Strategies for Effective, Nonstigmatizing Weight Loss Counseling

Jennifer Middleton, MD, MPH
Posted on December 19, 2022

A qualitative study published last week explored the conversations physicians have with patients about weight loss; after analyzing transcripts of these recorded conversations, the researchers found that little of the physicians' advice was tailored to individual patients’ situations. Some of the physicians in this study also voiced their concerns about perpetuating or worsening the weight stigma many persons with obesity experience, leading some of them to hesitate in providing such counseling at all.

The researchers analyzed 159 very brief (30 seconds or less) conversations between patients and their general practitioners in the United Kingdom. “Qualitative content analysis was applied to 159 audio recordings of consultations from the Brief Interventions for Weight Loss (BWeL) trial, where general practitioners gave brief weight-loss advice to patients with a body mass index ≥30 kg/m² (or ≥25 kg/m² if Asian).” These participants and their general practitioners were participating in a larger randomized controlled trial examining the effect of general practitioner referrals to weight loss centers on participants’ weight (which did show modest increases in weight loss compared to standard care after one year). The researchers followed standard qualitative thematic coding methodology and found that in 126 of the 159 recordings, general practitioners provided vague, nonpersonalized advice (e.g., “look at your diet,” “reduce your carbohydrates,” “increase your physical activity safely”). The researchers did not correlate or connect these conversations to the results of their larger randomized control trial, although other studies have found that more tailored messaging delivered via motivational interviewing is generally more successful.

In their discussion section, the researchers also mentioned some of the participating general practitioners’ concerns about broaching the topic of weight with their patients, worrying that they might inadvertently perpetuate weight stigma. In the United Kingdom and in the United States, people with obesity are frequently blamed and stigmatized for their lack of “personal control” contributing to their condition, despite established scientific consensus that obesity is a multifactorial problem caused by larger socioeconomic forces. The body mass index itself has also come under significant scrutiny, as it correlates poorly with POEM-level health outcomes; simply living in a larger body does not necessarily predispose to worsened health. Before considering how to deliver messaging about weight loss, we must first determine which patients are likely to benefit from that message.

For those patients we do want to discuss weight loss with, providing specific strategies, incorporating motivational interviewing, and referral to multidisciplinary weight loss programs can all help. Several medication options now exist to support weight loss, and bariatric surgery improves type 2 diabetes and overall mortality. Be sure to check out the AFP By Topic on Obesity for additional resources.