I just finished watching Joy Pape's lecture titled Diabesity. She asked some pertinent questions about how we as healthcare professionals view persons who are obese. It made me stop and reflect about my honest feelings toward the obese patient. I think often about the concept of self-empowerment and wonder how we can promote self-efficacy. How do you think our negative attitudes might effect our patients? How can we be sure that we don't participate in the "blame game"? How can we encourage someone to make best choices for themselves?
In reflecting on my own patient population, I wonder how many patients tend to blame themselves for their elevated BG or A1c whether it's their fault or not? What do you think?

The art of empowerment is really not coming easy and we as diabetes educators need to constantly re-evaluate ourselves and strive to improve our skills.  A book that I've found very inspiring is "Motivational Interviewing in Health Care", S. Rollnick and W.R. Miller. 
To me it is important to remind myself that this obese person had a lifestyle maybe already from babyhood that contributed to his/her problem.  To change is painful and even once in the action stage the person might get disponded because of not having the expected results is getting "burned out" and it is very easy to recycle back into precontemplation.  I hate it if health care providers tell (sometimes instruct) their patients "you've got to loose weight" and just leave it there.  I personally abandon the message of loosing weight but rather focus on the pros of a healthier lifestyle and to preserve or improve quality of life.  
Yes, often patients have self blame if their blood glucose is out of target and they will sort of confess that they've been "naughty".  To me it is actually wonderful if they do indentify the reasons for out of target blood glucose readings because then they are already in a process of analizing and not only pulling the shoulders up of "don't know".  

Thanks for your insightful comments and recommendations. I oftentimes remind myself that I am to be an encourager as much or more than an instructor.

Good Morning All:
The blame game is not productive and is destructive.   Cognitive behavioural therapy is a new field to me.  As  dieitatian that had training over 30 years ago, we only studied the why, and not the how.  Has anyone done any training or attended any classes on CBT?

I have not had formal training in CBT and I too often have to give myself a "time out" when it comes to judging obese people.  One of my responsibilites in the hospital is the approval of specialty rental beds and I often find myself judging obese people when I am asked to approve a bariatric bed. I often wonder to myself how could the patient not know how big they are getting and do something about it?  You dont just wake up one day and you find yourself at 750 lbs. Then I have to remind myself that there may be so many other factors that led to that weight gain. I recently had a very obese patient come in for a surgical procedure and there was a complication with the procedure, secondary to his weight.  He was so angry at the surgeon and at the nurses and just kept repeating that he didnt come in with this problem and didnt want to leave with it and everyone was getting fed up.  Having had enough of the abuse the surgeon finally went in and told him the complication was directly related to his obesity and he was informed during the consent process that this was a risk and he accepted the risk.  He told the patient to focus on getting well and told him to start thinking about bariatric surgery.  The patient did calm down and did actually ask for a referral to the bariatric center. Hopefully he will persue it. Sometimes it takes a little tough love to get through to someone.  In this day and age everyone is so preoccupied with being "politically correct".  I think, in so many ways, being pc is going to hurt us as a nation more than it helps us!

I have to agree. There's a way to talk with patients without blaming them. We need to encourage them, tell them there's hope, and give them options.