Discussing unhealthy weight may motivate behavioral changes

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Simply talking to overweight and obese patients about their health risks may help motivate lifestyle changes and prevent further weight gain, according to results from two studies published in Archives of Internal Medicine this week.

Less than one half of overweight and less than two-thirds of obese participants had been told by a health care provider that they were overweight, according to a study by Robert E. Post, MD, of the Medical University of South Carolina in Charleston, and colleagues.

They analyzed data from 5,474 adults aged 20 to 64 years who had a BMI of at least 25 who were included in the 2005-2008 National Health and Nutrition Examination Survey, and found that participants were more likely to perceive themselves as overweight if a health care provider had discussed their weight problem with them (BMI ≥25, OR=6.11, 95% CI: 4.38-8.53; BMI ≥30, or=7.58, 95% CI: 5.83-9.84).

Furthermore, participants whose health care provider had told them they were overweight were more likely to have attempted to lose weight during the previous 12 months (BMI ≥25, OR=2.51; 95% CI: 2.15-1.94; BMI ≥30, OR=2.24, 95% CI: 1.74-2.88).

“This is an important intervention point that is being missed by many physicians,” Post et al wrote. “Physicians need to tell more overweight and obese patients that they are overweight because this may help encourage them to change their behavior to lose weight and lower their risk for many diseases.”

In an accompanying editorial, Robert B. Baron, MD, MS, of the University of California, San Francisco, suggested that BMI be calculated along with other vital signs like BP and cholesterol at each office visit.

“Expressing concern rather than judgment and normalizing the conversation by simply comparing measured weight with standard definitions is likely to be effective,” Baron wrote.

He suggested that clinicians adopt strategies similar to those used in communicating risks associated with cardiovascular disease, and emphasized the importance of evaluating patients for other markers of serious disease, including fasting lipid and glucose levels, BP and abdominal circumference to avoid mislabeling unhealthy BMI.

Baron also acknowledged that long-term office-based approaches to weight loss are challenging. Although little evidence exists to suggest that one strategy may be more effective than another, he suggested that encouraging weight maintenance rather than weight loss may be more realistic.

Challenges to implementing weight-loss interventions

Some of the challenges with primary care office-based weight-loss interventions that Baron discussed in his editorial were analyzed in a separate study by van der Meer et al, published in the same issue.

In this study, researchers from the Netherlands compared body weight, waist circumference, fasting glucose and blood lipid levels among 457 patients from 11 general practices who had BMIs between 24 and 40. All patients had hypertension, dyslipidemia or both, and were randomly assigned to receive either lifestyle counseling from an NP or usual care from GP.

“After one year, 80% of the participants in the NP group indeed achieved weight maintenance vs. 64% in the GP usual care group,” the researchers wrote. “However, after three years, differences between both groups had disappeared: with 60% success in weight maintenance of the participants in both groups (mean weight change -1.2% in the NP group vs. -0.6% in the GP group (P=0.37).”

Fasting glucose levels were the only marker that improved among patients in the NP group compared to those in the GP group (-0.02 mmol/L vs. 0.10 mmol/L; P=.02), but the changes were not statistically significant when compared to baseline levels.

But when the researchers compared average weight gain in the overall Dutch population from 1981 to 2004 (BMI increased 0.05 per year) with the study population, intervention with either an NP (BMI decreased -0.4) or GP (BMI decreased -0.2) successfully prevented further weight gain.

“These results are consistent with recent reviews showing mixed evidence for effectiveness of weight-loss interventions in primary care settings,” Debra Haire-Joshu, PhD, and Samuel Klein, MD, both of the Washington University School of Medicine in St. Louis, Missouri, wrote in an accompanying editorial.

Haire-Joshu and Klein pointed out that systemic reorganization within the primary care office is necessary to encourage “comprehensive obesity screening and management” and that this type of change may be hindered by financial constraints, resistance to change among office workers and lack of reimbursement for these types of services. Other barriers to successful intervention include poor patient motivation and lack of time, training or financial incentives for primary care providers.

“Weight-loss interventions in primary care settings will be more effective if coordinated care is reimbursed and more sustainable if supported by complementary actions of multiple settings, such as worksite or community,” they wrote.

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