Room for improvement in clinicians' weight-loss advice for patients with obesity, study finds
An analysis of audio recordings of consultations from the Brief Interventions for Weight Loss trial found that primary care clinicians who were trained to provide weight-loss advice in around 30 seconds commonly advised a general “Eat less, do more” approach.
Primary care clinicians who offered brief weight-loss advice to patients with obesity commonly communicated broad messages to eat less and do more, often without providing detail on how to do so, a recent study found.
Researchers applied qualitative content analysis to audio recordings of consultations from the Brief Interventions for Weight Loss trial, in which U.K. primary care clinicians randomized to one arm gave very brief weight-loss advice to adult patients with a body mass index of 30 kg/m2 or greater (≥25 kg/m2 or greater if Asian). Enrollment ran from June 4, 2013, to Dec. 23, 2014. Prior to participating, clinicians watched a training video that encouraged them to communicate that weight loss would improve health, using their usual style. The researchers coded consultation transcripts to capture the advice clinicians were giving, then grouped codes into categories, which they further grouped into four clusters representing broader themes of weight-loss advice: 1) diet and physical activity changes, 2) implementation tips to support diet and physical activity changes, 3) signposting support, and 4) style of advice delivery. Results were published Dec. 13 by Family Practice.
Of 237 available recordings, the researchers randomly selected 159 to analyze. Of the 159 patients, 62 were male and 92 were female; data were missing for the remaining five patients. The mean age of patients was 57 years, and the mean initial body mass index was 35 kg/m2. Clinicians advised making dietary changes in 44 consultations, physical activity changes in 23 consultations, and both in 14 interactions, commonly communicating messages to eat less and do more. In 33 consultations, clinicians provided implementation tips, with specific advice such as eating smaller portions (21 consultations), changes to mindset or intention (13 consultations), avoiding alcohol (six consultations), and daily or weekly self-weighing (five consultations). One of the most common pieces of advice (126 instances in 78 consultations) was that patients find additional support, either through a follow-up appointment (84 instances) or elsewhere (37 instances). As for style of advice delivery, the advice was superficial/general in 58 consultations and personalized to the patient in 30 consultations. The researchers observed that clinicians tended to provide superficial advice unprompted or after the patient mentioned difficulty in trying to lose weight and personalized advice when the patient had explained what they were doing to try to lose weight.
The content of the advice of clinicians in the trial may differ from that of others who have not received training in delivering brief interventions for weight loss, the study authors noted. They added that a further limitation was that participants were encouraged to provide weight-loss advice in around 30 seconds, limiting the opportunity to personalize it to the patient.
“When clinicians lacked support services to offer patients they commonly advocated a general ‘eat less, do more’ approach. This message is disliked by patients, and unlikely to be effective,” the authors concluded. “Future training and guidelines can address misconceptions that this approach is effective for the population of people living with obesity, and instead emphasize the importance of offering support through referrals to weight management services if possible.”