effective weight management serves as an essential component of comprehensive diabetes care, yet initiating discussions about weight and weight loss remains a difficult task in office settings. Discussing weight is recognized as a potentially stigmatizing topic during routine primary care.

To examine clinicians’ actual practices during real-world care, investigators evaluated 123 videorecorded primary care encounters. These recordings were originally collected during the QBSAFE randomized clinical trial (ClinicalTrials.gov identifier NCT05553912), an investigation that assessed usual primary care with and without an agenda-setting intervention kit for patients diagnosed with type 2 diabetes.

The analyzed cohort comprised 47 male and 76 female patients who presented with an average age of 56 years, a mean body mass index of 32 kg/m2, and a mean glycated hemoglobin level of 10 percent. Eligible participants were fluent in English or Spanish, had an HbA1c level of at least 8 percent, and had a BMI of 25 kg/m2 or higher. Two independent researchers coded each visit using an ad hoc codebook to track conversation initiation, phrasing, conversation types, and recommended treatments, utilizing binary and multinomial mixed models to evaluate statistical associations.

Across the 48 clinical encounters where weight came up, healthcare clinicians initiated the discussion in 27 instances, representing 56 percent of those dialogues. When conversations occurred, clinicians frequently recommended dietary changes in 21 encounters (44 percent) and diabetes medications associated with weight loss in 25 encounters (52 percent), while bariatric surgery was not discussed in any visit. In addition, weight conversations were significantly more likely to occur with individuals already prescribed glucagon-like peptide-1 receptor agonists compared to patients not taking those medications (p = 0.03).

Throughout the observed visits, clinicians deliberately refrained from using the specific terms “overweight” or “obesity,” opting instead to discuss “weight.” While the research team noted that utilizing less stigmatizing vocabulary appears to improve the overall quality of primary care encounters, they emphasized that further studies remain necessary to establish effective interventions that increase the overall frequency of weight-related discussions in routine diabetes management.

Subject of Research: Clinician approaches to discussing weight during routine primary care encounters for type 2 diabetes

Article Title: Examining clinicians’ approaches to discussing weight during routine diabetes care: an observational study

Article References: Dower, J. A., Gonzalez Lopez, C., Branda, M. E., Camp, A. W., Chen, A. S., Montori, V. M., Ochoa-Prieto, M., & Lipska, K. J. (2026). Examining clinicians’ approaches to discussing weight during routine diabetes care: an observational study. BMC Primary Care. https://doi.org/10.1186/s12875-026-03588-9

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03588-9

Keywords: type 2 diabetes, weight management, primary care, clinical encounters, GLP-1 receptor agonists, weight loss medications, dietary changes, weight stigma, patient-clinician communication, agenda setting, QBSAFE trial, observational study, body mass index, HbA1c, bariatric surgery, video recordings, routine diabetes care