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“Are you really going to eat that cake?” and other things you should never say to a loved one who's gained weight

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Dear Julia: I have a family member who's recently gained a lot of weight, and I’m worried about his health. Should I speak to him about it?

This one is tricky. Anyone who has been on the receiving end of comments like, "Are you really going to have that piece of birthday cake?" knows there are really, really bad ways to raise concerns about a loved one's weight gain.

There's also evidence that these negative remarks can backfire. The literature is quite consistent on the link between stigmatizing comments about weight and poor mental and physical health outcomes. The last thing you want to do is make your family member feel worse, even if you did have the best intentions in broaching the subject.

Since this is such a sensitive topic, I asked a few obesity experts about how they'd navigate it. They all said that talking about weight with others is awkward — but there are a few things you can try to make it easier.

1) Ask for permission first

Before you dive into all the things you think your family member could do to get his weight down, you should gauge whether he even wants to even talk about it in the first place.

As Kimberly Gudzune, an assistant professor of medicine at Johns Hopkins, told me, weight gain can often be a symptom of extreme stress or depression. Blindsiding your family member with your concerns about his weight might just increase his stress at a time when he isn't ready or equipped to address the issue.

If he's not prepared to engage, drop the conversation, obesity researcher Arya Sharma advised: "No matter how hard it is, you must also accept that some people are just not ready for any number of reasons."

2) Frame the issue in the health context

If your family member is ready to talk, don't say things like, "I've noticed you've gained a lot of weight." (He is already aware.) And don't start rattling off inane and obvious advice about exercising more and eating fruits and vegetables.

Instead, frame the issue in the context of health — the reason you're concerned in the first place. Gudzune suggested saying something like, "I’ve noticed that you seem to be going through some changes, and I wanted to talk to you about your health."

If the family member responds positively, you can come back with something supportive like, "Is this something we can work on together?"

But there is really no need to start lecturing him on the health risks from obesity, warns Yoni Freedhoff, an obesity doctor and author of The Diet Fix. "Society and the media has already ensured that they are not lacking in appreciation that weight carries risk," he says. (They've also fully encountered "the erroneous belief that obesity must be served with heaping helpings of guilt and shame," he adds.)

Sharma agrees: "Cajoling or 'friendly words of advice' do very little to help and can in fact result in the opposite — resistance and defiance."

3) Help create a healthy environment

There are other little things you can do to make life healthier for those around you. There's good evidence that the way we set up our environments can have an impact on our weight. Make sure the cupboards at home aren't stuffed with junk food; keep cookies and chips off the countertops or out of the house; stock the fridge with healthy options.

Freedhoff added these other tips: "Ensure Thanksgiving dinner isn’t an over-the-top indulgence fest. Go for walks as a family. Don’t buy or serve sugar-sweetened beverages. Ensure regular meals are served so as to minimize hunger. Don’t bake to excess. Get rid of the chip cupboard." These are good ideas at any time. You don't need a formal weight loss goal to start.

Welcome to Dear Julia, a weekly column where readers can submit everyday health questions. Which over-the-counter painkillers work best? Is it better to run or walk for exercise? How much harm does frequent flying do to your body? Julia Belluz will sift through the research and consult with experts in the field to figure out how science can help us live happier and healthier lives.

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