The manner in which GPs present their diagnosis and recommendations to patients with obesity affects the likelihood that they will agree to participate in treatment, and that their weight loss efforts will succeed, according to a study.
Researchers at the University of Oxford analysed the linguistic approaches taken by 87 clinicians in discussions with patients about referral to a weight loss programme to manage obesity.
The study, which involved 246 patients attending 38 practices, was embedded in a parallel randomised controlled trial assessing different approaches to weight management for a larger cohort of adults with obesity.
International guidelines recommend that primary care clinicians screen for overweight and obesity, and offer opportunities for treatment. However, primary care records show that such intervention occurs with only around 5% of people with obesity, and mainly involves advice to lose weight rather than an offer of supportive treatment.
When asked to account for this failure to follow guidelines, clinicians reported concerns about offending patients, a lack of confidence that interventions will be effective, and uncertainty about what to say. In another study at the University of Oxford, performed in 2022, GPs' weight loss advice was reported to be generally "vague", "superficial", and "unlikely to be effective".
In the latest study, published in Annals of Internal Medicine, the researchers discovered that the words and tone used by doctors when discussing weight management with their patients can either motivate them to try to lose weight, or discourage them from doing so. However, there is a lack of evidence to show clinicians how best to approach such discussions and offer treatment.
The team assessed recorded conversations between GPs and patients in the intervention group of the parent trial, in which the GPs endorsed, offered, and facilitated referrals to a free 12-week behavioural weight loss course donated to the trial by Slimming World and Rosemary Conley.
Linguistic analyses showed that GPs adopted three different interaction styles in the consultations:
- 'Good news': GPs communicated positivity and optimism, focused on the benefits of weight loss, and presented the programme as an 'opportunity', with very little mention of obesity, body mass index, or weight as a problem. The message was delivered to the patient in a smooth and fast-paced style that conveyed excitement (62 consultations).
- 'Bad news': GPs emphasised the 'problem' of obesity, with physicians asserting themselves as the expert, focusing on the challenges of weight control. This style of delivery conveyed regret and pessimism (82 consultations).
- 'Neutral': The GPs' message to patients lacked either positive or negative features (102 consultations).
Better Weight Loss After 'Optimistic' Consultations
There was no evidence of differences in patient satisfaction across the three approaches, but the responses to 'bad news' and 'neutral' styles were less positive. In addition, there was no significant difference in mean weight change between these two groups, with weight losses of 2.7 and 1.2 kg, respectively, at 12 months.
However, compared with the 'neutral' group, those in the 'good news' group were more likely to accept referral (adjusted risk difference, 0.25 [95% CI, 0.15 to 0.35]) and to attend the weight loss programme (adjusted risk difference, 0.45 [CI, 0.34 to 0.56]), and they had significantly greater weight loss after 12 months: 4.8 kg on average (adjusted risk difference, −3.60 [CI, −6.58 to −0.62]).
The team concluded that the way in which clinicians communicated was associated with "a meaningful difference in whether patients accepted the treatment offered, and [in] their subsequent weight loss at 12 months". Higher agreement to attend the weight management programme carried through to changes in behaviour, they said.
Current Guidance Promotes a Less Effective 'Bad News' Style
The bad news is that the 'good news' approach was the least common language style observed. "These results reinforce the notion that offering support, as opposed to advising on health harms, is motivating," the researchers said. However, they noted that the analyses contradict National Institute for Health and Care Excellence (NICE) guidelines that advise clinicians to "discuss the effort and commitment needed to lose weight" — an emphasis characteristic of the 'bad news' style, which could generate resistance, and was not associated with programme uptake or attendance in the study.
In an accompanying editorial, Dr Christina Wee, senior deputy editor of the Annals of Internal Medicine, and Dr John Cornell, PhD, its associate editor for statistics, pointed out: "The greater weight loss in the good news group seemed to be driven by greater enrolment in the 12-week weight loss program; 87% of participants in this group attended the program compared with less than half of those in the neutral news and bad news groups."
Persuading patients to undertake the programme seemed to be a crucial step. Once enroled, weight loss outcomes did not appear to vary substantially, regardless of how the initial counselling was delivered, according to Wee and Cornell. Furthermore, the median duration of conversations across all three delivery styles was only 78 seconds (range 8–458 seconds), "suggesting that when physicians are supported with appropriate resources, even brief counselling can be effective".
The results "suggest a promising path forward for physicians to engage with patients about weight and treatment in an effective yet respectful way", they concluded.
The study was funded primarily by the National Institute for Health and Care Research and the Foundation for the Sociology of Health and Illness.