Clinicians should present weight loss treatments as positive opportunities when discussing excess weight during clinical visits rather than framing the conversation in negative terms, a study shows. “Patients have reported that clinicians’ words and tone matter to them and can motivate or demotivate weight loss,” write the authors. “Our analyses show that presenting treatments for obesity as good news and as an ‘opportunity’ with a style of talk that sounds positive, and emphasizes that clinicians are pleased to help, is associated with more weight loss than other approaches.”
The Brief Intervention for Weight Loss trial included 246 participants with obesity seen by 87 general practitioners at 38 primary care clinics in England. Recorded conversations between health professionals and patients with obesity about a 12-week behavioral weight management program offered as part of the randomized clinical trial were analyzed.
Clinicians’ approaches during the conversation had these effects on a primary outcome of patient weight loss at 12 months: “Three interactional approaches were identified on the basis of clinicians’ linguistic and paralinguistic practices: creating a sense of referrals as ‘good news’ related to the opportunity of the referral (n = 62); ‘bad news,’ focusing on the harms of obesity (n = 82); or neutral (n = 102). Outcome data were missing from 57 participants, so weighted analyses were done to adjust for missingness. Relative to neutral news, good news was associated with increased agreement to attend the program (adjusted risk difference, 0.25 [95% CI, 0.15 to 0.35]), increased attendance (adjusted risk difference, 0.45 [CI, 0.34 to 0.56]), and weight change (adjusted difference, −3.60 [CI, −6.58 to −0.62]). There was no evidence of differences in mean weight change comparing bad and neutral news, and no evidence of differences in patient satisfaction across all 3 approaches.”
Editorial: “[These findings], although preliminary, suggest a promising path forward for physicians to engage with patients about weight and treatment in an effective yet respectful way,” write editorialists. “Although studying the role of weight stigmatizing language was not a prespecified study goal, the good news delivery style does appear to be consistent with a less stigmatizing approach. Moreover, the median duration of conversations across all 3 delivery styles was only 78 seconds (range, 8 to 458 seconds), suggesting that when physicians are supported with appropriate resources, even brief counseling can be effective. This contrasts with results from an earlier systematic review of motivational interviewing—a nonconfrontational but often time-intensive psychotherapeutic approach that seeks to help patients clarify their goals and motivations. This review found no evidence that interventions integrating motivational interviewing were more effective than standard behavioral approaches. Nevertheless, [the current results] must be interpreted with caution. Although embedded within a clinical trial, the counseling delivery styles were not randomized; it is possible that patients who were more likely to engage in behavior change and weight loss treatment were also more likely to elicit positive news delivery communication from their physicians. Comorbid conditions were not collected, and authors could not account for baseline clinical differences other than age, sex, and body mass index. Thus, these findings need to be replicated in future work. Interestingly, a more neutral counseling delivery did not produce better results than the bad news delivery style.”