June 6, 2019

Why telling patients to 'lose weight' just doesn't work

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on May 15, 2020.

    Weight loss management can be frustrating for both patients and clinicians—but a recent study published in the Journal of General Internal Medicine reveals concrete ways that providers can improve their patients' odds of success. 

    Slide deck: Social Determinants 101

    Study details

    For the study, researchers sought to determine what type of weight management advice led to the greatest weight loss for patients. They enlisted 134 patients with an average body mass index of 36 to participate in a comprehensive weight loss program called Track, and they arranged for 64 doctors or nurse practitioners to monitor the patients' progress for a year.

    Patients in the Track program received updated personalized exercise and wellness goals every two months, as well as educational materials and weekly phone calls or text messages to check in about their progress. Participants also received reinforcement and support throughout the year from dieticians, psychology graduate students, and other coaches.

    Throughout the study period, participants continued to meet regularly with their participating doctors or nurse practitioners. Participating clinicians were asked to document the type of weight loss counseling they provided, and patients were asked to rate how empathetic their clinicians seemed about their weight loss progress.

    So what matters for weight loss? Specific recommendations—and empathy.

    Overall, the researchers found study participants lost an average of 8.8 pounds over one year, but the amount of weight patients lost varied by the approach their clinicians used.

    For instance, participants who received specific weight-loss recommendations lost about 7 pounds more than those who received "generic counseling (such as being told to lose weight, eat better)," Gary Bennett, professor of psychology at Duke University and the study's senior author, said.

    Empathy also was linked to more weight loss. Participants who rated their clinicians as "most empathetic" lost about 7 more pounds than participants who rated their clinicians as "least empathetic."

    Why empathy should be the first step to weight-loss management

    The results suggest that "doctors can be helpful in assisting their patients to lose weight, but they have to counsel their patients in a very specific way," Bennett said.  

    He noted that patients respond best to empathetic clinicians "who really show a lot of care and concern, and especially for something that is difficult like weight loss."

    Bennett said that clinicians who fail to show empathy might make patients feel shamed for their health status, which could make them less likely to adhere to any advice and suggestions.

    Katrina Hartog, a registered dietitian and clinical nutrition manager at Lenox Hill Hospital, who was not involved with the study, similarly said, "If you can connect more with a person, it enhances the rapport and opens further dialogue." She added, "Then the patient feels more comfortable discussing their struggles or will tell you where they need more guidance."

    The 'ABCDEF' framework to help patients lose weight

    In a separate JAMA viewpoint,  Scott Kahan, from the Department of Health Policy and Management  at Johns Hopkins Bloomberg School of Public Health and JoAnn Manson from the Department of Medicine at Brigham and Women's Hospital, offered a practical framework for physicians to build an empathetic, effective connection to patients.

    Kahan and Manson write, "Advising patients to 'just eat less and exercise more' is unhelpful, especially for patients affected by binge eating disorder, adverse childhood experiences and trauma, medication-induced weight gain, and other common contributors to weight gain," they write. Instead, the authors suggest the "ABCDEF" framework, a "practical and useful" approach to weight loss counseling for clinicians.

    The acronym suggests that clinicians:

    • Ask permission before discussing weight loss;
    • Be systematic in their approach to weight loss;
    • Provide counseling and support;
    • Determine health status;
    • Escalate treatment when appropriate; and
    • Follow up regularly and leverage available resources.

    Overall, Kahan and Manson write, "Treating each patient with respect, offering attention and support, and developing individualized treatment approaches will be important steps to making progress" (Doheny, WebMD, 3/20; Kahan/Manson, JAMA Viewpoint, 3/21).

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