Empathy goes a long way in weight loss discussions
Female patients are more likely to step up weight loss efforts when a physician shows empathy and offers support
We identified 202 eligible female patients. Of those, 96 had appointments that passed before we could contact them; 11 called the 800 number to refuse. Of the remaining 95 women, we reached 94 by phone. Of those, 19 refused to participate, 46 were ineligible because we had reached the targeted number of women in their weight category, and 4 skipped their appointments. Thus, we audio-recorded 25 encounters (for 14 obese and 11 overweight patients). Of these 25 patients, 24 completed the 1-month follow-up.
Patient demographics. Patients had a mean age of 59 years (standard deviation [SD]=11). Half were white; 42% were college-educated. Forty-two percent reported being in poor to fair health (TABLE 1).
The typical participant was moderately confident and ready to lose weight both before and after their visit. One month after their visit, 63% reported attempting to lose weight. More than half attempted to change their diet (67%); slightly more than half changed their exercise patterns (58%) (TABLE 2).
Physician demographics. Physicians had a mean age of 43 years (SD=10). About half were white; about half were female. No physicians were overweight.
TABLE 1
Characteristics of patients and physicians
| CHARACTERISTIC | PATIENT (N=25) | PHYSICIAN (N=7) |
|---|---|---|
| Age (M, SD) | 59 (11) | 43 (10) |
| Race (%)* | ||
| White | 50 | 57 |
| Black | 50 | 29 |
| Indian | 14 | |
| Female (%) | 100 | 57 |
| Married (%) | 46 | — |
| Employed (%) | 54 | 100 |
| College graduate (%) | 42 | 100 |
| Health status, self-reported (%) | ||
| Poor to fair | 42 | — |
| Good | 37 | — |
| Very good to excellent | 21 | — |
| Times lost at least 10 lbs (mean, SD) | 5.8 (4.0) | — |
| New patient with physician (%) | 12 | — |
| Body mass index (mean, SD) | 37 (11) | 22 (3) |
| * One participant did not provide his/her race. | ||
TABLE 2
Feeling about weight loss before and after the visit
| BASELINE | POST-VISIT | 1 MONTH | |
|---|---|---|---|
| Mediators of behavior change | |||
| Confidence in losing weight (M, SD)* | 3.8 (1.4) | 3.8 (1.1) | – |
| Stage of readiness to lose weight (%) | |||
| Precontemplation | 25% | 28% | – |
| Contemplation | 8% | 8% | – |
| Preparation | 67% | 64% | – |
| Behavior change variables | |||
| Attempted to lose weight (%) | – | – | 63% |
| Attempted to change diet (%) | – | – | 67% |
| Changed exercise patterns (%) | – | – | 58% |
| * Scale ranged from 1=not at all confident to 5=extremely confident. | |||
Patients were more likely to raise the weight issue
Weight-related topics were addressed in 19 of the 25 encounters (11 out of 12 preventive health visits, 8 out of 13 chronic care visits). The mean time spent discussing weight-related topics was 6.9 minutes out of an mean total of 27.0 minutes, or 26% of the total patient-physician time. Weight was more likely to be addressed with obese patients (86%) than with overweight patients (63%).
Patients were more likely than physicians to initiate discussions on weight. Physicians raised weight-related topics 37% of the time. Obese patients were slightly more likely to raise weight-related topics (8 out of 12 times [67%]) than overweight patients (4 out of 7 times [57%]).
The weight-related topics addressed were, in order from most to least frequent: physical activity, diet, BMI, psychosocial issues (eg, motivation to lose weight, triggers for unhealthful eating [such as family cookouts], negative talk [such as telling oneself that losing weight is too hard]), referral to a nutritionist, weight loss surgery, goal setting, health care avoidance, and weight loss medication. When comparing those who attempted to lose weight (n=15) with those who did not (n=9), there was no significant difference in whether or how often a topic was addressed.
Physicians’ empathy scores are moderate
Physicians had a moderate score for Empathy (mean=3.8, standard deviation [SD]=1.5, on 7-point scale), a low score for MI Spirit (mean=2.4, standard deviation [SD]=1.4, on 7-point scale), and displayed fewer MI-adherent behaviors than MI-nonadherent behaviors (mean=0.4, SD=0.3). These means did not differ significantly based on the patients’ weight.
Weight loss conversations linked to patients’ readiness
The discussion of weight-related topics, and the time spent doing so, were related to patients’ readiness to lose weight after their initial examination, when patients’ baseline readiness to lose weight was controlled. The more ready patients were to lose weight after their visit, the more likely they had discussed weight (Spearman’s rank correlation coefficient [r]=.52, P=.01) and spent more time discussing weight (r=.42, P=.05). No other associations were statistically significant (TABLE W1).
Several of the Motivational Interviewing scores predicted patients’ outcomes. When physicians showed more empathy, patients were more likely to report changing their exercise patterns 1 month after the visit (r=.50, P=.02). When physicians displayed more of an MI Spirit, patients were more likely to be ready to lose weight (r=.63, P=.005) and change their exercise patterns (r=.47, P=.04). Further, when physicians used more MI-adherent techniques, patients were more likely to attempt to lose weight (r=.42, P=.08).
Discussion: Good quality discussions lead to change
While more discussion about weight loss led to a greater readiness to lose weight, it was the quality of the discussions that actually led to behavior changes. Most patients had virtually the same levels of readiness to lose weight before and after the visit. It is likely that patients who were ready to lose weight discussed their weight with their physicians—and spent more time discussing it than those patients who were not ready to lose weight.
