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
How patients and physicians discussed weight influenced behavior change. When physicians were more empathic and used techniques consistent with Motivational Interviewing, patients were more likely to report changing their exercise routine and attempting to lose weight.
To date, no one has examined the effect of physicians’ MI techniques on weight-related behavior change in a large study. The low adherence to MI techniques suggests that physicians can improve their counseling skills.
Patients aren’t afraid to talk about their weight
Unexpectedly, patients were more likely than physicians to initiate weight-related discussions. Only one third of the time did physicians raise the topic. Patients appear to be “empowered” to initiate discussions about weight loss. We expected physicians and patients to both be somewhat apprehensive about raising this sensitive topic. However, these findings suggest that overweight and obese patients will initiate the discussion most of the time.
Limitations and strengths of this study
The small sample size limited the analyses. Nonetheless, we found strong correlations in this sample that suggest true relationships that were unlikely to have occurred by chance. Also, we were unable to conduct nested analyses to account for the clustering of patients seen by the same physicians. The results may not generalize to settings outside of academic medical centers and practices in which physicians have less time to spend with patients.
The physicians in this study were not overweight, which could limit the generalizability of the results. Patients may be less likely to raise the topic of weight with physicians who were themselves overweight. In addition, while we assessed single-item outcomes, more objective and extensive standard measures of diet, physical activity, and weight loss would have been optimal.
Some notable strengths of this study were that we used a comprehensive multimodal measurement in assessing both content and style of conversations in addition to patient self-report. We also examined Motivational Interviewing techniques among physicians with little or no MI training; most studies have examined MI among trained counselors only.
How to talk about weight loss: More study is needed
The most commonly addressed weight-related topics were diet and physical activity. However, when looking at the topics that were discussed, we found no patterns between those who attempted to lose weight and those who didn’t. This may mean that because weight loss is such a complex behavior, mention of any aspect of it—be it physical activity, diet, psychosocial issues, and so on—helps patients in their efforts. It also could be that the physician and patient discussed some other aspects in a previous visit; therefore, it was the cumulative effect of many conversations that influenced the patient to change.
These results need to be explored in a larger study to understand whether discussing certain topics is more influential than discussing others in promoting weight loss.
Acknowledgments
We thank Miranda West, Laura Fish, and Mary Sochaki for their work on this project. We are also grateful to the physicians and patients who agreed to have their encounters audio recorded.
Funding
This work was supported by National Cancer Institute grant 2P50 CA68438-06A2. The authors were supported in part by National Cancer Institute grants R01CA089053, R01CA100387, and National Institute of Diabetes and Digestive and Kidney Disorders grant R01DK64986.
CorrespondenceKathryn I. Pollak, PhD, Duke Comprehensive Cancer Center, Cancer Prevention, Detection and Control Research Program, 2424 Erwin Road, Room 6029, Hock Plaza I, Suite 602, Durham, NC 27705; kathryn.pollak@duke.edu.
