When doctors tell patients living with obesity to lose weight the guidance they give is generally vague, superficial, and commonly not supported by scientific evidence, according to a study by researchers from the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. The study authors stated that weight-loss advice from GPs to patients with obesity rarely included effective methods, mostly communicating a general “eat less, do more” approach.
They reported that the advice was mostly generic, and rarely tailored to patients’ existing knowledge and behaviours, and that the effectiveness of brief weight-loss advice could be improved if GPs were given clearer guidance on evidence-based recommendations.
“This research demonstrates that doctors need clear guidelines on how to talk opportunistically to patients living with obesity about weight loss,” said one of the paper’s lead authors, Madeleine Tremblett. “This can help them to avoid amplifying stigmatizing stereotypes and give effective help to patients who want to lose weight."
In their paper, ‘What advice do general practitioners give to people living with obesity to lose weight? A qualitative content analysis of recorded interactions’, published in Family Practice, the researchers analysed 159 audio recordings of consultations between general practitioners and patients from the Brief Interventions for Weight Loss (BWeL) trial, where GPs gave brief weight-loss advice to patients with a body mass index ≥30 kg/m2 (or ≥25 kg/m2 if Asian) in 137 UK surgeries.
The investigation found that weight-loss advice from doctors to patients with obesity rarely included effective methods and mostly consisted of telling patients merely to eat less and be more physically active. The advice was mostly generic and rarely tailored to patients’ existing knowledge and behaviours, such as what strategies they had tried to lose weight before.
The advice was mostly (97% of the time in analysed consultations) abstract or general. Superficial guidance, such as one doctor telling a patient to just “change their lifestyle a bit” was common. Doctors gave patients information on how to carry out their advice in only 20% of the consultations. They mostly offered weight loss guidance without any detail about how to follow it. Doctors frequently (76% of the time in the consultations) told patients to get help somewhere else for support in weight loss, often suggesting that they return for another consultation at their surgery.
The analysis indicated that when doctors did offer specific information it was often scientifically unsupported and unlikely to result in actual weight loss. The notion that small changes in behaviour (“take the stairs more often”) can have a large weight loss impact is a common myth and is even prevalent in scientific literature, but it isn’t supported by research. Another common myth was that patients just needed the “right mindset” to lose weight.
“Primary care clinicians are uncertain about what advice is effective when talking to patients living with obesity about weight, and think that patients do not follow the advice they give,” the authors concluded. “Our analysis identifies that clinicians mostly do not provide effective advice, and so even if patients were to follow the advice, they would be unlikely to lose weight. When clinicians lacked support services to offer patients they commonly advocated a general “eat less, do more” approach. This message is disliked by patients, and unlikely to be effective. Future training and guidelines can address misconceptions that this approach is effective for the population of people living with obesity, and instead emphasize the importance of offering support through referrals to weight management services if possible.”
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