Effective Weight Management Conversations: A Physio’s Guide

Weight management has long been a sensitive topic in healthcare, and physiotherapy is no exception.

We know body composition can play a role in musculoskeletal (MSK) health, but bringing it up with patients isn’t always straightforward. It’s easy to worry about saying the wrong thing, offending someone, or overstepping scope. Yet, when handled thoughtfully, these conversations can be invaluable – improving outcomes, empowering patients, and preventing longer-term complications. This blog outlines the when and how of addressing weight management in physiotherapy.

If you want a deep dive into everything physios need to know about nutrition for MSK conditions, watch Ben Steele Turner’s new Masterclass HERE.

When is the conversation appropriate?

There’s no denying that excess body weight can increase the load on the MSK system. The evidence indicates higher Body Mass Index (BMI) and waist circumference are linked to greater rates of knee osteoarthritis, Achilles tendinopathy, and even tendon rupture. Additionally, central adiposity isn’t just about mechanical strain either; it drives inflammation and metabolic changes that slow tissue recovery and worsen pain perception. See Ben explain this in the below video from his Masterclass:

But here’s a key point Ben raises: body composition matters differently in different contexts, and we shouldn’t jump to conclusions based on weight alone. For instance, bringing up body weight during an appointment for an acute ankle sprain isn’t usually relevant or appropriate. However, in conditions like osteoarthritis, chronic tendon issues, or post-injury rehabilitation, it can be both justified and clinically significant.

In cases such as post-ACL reconstruction, research on adolescent and paediatric populations shows that changes in body composition can persist long after surgery. Reduced activity, missed sports, and altered routines all contribute. For physios, this means rehab isn’t just about restoring movement, it’s also about supporting patients to return to healthy, active lifestyles that protect long-term joint and metabolic health.

Addressing weight with a patient should always be justified by clinical relevance to their presenting complaint. If it’s not, forcing the topic risks alienating the patient and undermining trust.

But when it is relevant, for example, with osteoarthritis, it’s our responsibility to bring it up sensitively. The language we use, and the intent behind it, makes all the difference!

How to address it?

A qualitative review of patient experiences around obesity and healthcare (1) gives us several guiding principles that are applicable in physiotherapy:

• Never imply that weight is the sole factor. MSK conditions are multifactorial, and patients should never feel reduced to their weight.
• Not discussing weight can also send a message. Patients may interpret silence as avoidance or lack of care.
• Gain permission before diving in. A simple “Would you be open to talking about how your weight might be influencing your recovery?” can make a big difference.
• Always address their primary complaint first. If they’ve come to see you for pain, that should be your focus before any lifestyle discussion.
• Ask before you advise. Find out what’s worked (or hasn’t) before. Has the patient ever had support with weight management? What barriers have they faced?

By following these principles, we avoid the trap of “fixing” and instead become partners in problem-solving.

Sometimes, the physiotherapist’s role isn’t to deliver a weight management plan directly, but to start the conversation, educate, and refer on, all within our professional scope.

If you do decide it’s appropriate to discuss weight, structure helps. The weight management continuum gives physiotherapists a spectrum of involvement. You might choose to simply acknowledge the link between weight and pain, or you might take it further by helping the patient set goals and connect with a dietitian. Wherever you sit on that continuum, you’re contributing meaningfully to the patient’s overall health. See Ben explain the continuum in the below clip from his Masterclass:

Alongside this, Ben introduces the Five A’s framework offers a practical roadmap for communication:

• Ask: Gain permission before starting the conversation.
• Assess: Gather appropriate measures (weight, BMI, waist circumference) just as you would for other outcomes, only when relevant and with consent.
• Advise: Provide clear, evidence-based reasons why improving or maintaining weight supports recovery.
• Agree: Set goals collaboratively, whether that’s referral, education, or a simple plan for increased activity.
• Assist: Help remove barriers, offer follow-up, and connect the patient to further support if needed.

This framework helps clinicians facilitate safe, respectful, and effective discussions that improve patient outcomes. It’s especially useful to remember if you’re lacking confidence in leading these conversations!

Wrapping up

Weight management in physiotherapy is about the opportunity to help patients recover better, move better, and live healthier lives. As clinicians, our role is to approach these conversations non-judgementally, with empathy, evidence, and clarity.

By using structured frameworks like the continuum and the Five A’s, and by grounding every discussion in relevance to the patient’s goals, we can transform what might feel like a difficult topic into a constructive, empowering one. When done well, these moments of honest, compassionate dialogue can be a true facilitator to patient-clinician trust and meaningful change, and that’s exactly the kind of impact physiotherapists are made for.

If you want a complete guide to nutrition for physiotherapists, from post-surgical recovery to supplementation for MSK injury rehab, watch Ben’s full Masterclass HERE.