We found that there were strong associations between how GPs communicated the offer of commercial weight management referral and whether or not patients went on to attend. By analysing these recordings I identified the most effective ways to motivate people to attend their weight management referral, and we’ve developed guidelines and training based on this evidence base.
- Charlotte Albury, University of Oxford
In BBC One’s latest programme on weight, Britain’s Fat Fight, celebrity chef Hugh Fearnley-Whittingstall is asking food producers, restaurants and the government to confront obesity head on.
This week’s programme featured GP and Professor of Behavioural Medicine, Paul Aveyard with DPhil student Charlotte Albury from Oxford University’s Nuffield Department of Primary Care Health Sciences. The pair trained a group of Bristol GPs to talk to their patients about weight loss using a brief 30-second intervention developed and evaluated by the department’s Health Behaviours Team and Primary Care Clinical Trials Unit along with colleagues from the Universities of Birmingham, Bristol and Coventry.
Hugh tasked the GPs, who admitted they find it challenging to bring up the issue of weight in a consultation, with inviting every patient to weigh themselves when they visit the clinic. Then, at the end of their consultation, to spend just 30 seconds advising overweight patients that the best way to lose weight is to attend a weight loss programme.
When Hugh returned two weeks later, the GPs reported the intervention had been a success, and patients actually welcomed the conversation.
The brief intervention was originally evaluated in a randomised trial involving over 1800 people and 137 GPs in England, with GPs offering an NHS referral to a weight-loss group in their local community. Led by Oxford University and published in the Lancet, the study found over three quarters (77%) of patients offered the intervention agreed to take part in the weight management programme and over 40% attended. Those in the referral group lost on average 1.43kg more weight than those in the control group, with a quarter of participants in the referral group losing at least 5% of their body weight after a year, and 12% losing at least 10% - double the rate of the control group.
Clinical guidelines recommend that physicians screen for obesity and offer referral to weight loss programmes, but in reality doctors rarely intervene because of a lack of time, fear of causing offence or a belief that the intervention would be ineffective. The trial showed that the vast majority of people (81%) find the brief intervention to be both appropriate and helpful.
Professor Paul Aveyard, who led the trial, said “On average, people consult their doctor five times a year meaning there is a huge opportunity to deliver this low-cost intervention on a large scale.”
DPhil student Charlotte Albury trained the Bristol-based GPs featured in the BBC programme, and says the intervention hinges on how doctors offer the brief advice: “We audio recorded the brief intervention discussion in the BWeL trial, and we found that there were strong associations between how GPs communicated the offer of commercial weight management referral and whether or not patients went on to attend. By analysing these recordings I identified the most effective ways to motivate people to attend their weight management referral, and we’ve developed guidelines and training based on this evidence base. I trained GPs in Britain’s Fat Fight to use these motivational patterns of communication”.