Primary care providers' communication with patients during weight counseling: A focus group study

Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA. Electronic address: .
Patient Education and Counseling (Impact Factor: 2.2). 07/2012; 89(1):152-7. DOI: 10.1016/j.pec.2012.06.033
Source: PubMed


Primary care providers (PCPs) are encouraged to counsel their obese patients about weight loss. We used focus groups to explore how PCPs communicate with patients about weight management.
During the summer of 2010, we conducted five focus groups of community-based PCPs who had patients enrolled in a practice-based, randomized controlled weight loss trial in Maryland. Focus groups were audio-recorded and transcribed verbatim. Two investigators independently coded transcripts for thematic content using editing style analysis.
Twenty-six PCPs from six different practices participated. Mean years in practice were 16.4 (SD 11.7) and 77% practiced internal medicine. We identified three communication-based themes about weight loss counseling: (1) motivating patients to lose weight, (2) partnering with the patient to achieve weight loss, and (3) handling challenges that arise during weight counseling.
PCPs use a variety of strategies to communicate with their patients about weight loss. Some PCPs already use patient-centered approaches to communicate with their patients about weight loss, suggesting that future weight counseling interventions should be tailored to build upon this strength.
PCPs' weight loss counseling may be improved by using techniques with demonstrated behavior change effectiveness such as the 5A's or motivational interviewing.

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    • "There is evidence to suggest that professional attitudes interact with patient characteristics to influence how healthcare professionals deliver lifestyle advice [7][8][9][10]. For example Arber et al.[11] found that healthcare professionals were less likely to ask about smoking and alcohol consumption during screening for coronary heart disease, if the patient was female or more elderly. "
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    ABSTRACT: The UK Department of Health introduced the National Health Service (NHS) Health Check Programme in April 2009 in an attempt to improve primary and secondary prevention of cardiovascular disease in the UK population and to reduce health inequalities. Healthcare professionals' attitudes towards giving lifestyle advice will influence how they interact with patients during consultations We therefore sought to identify the attitudes of primary care healthcare professionals towards the delivery of lifestyle advice in the context of the NHS Health Check Programme. Fifty-two primary care healthcare professionals undertook a Q sort with 36 statements that represented a range of viewpoints about the importance of lifestyle change, medication, giving lifestyle advice in the primary care setting, and the individual, social and material factors that might impact on lifestyle related behaviour change. Sorts were analysed by-person using principal components analysis and varimax rotation. Five statistically independent factors (accounts) reflected distinct views on the topic. Account 1 was supportive of initiatives like the NHS Health Check, and emphasised the importance of professionals working collaboratively with patients to facilitate lifestyle change. Account 2 expressed views on the potential overuse of statin medication and placed responsibility for lifestyle change with the patient. Account 3 viewed the healthcare professional role to be one of educator, emphasising the provision of information. Account 4 perceived lifestyle change to be difficult for patients and emphasised the need for healthcare professionals to be role models. Account 5 was inconsistent about the value of lifestyle change, or the role of healthcare professionals in promoting it, a finding that may be due to ambivalence about the health check or to lack of engagement with the Q sort task. We found no strong associations between any of the factors and, gender, role, age or ethnicity. Our findings suggest that healthcare professionals hold viewpoints that may influence how they interact with patients during health checks. When implementing programmes like the NHS Health Check, it would be useful to take healthcare professionals' views into account. Attitudes and beliefs could be explored during training sessions, for example.
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    ABSTRACT: Although the treatment of both adult and pediatric obesity in primary care is in its infancy, there is a growing base of evidence that patient-centered strategies, used by clinicians alone or in combination with other health-care professionals or community programs, can be effective. This paper presents, using the 5 As framework (Ask, Advise, Agree/Assess, Assist, and Arrange), behavioral strategies that assist patients making lifestyle changes for weight management.
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    ABSTRACT: Objective To examine the association between patient-perceived judgments about weight by primary care providers (PCP) and self-reported weight loss. Methods We conducted a national internet-based survey of 600 adults engaged in primary care with a BMI ≥ 25 kg/m2 in 2012. Our weight loss outcomes included attempted weight loss and achieved ≥ 10% weight loss in the last 12 months. Our independent variable was “feeling judged about my weight by my PCP.” We created an interaction between perceiving judgment and PCP discussing weight loss as an independent variable. We conducted a multivariate logistic regression model adjusted for patient and PCP factors using survey weights. Results Overall, 21% perceived that their PCP judged them about their weight. Respondents who perceived judgment were significantly more likely to attempt weight loss [OR 4.67, 95%CI 1.96-11.14]. They were not more likely to achieve ≥ 10% weight loss [OR 0.87, 95%CI 0.42-1.76]. Among patients whose PCPs discussed weight loss, 20.1% achieved ≥ 10% weight loss if they did not perceive judgment by their PCP as compared to 13.5% who perceived judgment. Conclusions Weight loss discussions between patients and PCPs may lead to greater weight loss in relationships where patients do not perceive judgment about their weight.
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