You’ve heard the caveat at the end of a million ads: Before starting any diet or exercise program, talk to your doctor.

But patients find that harder to do than advertised. Despite the fact that 120 million overweight and obese American adults face a wide range of medical risks, many physicians lack the nutrition training, the bedside manner or even the willingness to venture into the minefield of weight-control treatment.

The following sets of tips offer patients — and the doctors who treat them — ways to ease into conversations about a touchy topic.

FOR PATIENTS:

• The once-over. What kind of shape is your doctor in under that white coat? A recent study from Mercer University School of Medicine in Macon, Ga., found patients were less likely to listen to diet and exercise advice from overweight doctors.
   
• Prepare yourself. Before your appointment, make a list of your questions and concerns. If you think you will need more than the allotted time — typically 10 to 15 minutes — schedule a longer appointment, advises Dr. Patricia Loofbourrow, a family physician turned medical writer in San Bernardino, Calif.
   
• By the way … Don’t wait until the last minute to bring up weight issues. Loofburrow says patients should schedule appointments to discuss obesity just as they would any other medical problem.
• Feel comfortable. Does your regular doctor put you at ease when you bring up your diet and exercise habits or goals? Does she have — and share — knowledge of the links between obesity and disease?
   
• Be realistic. Don’t trust a doctor who prescribes a pill or fad diet to melt away your fat. It’s probably taken a long time to put on those extra pounds; it most likely will take you longer to lose them. “Patients need to mentally prepare themselves for why they want to lose weight and realize they have to work for it,” Loofbourrow says.
   
• Get specifics. “Yes’ and ‘no’ answers should not be tolerated, nor should the generalizations such as ‘eat less and exercise more,”’ says Dr. Jim Early, director of Prevention at University of Kansas School of Medicine in Wichita. “You want details, not just general information. You want his thoughts about your weight and how important he thinks exercise is to your specific health needs. You want to know how he is going to work to make you healthier over the next five years.” If you’re feeling good about the conversation — that the doctor is listening and respecting your needs — continue your interview.
   
• Clear out the medicine cabinet. Lay out all your medications and ask which ones you can eliminate with healthier foods and exercise. And ask if there are alternatives.
   
• Don’t give up. If a doctor takes the Fifth on nutrition issues, it isn’t necessarily the end of the conversation, as long as she has the right resources to compensate. “Doctors don’t have to know everything,” says Dr. Pamela Peeke, nutrition researcher and author of “Fight Fat After Forty.” “But they should have a nutritionist on staff and a nurse to make certain those connections are made.”
   
• Just do it. Once you’ve got the right doctor, make a commitment and stay motivated. “It’s not the diets that don’t work,” says Dr. David Heber, director of the Nutrition/Obesity Training Program at the University of California in Los Angeles, “it’s the lifestyles that people choose that don’t work.”

FOR DOCTORS:

Texas Department of Health Commissioner Eduardo Sanchez, a family practitioner in Austin from 1994 to 2001, offers this advice to doctors to help overweight and obese patients feel more comfortable.

• Wait for the right time. A doctor-patient relationship is built on trust. “I felt it was important for me to get to know the patient and the patient to get to know me,” Sanchez said. Unless a patient is dangerously obese, “The first visit is not the time to bring up weight issues.”
   
• Just the facts, ma’am. Use language the patient can understand. And instead of relying on the scale or societal standards, use the body mass index (BMI) that connects body fat to health risks. Any number over 25 BMI increases the risks of illnesses. A BMI of 30 or more is considered obese and moves health risks to dangerous levels.
   
• Easy does it. Don’t prescribe an overwhelming exercise regimen to someone who barely gets up from the recliner. Take a gentler approach by suggesting “more daily physical activity,” Sanchez said. For example, suggest walking a bit more than usual or taking the stairs.
   
• Live by example. Studies show that patients are more receptive to weight-loss advice from physicians who are fit.
   
• Forgive, but don’t forget. If some patients aren’t interested in a weight-loss plan, don’t take it personally. Take the opportunity at every meeting to approach the subject again, just as you would with a patient with high blood pressure. “In those situations, we need to remind ourselves as doctors that there is a stigma attached to being overweight,” Sanchez said. “Talking about a person being overweight is just like saying, ‘You’re ugly.’”

Lauralee Ortiz writes about medical and fitness issues for the Detroit Free Press.
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(c) 2003, The Robert Wood Johnson Foundation
Distributed by Knight Ridder/Tribune Information Services.