Practice recommendation
- A physician’s empathy, collaborative approach, and words of support can have a positive effect on overweight and obese women’s weight loss efforts.
Abstract
Purpose This study explores how weight-related topics are discussed between physicians and their overweight and obese female patients.
Methods We surveyed and audio-recorded preventive health and chronic care visits with 25 overweight and obese female patients. We coded both for quantity (content and time) of weight-related discussions and quality (adherence to Motivational Interviewing [MI] techniques). We then tested correlations of these measures with patients’ reported attempts to lose weight, change diet, and change exercise patterns 1 month after the visit.
Results Weight was routinely addressed (19 of 25 encounters). Patients usually initiated the topic (67% of time). Physicians’ use of MI techniques resulted in patients attempting to lose weight and changing their exercise patterns.
Conclusion Physicians may benefit from MI training to help patients lose weight.
Research has shown that when physicians advise overweight patients to lose weight, improve their diet, or increase their physical activity, patients are more likely to report attempting to do so.1-3 In a study of 433 primary care patients, 46% reported trying to lose weight after their physician counseled them about nutrition, compared with 37% who were not counseled.1
The reality, though, is that physicians are not very likely to address weight loss. Data from the Behavioral Risk Factor Surveillance System indicate that patients report their providers address weight loss in fewer than 20% of their examinations.4 These low rates are concerning; when physicians do not advise patients to lose weight, patients may believe their weight is not a problem.5 Even more worrisome: Physicians are rarely trained on how to counsel patients about weight loss. So, when physicians do counsel patients, it may not be effective.
Using Motivational Interviewing
One effective style of counseling is Motivational Interviewing (MI). MI is a patient-centered, directive counseling style used to help patients explore and resolve their ambivalence related to a particular behavior change (see What is Motivational Interviewing?).6,7 Researchers have studied the use of MI by counselors and case managers (in handling smoking cessation),8-11 but not by physicians. Further, no one has examined whether physicians instinctively use MI techniques when discussing weight loss with their patients, or whether MI counseling results in patients trying to lose weight.
The primary aim of this study was to assess how overweight and obese female patients discuss weight loss with their physicians. We also wanted to explore the role that physicians’ way of discussing weight loss—and the use of MI in particular—might play in their patients’ motivation to lose weight.
What is Motivational Interviewing?
Motivational Interviewing is a counseling style intended to create changes in behavior by helping patients to explore and resolve their ambivalence.7 In a patient-physician encounter guided by MI:
- The motivation to change comes from the patient.
- It is the patient’s job to articulate and resolve his or her ambivalence.
- Direct persuasion is not used; the physician is quiet and eliciting, but directive in helping the patient examine his or her ambivalence.
- Readiness for change is recognized not as a patient trait, but as a part of the interaction between physician and patient.
- The patient-physician relationship is regarded more like a partnership.
Methods
Setting and recruitment
All data were collected in a family practice clinic within Duke University Medical Center. We approached 9 physicians in the practice to participate, and all consented. Only 7 physicians had visits with overweight or obese patients and were included in this report. We reviewed their electronic patient appointment schedules twice a week to identify female patients meeting the following criteria: English-speaking, overweight or obese (body mass index [BMI] ≥25 kg/m2), 40 years of age or older, and with health maintenance or chronic care appointments scheduled at least 7 days later. We sent these patients a letter describing the study, and allowed them 7 days to call a toll-free number if they didn’t want to participate.
We took several steps to avoid priming physicians and patients about the purpose of the study. First, both physicians and patients were told the study was about how doctors and patients discuss preventive health topics—they were not told the study was about examining discussions of weight. Second, we surveyed physicians 1 month prior to audio-recording visits, and patients 1 week prior to their visit. Third, we included measures for other preventive health topics (eg, smoking and alcohol) to detract attention from weight.