Talk weight: an observational study of communication about patient weight in primary care consultations

Abstract

BackgroundObesity is a major public health issue and primary care practitioners are well placed to opportunistically raise the issue of overweight or obesity with their patients.Aim and methodsThis study investigated the prevalence of weight discussion in primary care consultations with overweight and obese patients, in a practice in Fife, Scotland, and described weight-related communication using video analysis.FindingsWeight was raised in 25% of consultations with overweight and obese patients. GPs initiated weight discussion more often than patients; however, these attempts were often blocked by patients. Weight-related outcomes were more common when patients initiated the weight discussion. This study confirms the potential of video analysis for understanding primary care weight discussion. It also suggests that GPs may benefit from a communication-based intervention to tackle patient blocking behaviours and contributes to the evidence suggesting that interventions targeted to increase the prevalence of weight-related discussions with their patients are needed.

Talking about overweight and obesity in rural Australian general practice

“…Given their frequent contact with patients who are considered overweight or obese (Heintze et al, ; Laidlaw, McHale, Locke, & Cecil, ; Peters et al, ; Swift, Choi, Puhl, & Glazebrook, ), primary health care physicians (GPs in Australia) are often identified in dominant discourse as the central actors in responding to rates of overweight and obesity (Heintze et al, ; Laidlaw et al, ; Peters et al, ). Consequently, GPs increasingly receive explicit directives from overseeing bodies to work intensively with patients around overweight and obesity (Alexander et al, ; Laidlaw et al, ). However, currently available evidence suggests that discussions about overweight and obesity between a patient and their primary health care professional are uncommon (Turner, Harris, & Mazza, ).…”

“…It should be noted that patients have often been found to be reticent about bringing up their weight with doctors (Tham & Young, ; Thomas, Hyde, Karunaratne, Herbert, & Komesaroff, ). GPs in Laidlaw et al’s (, p. 313) study were more likely to initiate a discussion about weight than patients, but these discussions were rarely successful and patients frequently “reduced space” (defined by Laidlaw et al (, p. 311) as “using behaviours that are not facilitative for discussing weight, such as blocking or reducing scope for further discussion or changing the topic of discussion”) for these conversations. Patient‐initiated discussions were “more likely to result in a weight‐related outcome” (Laidlaw et al, , p. 313).…”

“…GPs in Laidlaw et al’s (, p. 313) study were more likely to initiate a discussion about weight than patients, but these discussions were rarely successful and patients frequently “reduced space” (defined by Laidlaw et al (, p. 311) as “using behaviours that are not facilitative for discussing weight, such as blocking or reducing scope for further discussion or changing the topic of discussion”) for these conversations. Patient‐initiated discussions were “more likely to result in a weight‐related outcome” (Laidlaw et al, , p. 313). However, if patients attempted to raise the issue of weight towards the end of the consultation, GPs frequently “blocked” the discussion, which suggests that time constraints may encourage blocking behaviours and that weight discussions are understood as time consuming (Laidlaw et al, , p. 313).…”

“…Patient‐initiated discussions were “more likely to result in a weight‐related outcome” (Laidlaw et al, , p. 313). However, if patients attempted to raise the issue of weight towards the end of the consultation, GPs frequently “blocked” the discussion, which suggests that time constraints may encourage blocking behaviours and that weight discussions are understood as time consuming (Laidlaw et al, , p. 313).…”

Why Australia needs to define obesity as a chronic condition

“…Poised in this vital position therefore, GPs are not only ideally placed, but entrusted by best practice to measure obesity predictors, diagnose obesity and monitor progress [2, 5]. Laidlaw et al (2015) reported that although GPs initiated weight discussions more often than patients did, their attempts were often blocked by the patients [6]. …”