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In Reply: Dr Middleton questions the relevance of our findings to individuals' health decision making. This should be considered in the context of shared decision making, which has the goal of reaching a decision that is informed and is jointly made between patient and clinician. The patient must understand the risk of the disease or condition to be prevented; understand the preventive service, including its risks, benefits, alternatives, and uncertainties; weigh his or her values regarding the potential benefits and harms associated with the service; and engage in decision making at a level that he or she desires.¹ Accurate understanding of weight-related health risk is therefore integral to shared decision making for obesity.

Counseling-based interventions, a cornerstone of obesity treatment, are expensive and difficult and require substantial patient commitment but can have significant health benefits.² I disagree with Middleton's suggestion that understanding how risk changes throughout the obese range increases . . . [Full Text of this Article]

Kathleen McTigue, MD, MS, MPH
mctiguekm@upmc.edu
Division of General Internal Medicine
Department of Medicine
University of Pittsburgh
Pittsburgh, Pa

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