Despite what it might seem, "weight" is a four letter word.
Doctors don't bring it up as often as they should. Patients also rarely bring up how their weight bothers them - embarrassment, denial or other factors might cause them to sit quietly in the office chair. I will often talk to patients about it, if it factors easily into their disease - people with high blood pressure or diabetes, for example. Then, I feel I have a legitimate reason to call attention to their obesity. Even then, many patients do not want to engage in a conversation about it. They start making excuses about how they are too busy to work out, or about how things are really stressful right now, but they have a plan to fix things in the future.
I am not trying to make light of these very real scenarios. In my experience, patients usually do not take responsibility for their weight. Some external force is keeping them from being healthy. It is very difficult to talk to people about weight loss in a 15 minute office visit, when there are other things to talk about. I always like when patients make appoints to talk only about their weight. It gives me more time to find out about their eating habits. But, more often than not, I am the one trying to talk about their weight. It's actually very frustrating to see someone come in every few months and not see their weight drop. I end up not talking about it any more, because it doesn't seem to be helping.
I understand that it's hard to lose weight. I don't think it's as expensive as people think. I do think it's easy to make small diet changes that can have a big impact. I need to not get frustrated with my patients when they struggle with their weight. Perhaps if I keep bringing it up, something will stick and they'll actually make some changes.