Obesity is the elephant in the room — the one taboo condition that everyone can see, that most people cannot help but judge, and that daren't be mentioned to the obese.
Bring the subject to the table and we risk insulting them, hurting their feelings and irrevocably damaging the relationship we share. Yet, by now, we all know about the risks of heart disease and diabetes that go hand in hand with being heavily overweight, as well as its physical and psychosocial challenges.
So how do you offer to help a friend, relative or spouse who is obese? How do you walk on those eggshells so that your offers of concern and assistance aren't misconstrued as an insult? How do you help an obese loved one make constructive changes to his or her lifestyle, and get a handle on the weight problem?
One thing you don't want to do is mention their weight out of the blue, says Dr. Gary Foster, director of the Centre for Obesity Research and Education at Temple University.
"Take your cues from the person themselves," he advises. "If they mention they're unhappy with their weight or have shortness of breath, that's your cue. But without knowing what the person him or herself thinks about their weight, you have no right to comment on it yourself."
Weight is such a complicated issue in this society, where one-third of the American population is obese and two-thirds are classified as being overweight. The rates of childhood obesity have tripled in the last 30 years, which means that there will be increasing numbers of obese adults in the years ahead.
Still, dealing with obesity is full of land mines.
"It's always better to start a conversation saying, 'You said you were concerned about your weight — is there anything I can do to help?' " says Foster.
"Only bring up the conversation if they bring it up first," he continues. "That way, you will have waited for the signal and can be supportive in the way the obese person defines as supportive — not in the way you define as supportive."
You don't want to enter the subject blindly, cautions Dave Baron, professor of psychiatry at the Temple University School of Medicine: "Maybe they just joined a weight-loss program or they're always trying to diet. Understand where they are in their weight and their lives, and if you're going to mention their weight, do it with a strong sense of respect and empathy rather than relegating them to the role of patient, with you being the self-appointed doctor."
Timing is crucial, but so is the setting. You don't want to broach a subject this sensitive at a party, for example, or during a meal.
"Go for a walk," continues Baron. "Maybe suggest that the two of you join a swimming pool together, or start a walking club so that you can spend more time together in an active way. Pointing out a weight problem doesn't do a whole lot because people know if they're overweight. But trying to be part of the solution can be more helpful."
Foster agrees: "It's not as if obese people don't know they're obese — you're not giving them insight by mentioning it."
"Obese people tend to think negative thoughts about themselves and to feel judged by others. So if you bring it up, it is judgmental, which is not a good formula for success, no matter how well-intentioned it is."
If the obese person is in your home, you have a little more control, particularly if it happens to be your child who is grossly overweight.
"Limit television viewing to less than two hours a day, as that seems to be one of the biggest variables for childhood obesity," advises Foster. "Limit the availability of high-calorie foods in the house, and rather than tell kids what to eat and what not to eat, model the correct behavior yourself."