While general practitioners (GPs) are the first responders for patients outside of a hospital setting, they still remain poorly equipped in offering valuable advice for weight loss — specifically to patients with obesity. According to a new study published in the journal Family Practice, although current guidelines make GPs bring up the topic of weight loss with patients who have obesity, their advice is generic, lacking in scientific evidence, and not tailored to each patient’s behaviors or habits.
A group of researchers from the University of Oxford analyzed 159 audio recordings of interactions that occurred between GPs and patients with obesity. “We found that GPs gave mainly generic diet and exercise messages for example ‘reduce your carbohydrates and ‘move more’,” the researchers wrote in their study. “Obesity is a chronic and relapsing condition, but patients were not given specific or evidence-based advice to support them to manage this.”
In the United States, UK, and Canada, public health policy encourages GPs and other doctors to discuss weight loss strategies with obese patients. From 2017 to 2020, the prevalence of obesity was 41.9% in the U.S. and severe obesity was 9.2%, according to the Centers for Disease Control and Prevention.
Previous studies have shown weight loss interventions and even small pieces of advice can help in providing support that might improve an individual’s health and general well-being. “It is rare for GPs to talk to patients living with obesity about weight. GPs report a number of barriers that mean weight becomes a low priority topic in consultations, including being unsure what advice to give patients, lacking knowledge about the best ways to lose weight, and not feeling that advice will be effective,” the researchers wrote. “When they do talk to patients about weight, a common strategy by GPs is ‘advice giving,’ but we are not sure what the content of this advice is.”
One of the lead authors, Madeleine Tremblett and colleagues collected data from the Brief Interventions for Weight Loss trial that investigates the effects of UK-based general practitioners’ brief weight loss interventions. From mid 2013 to late 2014, patients with obesity were enrolled in the trial.
Prior to the trial, GPs were made to watch a training video on communicating the importance of weight loss to patients. After each consultation with obese patients, the GPs either offered very brief weight loss advice or a free referral to a community weight management service. Out of that 159 patients — 62 men and 92 women with a mean age of 58 — who received advice and consented to an audio recording of their consultation were randomly selected to be a part of this new study.
“Most advice was “superficial” comprising uni- laterally delivered content which was not personalized to patients, unless prompted by the patients in their response to general advice,” the researchers observed.
In 44 of those consultations, GPs recommended making “dietary changes.” That included reducing the amount and type of food consumption like telling patients to eat “less carbohydrates.” In only 14 consultations did GPs advice both, dietary changes and increased physical activities.
“This research demonstrates that doctors need clear guidelines on how to talk opportunistically to patients living with obesity about weight loss,” said Tremblett in a press release. “This can help them to avoid amplifying stigmatizing stereotypes and give effective help to patients who want to lose weight.”
The study further highlighted how poorly trained clinicians are in guiding patients through their weight loss journey as their advice tends to be scientifically unsupported. Merely exercising more and making small changes to calorie intake and the way people their energy has proven to be ineffective in treating obesity. Yet, GPs kept advising patients to do both. “The notion that small changes in behaviour can have large weight-loss impact is a common myth, highlighted in a study that showcased how “false and scientifically unsupported beliefs about obesity” are prevalent in the scientific literature and press,” the researchers added. “With a lack of specific training to counter these persistent and pervasive unscientific messages, clinicians may perpetuate them.”