Most people with obesity are actively trying to lose weight. Clinicians often want to help these efforts, but are often reluctant to offer weight loss support because they find these conversations difficult, are unsure of what to say, and have concerns that their language may cause offense.
Primary care providers who offer effective interventions to patients can improve weight loss. But reviews of primary care records show that such interventions only occur in around 5% (!) of people with obesity, and this is mainly documented as advice to lose weight as opposed to an offer of treatment to support weight loss.
A recent cohort study published in the Annals of Internal Medicine analyzed the way general practitioners (GPs) in England approached conversations about weight loss with patients, specifically looking at the relationship between clinician language and behavioral weight loss interventions. GPs were randomly assigned patients with a diagnosis of obesity to 1 of 2 brief opportunistic interventions (on average taking 90 seconds) aiming to motivate weight loss: very brief advice (control group) or discussing a referral to a weight management program (intervention group). The study authors then utilized conversation analysis (audio only) to examine the linguistic and paralinguistic (e.g., tone, pitch, pace) features of these conversations, categorizing them into 3 groups: positive as “good news”, negative as “bad news”, and neutral (a mixture of the “good news” and “bad news” approaches).
The study found that the “good news” approach (described in more detail below) resulted in a higher likelihood of accepting the referral and attending the weight loss program. Good news was also significantly associated with greater weight loss at 12 months. Bad news and neutral news were responded to less positively by patients, and were associated with similarly low uptake of treatment and similar outcomes.
Good news: “GPs often used optimistic projections to present weight loss positively and chose words that conveyed positivity—for example, “positively help”. They often described the “benefits” of weight loss and minimized the effort a patient would have to undertake to gain these. Referrals were presented as helpful but not as necessary… GPs regularly framed referrals as a “chance” or “good opportunity.” GPs used paralinguistic features to convey excitement or eagerness when delivering news, including fast pace; smooth delivery; few perturbations or hesitations; hearably smiled-through delivery; and a “bouncy” delivery with rising and falling pitch contours, where pitch often remained higher. GPs rarely mentioned that patients had obesity or discussed BMI.”
Bad news: “GPs often initiated discussions by asserting the patient’s BMI as a problem. They usually asserted themselves as knowledgeable and patients as unknowledgeable. In contrast to minimizing health issues, as in the positive approach, GPs here emphasized these problems. Weight loss was presented as a necessary solution to a medical problem. GPs who used this approach emphasized the actions the patient would need to undertake, stressing the burden of weight control. By emphasizing effort and medical problems, GPs presented referral negatively. GPs used paralinguistic features that conveyed “regret” in their telling. These included hesitation, disfluency, and elongated vowel sounds with falling pitch. Keywords, such as “weight,” were often quieter or delivered in a “creaky voice,” which reinforced negativity.”