Patients who feel their doctors judge them about their size have a harder time losing weight, Johns Hopkins researchers have found.

“Negative encounters can prompt a weight loss attempt, but our study shows they do not translate into success,” study leader Dr. Kimberly A. Gudzune, an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, said in a statement. “Ideally, we need to talk about weight loss without making patients feel they are being judged. It’s a fine line to walk, but if we can do it with sensitivity, a lot of patients would benefit.”

The researchers surveyed 600 adults with a body mass index of 25 or more who regularly see their primary care doctors. The participants were asked if they felt judged by a doctor about their weight in the last 12 months and 21 percent said they had.

Ninety-six percent who felt judged tried to lose weight but only 14 percent lost 10 percent or more of their weight, an amount doctors say will improve health.

Gudzune said that doctors may need to be taught how to talk about the topic in ways that make patients feel supported.