An analysis of patient encounters at 38 primary care clinics in England found that patients were more likely to participate in a recommended weight loss programme and lose weight successfully if physicians presented treatments for obesity as good news and as an ‘opportunity’ rather than emphasising the negative consequences of obesity or using neutral language.
International guidelines recommend that primary care clinicians screen for overweight and obesity and offer treatment opportunistically. Patients have reported that clinicians' words and tone matter to them and can motivate or demotivate weight loss. However, evidence is lacking on effective strategies for discussing weight and offering treatment.
Researchers from the University of Oxford analysed recordings of conversations 87 general practitioners had with 246 patients regarding a 12-week no-cost behavioural weight loss intervention to examine relationships between language used in the clinical visit and patient behaviours, including participation in the programme and weight loss outcomes. Interaction patterns were characterised one of three approach types.
The "good news" approach, which was the least common language style observed, communicated positivity and optimism, focused on the benefits of weight loss, and presented the weight loss program as an "opportunity," with very little mention of obesity, body mass index or weight as a problem. Paralinguistic style was smooth and fast-paced and conveyed excitement.
The "bad news" approach emphasised the "problem" of obesity, with physicians asserting themselves as the expert and focused on challenges of weight control, with a delivery that conveyed regret and pessimism. The "neutral" news delivery, the most common observed, lacked either positive or negative features.
The researchers found that patients who received counselling via the good news approach had the highest observed weight loss at the end of 12 months, losing approximately 4.8kg (10.6lb) on average compared with 2.7kg (6.0lb) among those in the bad news group and 1.2kg (2.6lb) among those in the neutral news group.
The greater weight loss in the good news group seemed to be driven by higher enrolment in the 12-week weight loss program, with 87% of participants in this group attended the program compared with less than half of those in the neutral news and bad news groups. Among those enrolled, weight loss outcomes did not vary substantially regardless of how the initial counselling was delivered.
The findings were featured in the paper, ‘Relationship Between Clinician Language and the Success of Behavioral Weight Loss Interventions’ published in the Annals of Internal Medicine.