Doctors’ Weight Loss Advice to Patients Is All in the Delivery

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At last it can be confirmed: The fact that you haven’t been able to lose weight is actually … your doctor’s fault. Sort of.

In an era in which one-third of all Americans are clinically obese and two-thirds are either obese or simply overweight, it’s fair to ask just what’s going on when people visit their doctors. Patients may be habitually resistant to heeding medical advice (how many times have most smokers been told to quit?), but are doctors doing nothing to talk sense into the heads of people whose weight puts them at serious risk of heart attack, stroke and diabetes? (More on The ‘Other’ Salt: 5 Foods Rich in Potassium)

Previous research does show that docs sometimes sidestep such potentially touchy questions. Indeed, one study from 2007 revealed that pediatricians often choose not to discuss the obvious with parents — that Johnny or Janie simply weighs too much — for fear of both giving offense and upsetting the child.

In a study just published in the American Journal of Preventive Medicine, investigators at Duke University Medical Center looked at whether primary care physicians were similarly dropping the ball when it came to their adult patients. The investigators received permission to record the conversations between 40 doctors and 461 of their overweight or obese patients over the course of 18 months. To ensure that the doctors did not simply give the investigators what they thought they wanted to hear, they were not told the specific purpose of the study — merely that it concerned general doctor-patient discussions.

When the tapes were transcribed and the results tabulated, the results were more impressive than the American obesity epidemic would suggest. In fully 69% of encounters, doctors did discuss weight issues with their patients, devoting an average of three and a half minutes to the topic. “That may not sound like much,” said lead author Kathryn Pollak of the Duke Comprehensive Cancer Center, in a statement. “But it amounted to about 15% of the time of an average office visit, which ran about 20 minutes.” (More on See a special report on overcoming obesity)

So why aren’t patients losing? Actually, they are; the key was which patients of which doctors. The investigators found that when doctors took a judgmental or confrontational approach, their patients tended to dig in and tune them out. This is consistent with bodies of research that have looked at why public health campaigns often fail. On at least some occasions, the authoritative tone of the messages — such as a “Click it or ticket” campaign that reminded people to use seat belts or risk a fine — are to blame. The response (“I’ll show you! I won’t wear my seat belt!”) may not make sense, but whoever said human beings are rational animals?

A more effective approach — as the new Duke study confirmed — is for doctors and other authority figures to take a motivational tone, encouraging rather than scolding and listening rather than lecturing. Part of that technique involves the reflective approach marriage counselors often tell spouses to take with each other. When a patient makes a dozen excuses for why it’s hard to fit exercise into a busy workday, physicians will make more progress if they refrain from saying, in effect, “Nonsense,” and opt instead for, “O.K., so it sounds like you’re having trouble finding time for a workout.”

That may sound contrived (it often does to quarreling spouses), but it tends to work — as it did in the Duke study, in which the patients of doctors who used the technique lost, on average, 3.5 lbs. three months after the first visit. “When doctors use reflective statements, it changes the relationship,” said Pollak. “The patient becomes more of an equal, more of a partner in care.”

It’s not every doctor who’s capable of forging that kind of bond with a patient; but it’s not every patient who manages to lose weight even when the benefits are so obvious. The fact that the successful doctors and the successful patients so often wind up together may say something important.

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Photos: Obesity Rehab

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