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Table 2 Examples of application of harm reduction principles for patients who are obese

From: Harm reduction principles for healthcare settings

Principle Example
1. Humanism • Providers do not shame or think less of patients with obesity.
• Providers strive to understand underlying factors contributing to patients’ obesity, which may include lack of access to healthy food or unhealthy eating habits that are rooted in family traditions or local culture.
• Clinicians do not impose their personal beliefs about diet upon patients who are overweight or assume that weight loss is the patients’ prioritized goal.
2. Pragmatism • Providers do not expect that the obese patient will never eat processed or sugary foods again.
• Behavioral interventionists encourage patients to reduce their consumption of processed or high-fat, low-nutrition foods.
• Rather than mandating that patients must lose a specific amount of weight, providers work with patients to establish realistic eating goals, which may or may not include weight goals.
3. Individualism • In working with patients who are obese, providers might strive to understand the patient’s experience and how it contributes to suboptimal health, then offer appropriate interventions. For example, food vouchers or referrals to food pantries with fresh produce might be a useful support for patients without access to healthy food.
4. Autonomy • In working with overweight patients, providers might assess readiness to lose weight and provide patients with health improvement education and options.
• Providers support their patients in developing plans to implement health-promoting strategies that are acceptable to the patient, such as adding exercise intervals or incorporating fresh produce into their diets.
5. Incrementalism • For the obese patient, any weight loss, increase in physical activity, or improvement in other clinical markers is seen as success.
• For patients who overeat, healthy eating is viewed as an ongoing, gradual process.
• For patients who are interested in losing weight, weight gain is not seen as failure but as part of the process.
6. Accountability without termination • Patients who are overweight and have diabetes continue to receive insulin even though they regularly eat foods with high sugar content.
• Patients who are obese are not terminated from care if they continue to gain weight.