How doctors communicate with patients with obesity can have a significant impact on their weight loss success, according to a new University of Oxford study published today in Annals of Internal Medicine. This pioneering study dives into uncharted waters by investigating not just that words matter, but how they matter over the short and long-term in a medical context.
The researchers analysed 246 recordings of doctor-patient conversations and found that subtle aspects of communication, like word choice and tone of voice, influenced patient outcomes and suggests training providers on compassionate communication could aid weight loss efforts. The research comes at a time when obesity treatment guidelines encourage doctors to discuss weight loss with patients and offer them referrals to weight loss services if appropriate. Yet, on a yearly basis, this only meaningful happens for around 5% of those affected. This gap between policy and practice reveals a need to better understand what the best communication approaches are for doctors to use.
When asked, doctors report hesitancy about bringing up such personally and socially charged matters, that they are concerned about causing offense or uncertainty discussing sensitive topics. Patients, on the other side of the desk, confirm that negative feelings arising from the tones or word choices used can inadvertently strain the rapport.
Until now, the long-term impact of communication variations in this context remained unexplored. Our findings give us a new understanding that could significantly alter how medical professionals approach conversations with patients.
- Dr Charlotte Albury, lead author and researcher, Nuffield Department of Primary Care Health Sciences
Carried out by the University of Oxford's Nuffield Department of Primary Care Health Sciences, and funded by the National Institute for Health and Care Research School for Primary Care Research, and Foundation for the Sociology of Health and Illness, the study analysed 246 audio recordings from a larger clinical trial in which doctors offered patients a referral to a 12-week weight loss programme (the BWel trial). Using ‘conversation analysis’, the researchers identified how the words used by the doctors and their tone of voice – 'paralinguistic' features – could impact obesity care.
They identified three main approaches doctors took: delivering the referral offer as "good news", "bad news" or neutrally. They went on to statistically analyse whether the conversation approach used was associated with patients agreeing to attend the program, actually attending, losing weight, and being satisfied. Only 50% of people offered weight loss programmes in a neutral way attended, but if offered as ‘good news’ 83% attended, and people who received ‘good news’ lost half a stone more (or 3.6kg).
Dr Charlotte Albury, lead author and researcher within the Nuffield Department of Primary Care Health Sciences, said:
‘What we found was that when doctors framed the conversation as "good news" – emphasising the benefits and opportunities of weight loss in a positive manner – patients were more likely to enrol in a weight loss programme, attend more sessions, and, importantly, lose more weight compared to a neutral or negative framing.’
‘From the perspective of patient outcomes, we found that 83% of patients attended the weight loss programme when the conversation and referral were framed as 'good news'. These patients lost approximately half a stone more (or 3.6kg, or 7lbs 15oz) compared to those who received "neutral" or "bad news". For the latter groups, only half of the people accepted the referral, and there was no significant difference in weight loss between them.’
‘We know words matter, and this research shows they really do – in the short and long term. Overall, our research shows that subtle changes in communication can significantly influence patient outcomes one year later. The elements that constituted 'good news' were subtle but had a clear and positive impact.’
Elements of ‘good’ and ‘bad’ news framing identified by the researchers:
Doctors emphasise the benefits of weight loss in an upbeat manner, frame referrals as positive opportunities, confidently share benefits, and deliver the news fluently and cheerfully.
Doctors highlight health issues related to being overweight and stress the effort needed from the patient for results. The referral is presented as a necessary medical solution. The delivery is slower, often interrupted by hesitations.
The doctor neither overly focuses on benefits nor issues, and presents referrals without a clear preference. The delivery is steady, with a consistent voice tone.
The researchers urge doctors and other medical professionals to adopt the 'good news' approach in their communications with patients living with obesity. By presenting weight loss help positively and as an opportunity, they can significantly boost patients' motivation to act. Through turning conversations into constructive dialogues, patients can truly be empowered to achieve healthier lifestyles.
The full paper is available here in the Annals of Internal Medicine.