Patient and physician characteristics associated with the provision of weight loss counseling in primary care.

BACKGROUND: A variety of physician and patient characteristics may influence whether weight loss counseling occurs in primary care encounters. OBJECTIVES: This study utilized a cross-sectional survey of primary care patients, which examined patient characteristics, physician characteristics, and characteristics of the physicianâ??patient relationship associated with weight loss counseling and recommendations provided by physicians. PARTICIPANTS: (N = 143, mean age = 46.8 years, mean BMI = 36.9 kg/m(2), 65% Caucasian) were overweight and obese primary care patients participating in a managed care weight loss program. MEASURES: PARTICIPANTS completed self-report surveys in the clinic prior to the initial weight loss session. Surveys included items assessing demographic/background characteristics, weight, height, and a health care questionnaire evaluating whether their physician had recommended weight loss, the frequency of their physiciansâ?? weight loss counseling, and whether their physician had referred them for obesity treatment. RESULTS: Patient BMI and physician sex were most consistently associated with physiciansâ?? weight loss counseling practices. Patients seen by female physicians were more likely to be told that they should lose weight, received more frequent obesity counseling, and were more likely to have been referred for obesity treatment by their physician. Length and frequency of physicianâ??patient contacts were unrelated to the likelihood of counseling. CONCLUSIONS: These findings add to previous evidence suggesting possible differences in the weight loss counseling practices of male and female physicians, although further research is needed to understand this potential difference between physicians.

What words should we use when discussing excess weight?

BACKGROUND: There is limited research on how patients prefer physicians to communicate about the topic of obesity, and there is even less understanding of which terms physicians most commonly use. METHODS: In this cross-sectional, nonrandom sampling study, patients who were seeking treatment for weight loss rated the desirability of 12 terms to describe excess weight, and physicians rated the likelihood with which they would use those terms during clinical encounters. Participants rated terms on a 5-point scale, with -2 representing "very undesirable" or "definitely would not use" and +2 representing "very desirable" or "definitely would use." RESULTS: Patients (n = 143; mean age, 46.8 years; mean body mass index, 36.9 kg/m(2)) rated "weight" (mean +/- SD) as the most desirable term (1.13 +/- 1.10), although it did not significantly differ from 5 other terms provided. They rated "fatness" (-1.30 +/- 1.22) as the most undesirable term, although this rating did not differ significantly from 4 other terms. Physicians affiliated with a community-based medical school (n = 108; mean age, 48.8 years; 79.6% primary care specialty) were most likely to use "weight" (1.42 +/- 0.89), which was significantly different from ratings for all other terms. They were least likely to use "fatness" (-1.74 +/- 0.59), although this rating did not differ significantly from 3 other terms. CONCLUSION: Physicians generally reported that they use terminology that patients had rated more favorably, and they tend to avoid terms that patients may find undesirable. Understanding the preferences and terminology used by patients and physicians is an important initial step to ensure that communications related to obesity and weight loss are efficient and effective.

Weight loss goals of patients in a health maintenance organization.

Individuals seeking weight loss treatment endorse unrealistic expectations regarding their goals for weight loss, although these conclusions are primarily based on research conducted in obesity specialty clinics and/or controlled clinical trials. This study examined the weight loss goals and predictors of these goals among patients participating in obesity treatment in an applied, clinical setting (i.e., managed care organization). Managed care patients enrolled in a behavioral weight loss program (N=143; mean age=46.8 years; mean BMI=36.9 kg/m(2); 89.5% female; 64.5% Caucasian) completed a self-report survey during an initial weight loss session. The survey included items assessing patients' weight loss expectations, including goals for dream, happy, acceptable, and disappointed weights. Participants completed questions regarding contacts with their primary care physician and physician provision of weight loss counseling and/or referrals. They also provided values for current height and weight. BMI's and weight loss associated with dream, happy, acceptable, and disappointed weight goals were 24.8 kg/m(2) (30.9% loss), 27.1 kg/m(2) (25.2% loss), 29.3 kg/m(2) (19.7% loss), and 33.0 kg/m(2) (10.4% loss), respectively. There were significant gender differences in weight loss goals, with women endorsing more unrealistic goals than men for dream and happy weights, ps<0.001. Significant predictors of all four weight loss goals included baseline BMI, gender, ethnicity, and frequency of visits with one's primary care physician, ps<0.01. Consistent with previous research, patients participating in a weight loss program implemented in a managed care setting endorsed unrealistic expectations for weight loss. However, more frequent contact with one's primary care physician was associated with more realistic goals. Future, longitudinal research is needed to document the discrepancy between these goals and actual weight loss achieved in such settings as well as to determine whether excessive goals are associated with diminished treatment outcomes.

Comparison of physician weight loss goals for obese male and female patients.

OBJECTIVE: The aim of this study was to compare physicians' weight loss goals for obese male and female patients. METHOD: This study was conducted in 2008-2009 in Florida, USA. Physicians (N=108; 79.6% primary care specialty) reviewed two hypothetical clinical scenarios that were identical with respect to health status and obesity (BMI=33 kg/m(2)) but differed in the gender of the patient. Physicians then completed a survey about the need for weight loss, intentions to provide weight loss counseling, and weight loss goals (i.e., ideal, successful, and acceptable goal weights) for each hypothetical patient. RESULTS: Physicians strongly agreed that both patients should lose weight and physician counseling and/or treatment referrals would be appropriate; however, physician weight loss goals for male and female patients differed. BMI values calculated from the suggested ideal, successful, and acceptable weight goals were significantly lower for female patients than male patients, 22.0 vs. 25. 2 kg/m(2); 25.4 vs. 27. 8 kg/m(2); and 27.0 vs. 29. 2 kg/m(2), respectively, P values <.001. CONCLUSIONS: Physicians endorsed significantly more stringent weight loss goals for obese female patients than obese male patients. Regardless of patient gender, physician goals exceeded the 5-10% losses currently recommended. Additional research is needed to better understand this gender discrepancy in physician expectations for obese patients.