Will Physicians Calling Out Patients On Their Weight Do Anything For Them?Monday, August 29, 2011
I was recently asked by the editor of the journal Evidence Based Medicine to provide a commentary on an article by Post and colleagues examine the influence of physician acknowledgment of patients’ weight status on patient perceptions of overweight and obesity published in the Archives of Internal Medicine.
The participants (NHANES 2005-2008) were asked whether they had been told by their physician or another health professional that they were overweight. The main outcome measure was the proportion of participants who considered themselves as ‘not overweight’ versus ‘overweight’ in two different BMI classifi cations: overweight (BMI 25.0) and obese (BMI 30.0). Secondary measures included participant perceptions of desired weight and weight loss attempts in the last 12 months.
Outcomes were controlled for age, sex, race, poverty-to-income ratio, marital status, education, whether the patient has a routine source of healthcare and the number of physician visits in the last 12 months.
In participants with BMIs of 25 or greater and 30 or greater,45.2% and 66.4% reported having been told by their physician that they were overweight or obese, respectively.
Participants who reported having been told they were overweight were more likely to identify themselves as overweight (94.0% vs 63.1%) or obese (96.7% vs 81.4%). Similarly, participants who reported having been told they were overweight were more likely to desire to lose weight (96.1% vs 73.7%) and report a weight-loss attempt (64.7% vs 39.0%).
From these finding the researchers concluded:
“Among patients who were overweight or obese, patient reports of being told by a physician that they were overweight were associated with more realistic perceptions of the patients’ own weight, desire to lose weight, and recent attempts to lose weight.”
Here are excerpts from the commentary that I had to offer:
Given the cross-sectional and retrospective nature of this study, it may
“be fairer to conclude from this study that patients who recall discussing their excess weight with their physicians are also more likely to consider themselves overweight and obese as well as more likely to recall a recent weight loss attempt.
“….even if identifying and raising the issue of excess weight may motivate more patients to lose weight, it is unclear that this would indeed result in a long-term benefit to patients…..one may argue that simply raising the issue of excess weight and getting patients to try to lose weight on their own may have little effect on long-term health outcomes unless this weight loss is achieved by healthy means and is sustainable in the long term. Evidence suggesting that increased numbers of weight loss attempts are prognostic of future weight gain should also give cause to caution in equating a history of weight loss attempts with better health.”
“…although it is safe to conclude that fewer than half of overweight and fewer than two-thirds of
obese participants have been told by their physicians that they were overweight, it remains unclear whether increasing these numbers to the levels reported in those individuals who have been told will actually result in improved health behaviour and outcomes for the individuals concerned.”
I’d certainly want to hear from my readers on this – has being having your weight pointed out by your doctor ever been helpful? Do my colleagues think that pointing out excess weight to their patients elicits a positive and healthy response? if not, why?
Sharma AM (2011). Physicians’ calling patients on excess weight may provide reality check and increase desire to lose weight in overweight and obese individuals. Evidence-based medicine PMID: 21856640
Post RE, Mainous AG 3rd, Gregorie SH, Knoll ME, Diaz VA, & Saxena SK (2011). The influence of physician acknowledgment of patients’ weight status on patient perceptions of overweight and obesity in the United States. Archives of internal medicine, 171 (4), 316-21 PMID: 21357807