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Five simple communication changes could enable doctors to have more equitable and effective conversations about weight loss, finds new research from the University of Oxford and Loughborough University. With obesity as one of the few modifiable risk factors for developing severe COVID, the findings are especially important during the current pandemic.

Living with obesity puts people at a greater risk of developing more severe symptoms of COVID upon infection, and there is a growing concern that repeated lockdowns may be leading to a surge in obesity.

However, the light at the end of the tunnel is that the evidence shows that even a brief intervention from GPs – just 30 seconds to refer them to a community weight management service – can be enough to support patients to lose a significant amount of weight, and keep it off for at least a year.

Such interventions are as easy to deliver during remote consultation, such as in lockdowns, as they are in person. And most community-weight management services are continuing to operate online through lockdowns.

And very soon almost every GP in the country will be able to offer weight management service referrals to their patients for free, following the July 2020 launch of the governments “Tackling obesity: empowering adults and children to live healthier lives” policy.

Clinical guidelines across the world, include NICE, encourage GPs to take the chance to talk to patients living with obesity when they are initially consulting for other reasons, and to offer support and advice for weight loss, and referrals to community-based weight-management services provided by Local Authorities and the NHS, which include approaches like Slimming World or WW.

“However, the evidence suggests that clinicians rarely do this in reality,” said Dr Charlotte Albury, Research Fellow in Health Behaviours, based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. “Part of the reason is that doctors aren’t always sure what to say to bring up weight issues and avoid misunderstanding or insult, and some are concerned about opening a ‘pandora’s box’ that would take significant consultation time.”

“Fortunately, these worries aren’t all borne out by the evidence,” said Paul Aveyard, a practising GP and Professor of Behavioural Medicine based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. “We showed in the BWeL (Brief Interventions for Weight Loss) trial that a doctor need only take 30 seconds to offer the opportunity to attend a weight loss programme and that this was welcomed by patients, and was effective, with patient keeping off on average 2.4 kg after a year.”

The researchers in this study used a method called ‘conversation analysis’ to examine 246 different recordings of British general practitioners (GPs) offering to refer patients to community weight management programmes, recorded as part of the BWeL trial.

Briefly, conversation analysis involves examining conversations to analyse what was said, what, and how it was said and the reaction to it in order to understand the outcomes of a social interaction, such as when a patient consults their doctor.

This allowed the researchers to identify which ways of talking about going to weight-management services led to misunderstandings, and which were clear, avoided misunderstandings, and were acceptable to patients.

They found that there were five components to clear, efficient opportunistic weight management referrals:

  1. Using an example of a community-based weight management programme with a recognisable brand name (such as Slimming World or Weight Watchers)
  2. Saying weight-management “programme” or “service”, rather than “group” or “club”
  3. Stating that the referral is “free” early on.
  4. Saying the number sessions that the person can attend through referral
  5. Stating that the weight management service was “local”

Researchers have collaborated Public Health England’s (PHE) Obesity and Healthy Weight team, and findings from this research have contributed to PHE’s ‘Let’s Talk About Weight’ guidelines. The researchers summarised their results into a short video, to help clinicians to have supportive and effective conversations with their patients, that provides specific, evidence-based, information about what to say when making an offer of referral to a community-based weight management service.

“We expect that this short resource will help GPs and other clinicians who might normally avoid opportunistic weight loss conversations to be much more confident about them in the future, and to have supportive and helpful conversations,” said Dr Albury.

 

Research paper: Discussing weight loss opportunistically and effectively in family practice: a qualitative study of clinical interactions using conversation analysis in UK family practice, Charlotte V A Albury, Sue Ziebland, Helena Webb, Elizabeth Stokoe, Paul Aveyard,
Family Practicehttps://doi.org/10.1093/fampra/cmaa121

Summary Video link: https://www.youtube.com/watch?v=L1MYBB_Bh8I

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