Optimistic about overcoming obesity

Research from Oxford University and the American College of Physicians, published this week in the Annals of Internal Medicine (AIM), has revealed that overweight and obese patients were more likely to lose weight if physicians offered advice using an optimistic tone.

People were more likely to participate in a recommended weight loss program and lose weight successfully if their doctors presented treatments for obesity as good news and as an “opportunity” rather than emphasizing the negative consequences of obesity or using neutral language. 

Patients have reported that clinicians’ words and tone matter to them and can motivate or demotivate weight loss, yet evidence has been lacking regarding effective strategies for discussing weight and offering treatment. 

The researchers analysed recordings of patient encounters at 38 primary care clinics where patients were offered a 12-week no-cost behavioural weight loss intervention and found that patients who received counselling via such an approach had the highest observed weight loss at the end of 12 months. 

“This seemed to be driven by higher enrolment in the weight loss program and supported the recommendations in the international guidelines calling for primary care clinicians to deal with overweight and obese patients with the same respect and positivity usually reserved for other chronic conditions,” they said.  

The team analysed recordings of conversations physicians had with their patients regarding a 12-week, no-cost, behavioural weight loss intervention to examine relationships between language used in the clinical visit and patient behaviours, including participation in the program and weight loss outcomes.  

Interaction patterns were characterized one of three approach types: 

  • The ‘good news’ approach, which was the least common language style observed, communicated positivity and optimism, focused on the benefits of weight loss, and presented the weight loss program as an ‘opportunity,’ with very little mention of obesity, body mass index, or weight as a problem.  
    • The paralinguistic style was smooth and fast-paced and conveyed excitement.  
  • The ‘bad news’ approach emphasized the ‘problem’ of obesity, with physicians asserting themselves as the expert and focused on challenges of weight control, with a delivery that conveyed regret and pessimism.  
  • The ‘neutral’ news delivery, the most common observed, lacked either positive or negative features. 

The results showed that patients who received counselling via the good news approach lost approximately 4.8 kg on average compared with 2.7 kg among those in the bad news group and 1.2 kg among those in the neutral news group.  

The greater weight loss in the good news group seemed to be driven by higher enrolment in the 12-week weight loss program, with 87% of participants in this group attended the program compared with less than half of those in the neutral news and bad news groups.