Q&A: Study shows PCPs often give 'unhelpful' weight-loss advice

With a lack of well-defined guidelines, many primary care providers in the United Kingdom provided generic weight-loss advice to patients with obesity, a recent study found.

Madeleine Tremblett, MSc, PhD, a qualitative researcher specializing in applied conversation analysis at Oxford University's Nuffield Department of Primary Care Health Sciences, and colleagues analyzed 159 audio recordings of consultations between patients with obesity and general practitioners (GPs) between 2013 and 2014.

The researchers reported that weight-loss advice “rarely included effective methods, mostly communicating a general ‘eat less, do more’ approach.”

Tremblett spoke with Healio about the findings, what weight-loss advice physicians should be giving and more.

Healio: Your study found that physicians often provide vague weight-loss advice for patients with obesity. What are some of the common phrases you heard, and why are they problematic?

Tremblett: We looked at GP-delivered very brief opportunistic advice. Most of the advice was about the patient making changes to their diet and physical activity to eat less and do more. For example, one of the doctors said, “otherwise it’s a question of — sort of portion control really and trying to get as much exercise as your joints will allow.” The problem with this type of message is that small changes are unlikely to be effective for patients to lose weight, and this type of message may amplify stigmatizing stereotypes.

Healio: What specific advice should primary care providers be giving to patients with obesity?

Tremblett: We would recommend that diet and exercise advice is avoided when giving brief opportunistic advice to patients living with obesity. Although doctors in this study were unable to make referrals to commercial weight loss services, other research has shown that these types of referrals and specialist support is effective.

Healio: You also found that, about three-quarters of the time, physicians told patients to get help elsewhere for weight loss. Where were they told to go and why?

Tremblett: GPs in this study were taking part in a trial and were asked to give their normal advice on the health benefits of weight loss and not to stray beyond that statement. As such, they were not encouraged to offer further support for patients but were told they could based on their own clinical judgment. We found that GPs would suggest follow-up appointments to discuss this in more depth or were given other resources (eg, a British Heart Foundation leaflet). Unfortunately, the findings from this study can’t give insight into why they did this. What we can say is that referring patients to services available in the community or signposting them to trained members of the general practice team who can provide support, such as healthy weight coaches, is a positive thing for GPs to do.

Healio: This study took place in the U.K., but do you think the findings could be applied to other countries like the U.S.?

Tremblett: We looked at very brief advice conversations between family doctors and patients living with obesity in the U.K., so the findings are specifically about the content of what those doctors said to patients in a very brief timeframe. However, other researchers in the U.S. and other countries have reported that family doctors are often unsure what advice to give to patients living with obesity, and patients living with obesity report that advice they receive is unhelpful.

Healio: What should be done to ensure that providers are giving consistent weight loss advice?

Tremblett: Better resources and training can be provided to support doctors and other health care professionals to give appropriate support to patients living with obesity that want to lose weight. Given the tight time constraints of a GP consultation, providing opportunistic personalized advice may be a challenge. Therefore, offering signposting and referrals to the range of dedicated services available on the National Health Service, rather than advice, could be the best ways GPs can provide support.

Healio: Is there anything else you’d like to add?

Tremblett: Obesity is a complex and recurring condition, family doctors are not obesity specialists and, in our study, were trying to give advice within tight time constraints, after prioritizing the patient’s presenting concern. Family doctors are trying their best with little evidence or clear guidelines to support patients. We hope that this study further demonstrates the need to provide better resources and training for doctors and other health care professionals.

References:

• Doctors give ineffective weight loss advice to patients with obesity. https://www.eurekalert.org/news-releases/973733. Published Dec. 13, 2022. Accessed Dec. 19, 2022.
• Tremblett M, et al. Family Practice. 2022;doi:10.1093/fampra/cmac137.