“Negative encounters can prompt a weight loss attempt, but our study shows they do not translate into success,” says study leader Kimberly A. Gudzune, M.D., M.P.H., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine.
“Ideally, we need to talk about weight loss without making patients feel they are being judged. It’s a fine line to walk, but if we can do it with sensitivity, a lot of patients would benefit.”
Prior to the study, the researchers suspected that negative attitudes and weight stigma may be limiting the effectiveness of advice from primary care providers to their obese patients.
To test this idea, the researchers conducted a national Internet-based survey of 600 adults with a body mass index of 25 or more who see their primary care doctors on a regular basis. One of the questions was, “In the last 12 months, did you ever feel that this doctor judged you because of your weight?” Twenty one percent of participants said yes.
Furthermore, 96 percent of those who felt judged said they attempted to lose weight in the previous year, compared to 84 percent who did not. However, only 14 percent of those who felt judged and who also discussed weight loss with their doctor lost 10 percent or more of their body weight, while 20 percent who did not feel judged and also discussed weight loss shed a similar amount.
Overall, just two-thirds of participants reported that their doctors talked about weight loss.
“Many doctors avoid the conversation because they don’t want to make anyone feel bad, worrying they’ll create a rift with their patients if they even bring it up. But that is not in the patients’ best interest in terms of their long-term health,” Gudzune says.
Gudzune, whose own practice focuses on obesity, believes that doctors should be trained in ways to bring up the topic while also making the patient feel understood and supported.
She says that it helps to start with smaller weight loss goals, such as a 10 percent reduction. A larger long-term goal of 70 or 100 pounds, for example, can be a setup for frustration and failure when tackled all at once.
“We don’t want to overwhelm them,” she says. “If we are their advocates in this process — and not their critics — we can really help patients to be healthier through weight loss.”
Other Johns Hopkins researchers who contributed to this study include Wendy L. Bennett, M.D., M.P.H.; Lisa A. Cooper, M.D., M.P.H.; and Sara N. Bleich, Ph.D.
The study is published in the journal Preventive Medicine.