Presenting weight loss in a positive way linked to greater treatment uptake

Key takeaways:

• Positive dialogue about weight loss resulted in higher program attendance and weight loss vs. neutral dialogue.
• Dialogues were around 78 seconds, representing an opportunity for quick interventions.

Weight loss presented as a positive opportunity by physicians was associated with greater uptake of treatment and weight loss, a study published in Annals of Internal Medicine found.

According to Charlotte Albury, MSc, AFHEA, PGCert, DPhil, a medical anthropologist in the Nuffield Department of Primary Care Health Sciences at the University of Oxford, and colleagues, many physicians do not adhere to obesity treatment guidelines because they do not know what to say to patients and are concerned that they will offend them.

“Reinforcing these concerns, patients report that tones of voice and language used by clinicians have created negative feelings and undermined motivation to lose weight,” they wrote.

So, the researchers explored whether more encouraging language could improve weight outcomes in a cohort of 246 participants across 38 U.K. primary care clinics.

Albury and colleagues recorded conversations between physicians and patients about a 12-month weight loss program, where participants were exposed to either a “good news” approach (n = 62), a “bad news” approach (n = 82) or a “neutral news” approach (n = 102).

For the good news approach, physicians focused on the benefits of weight loss and described the program as an opportunity, with few mentions of BMI or weight loss as a problem. In comparison, the bad news approach underlined the problems of obesity and challenges of weight loss — with the physician positioning themselves as an expert — whereas the neutral news approach lacked either positive or negative features.

At the end of 12 months, the researchers reported that the average amount of weight loss was:

• 4.79 kg (95% CI, –7.09 to –2.49) among those in the good news group;
• 2.74 kg (95% CI, –4.63 to –0.84) among those in the bad news group; and
• 1.19 kg (95% CI, –3.24 to 0.87) among those in the neutral news group.

Overall, when compared with neutral news, good news was linked to greater:

• agreement to attend the program (adjusted risk difference = 0.25; 95% CI, 0.15-0.35);
• program attendance (adjusted risk difference = 0.45; 95% CI, 0.34-0.56); and
• weight change (adjusted difference = –3.6; 95% CI, –6.58 to – 0.62).

“These results reinforce that notion that offering support, as opposed to advising on health harms, is motivating,” Albury and colleagues wrote. “Clinicians can decide for themselves on the potential of the good news style presented here to maximize the effect of their time and benefit their patients.”

In a related editorial, Christina C. Wee, MD, MPH, vice president of the ACP, and John E. Cornell, PhD, an adjunct assistant professor at the University of Texas School of Public Health, wrote that the findings “suggest a promising path forward for physicians to engage with patients about weight and treatment in an effective yet respectful way.”

“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,” they wrote. “Moreover, the median duration of conversations across all three delivery styles was only 78 seconds, suggesting that when physicians are supported with appropriate resources, even brief counseling can be effective.”

References:

• Albury C, et al. Ann Intern Med. 2023;doi:10.7326/M22-2360.
• Wee C, Cornell J. Ann Intern Med. 2023;doi:10.7326/M23-2568.