Oxford study shows doctors’ communication style crucial for patient weight loss success
A groundbreaking study from the University of Oxford, recently published in the Annals of Internal Medicine, has revealed that the manner in which doctors communicate with patients about obesity plays a pivotal role in their weight loss success. This innovative research delves into the nuances of communication, showing that not only do the words doctors use matter, but also their tone and delivery have a profound impact over both short and long-term patient outcomes in a medical setting.
Conducted by the Nuffield Department of Primary Care Health Sciences, the study analysed 246 recordings of consultations and discovered that even subtle elements like the choice of words and vocal tone significantly affect patient responses. The findings have emerged amidst obesity treatment guidelines urging doctors to initiate weight loss discussions and suggest weight loss services. However, effective communication on this front occurs for only about 5% of those affected annually, indicating a significant gap between policy and practice.
Many doctors express reluctance to broach sensitive topics like obesity due to fears of offending patients or feeling uncertain about handling such discussions. From the patients’ perspective, negative experiences stemming from certain tones or word choices can inadvertently harm the doctor-patient relationship.
This research, funded by the National Institute for Health and Care Research School for Primary Care Research and Foundation for the Sociology of Health and Illness, utilised conversation analysis techniques on audio recordings from the BWel trial. In this trial, doctors offered patients referrals to a 12-week weight loss programme, and the researchers observed how different communicative approaches – categorised as ‘good news’, ‘bad news’, or neutral – influenced patient engagement and satisfaction.
Statistical analysis revealed that patients were more likely to enrol in, attend, and lose more weight in programmes when the referral was framed as ‘good news’. Specifically, 83% of patients offered programmes in a positive light attended, compared to only 50% for neutrally framed offers. Those who received ‘good news’ also lost about half a stone (3.6kg) more compared to the ‘neutral’ or ‘bad’ news groups.
Dr Charlotte Albury, the study’s lead author, emphasised that framing weight loss conversations positively encourages patients to participate more actively in programmes, yielding better weight loss outcomes. She noted that while both ‘neutral’ and ‘negative’ framings led to similar levels of programme acceptance and weight loss, the ‘good news’ approach stood out for its effectiveness.
The study identified specific characteristics of ‘good’ and ‘bad’ news delivery. In the ‘good news’ approach, doctors focused on the benefits of weight loss in an optimistic manner, confidently shared advantages, and communicated fluently and cheerfully. In contrast, the ‘bad news’ framing centred on health issues related to overweight and emphasised patient effort, often marked by slower delivery and hesitations. The neutral approach maintained a steady tone without leaning towards either benefits or issues.
Dr Albury highlighted the importance of these findings for medical professionals, suggesting that adopting a ‘good news’ approach could significantly enhance patient motivation and success in weight management. By transforming discussions into positive and empowering dialogues, doctors can effectively encourage patients to adopt healthier lifestyles.
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Can cognitive behavioural therapy (CBT) help with weight loss?
Cognitive behavioural therapy (CBT) is a type of talk therapy that focuses on identifying unhelpful thoughts and behaviours and replacing them with more positive and constructive ones.
This therapy aims to help people overcome a variety of issues, including anxiety, depression, phobias, substance use disorders, eating disorders, insomnia, relationships, self-esteem, and personality disorders. CBT is not intended to be ongoing, and typically involves regular sessions with a therapist for anywhere from 4 to more than 20 sessions, depending on the issue being addressed.
CBT can be particularly helpful for people who struggle with weight management, as it focuses on changing the behavioural patterns that contribute to weight gain. For example, if someone tends to overeat in response to stress, CBT can help them develop more positive coping strategies to manage their stress. CBT is also considered a preferred treatment for obesity and binge-eating disorder (BED).
To use CBT for weight loss, a therapist will help an individual set specific and attainable goals, such as reaching a target weight range or adopting a healthier lifestyle. The therapist will also encourage self-monitoring to help the individual become aware of their eating behaviours and to identify potential setback triggers, such as boredom or stress eating.
By identifying these triggers early on, the individual can take steps to correct them and avoid undoing their progress. The therapist may also offer feedback and reinforcement to help the individual stay motivated and track their progress. While CBT can be a highly effective way to change habits and patterns of thinking, it’s important to remember that lifestyle and behavioural training can take time, and progress may not happen overnight.
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Positive parenting can reduce the risk that children develop obesity
Children with positive, early interactions with their caregivers — characterised by warmth, responsiveness, and a stimulating home environment — were at reduced risk of childhood obesity according to new research from Pennsylvania State University in the United States.
The study, “Family Psychosocial Assets, Child Behavioral Regulation, and Obesity,” appeared in the journal Pediatrics. In the article, Brandi Rollins, assistant research professor of biobehavioural health and Lori Francis, associate professor of biobehavioural health, analysed data from over 1,000 mother-child pairs and found that children’s early exposures to family psychosocial assets — including a quality home environment, emotional warmth from the mother, and a child’s ability to self-regulate — reduced the risk of developing childhood obesity.
“A lot of the discussion around childhood obesity and other health risks focuses on identifying and studying the exposure to risk,” said Rollins, “We took a strength-based approach in our analysis. We found that a supportive family and environment early in a child’s life may outweigh some of the cumulative risk factors that children can face.”
An especially encouraging aspect of the study found that these factors were protective even when children faced familial risks for obesity, including poverty, maternal depression, or residence in a single-parent home.
“Research on parenting has shown that these types of family assets influence children’s behaviour, academic success, career, and — not surprisingly — health,” Rollins said. “It is significant that these factors also protect against childhood obesity because the family assets we studied are not food or diet-specific at all. It is heartening to know that, by providing a loving, safe environment, we can reduce the risk that children will develop obesity.”
Children are deemed to have obesity when their body mass indices (BMIs) are greater than 95% of other children their age and gender. There is a great deal of variance, however, in the BMIs of children who exceed the obesity threshold. Children whose BMI is 20% higher than the obesity threshold are considered to have severe obesity.
The researchers found that children who had early-onset severe obesity did not face greater levels of family risk than children who were not obese. Children with severe obesity, however, did have fewer family assets than children who were not obese or who displayed moderate levels of obesity. More research is needed to understand which factors contribute to the development of severe obesity and which factors reduce the risk.
“Though the findings on severe obesity may seem discouraging, they offer some hope,” Rollins explained. “Some risk factors, like household poverty, can be very difficult to change. Assets, on the other hand, may be easier to build. People can learn to parent responsively. It is encouraging that parenting really matters, that family matters.”
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