Today's Apple

A Doctor’s Advice on Weight: Useful or Not?

Exactly how helpful can a primary care provider’s advice on weight be for a person who might be dealing with obesity? The answer is that it depends. Is the doctor offering up generic advice to lose weight? Or are they offering specific, empathetic advice? A new study in the Journal of General Internal Medicine tells us this simple distinction can make a big difference

Observational Findings on What Works

Let’s start with a caveat. This is a secondary analysis of observational data from a randomized study. But with that said, the observations are persuasive. In this trial of a primary care weight loss program, patients who found more empathy from their their providers had significantly better weight outcomes. On top of that, when a provider offered specific counseling at any point during this 12-month program, patients lost more weight. Comparing providers who offered specific advice versus general advice, the difference was almost seven pounds.

In fact, the providers who offered only general advice didn’t have much more effect than those who offered none at all. Senior author Gary Bennett explains:

Just telling somebody to lose weight or improve their diet or physical activity didn’t work. The doctor should instead encourage patient participation in a specific program.

The ABCDEF Framework

In JAMA last week, Scott Kahan and JoAnn Manson published a perfect complement to this finding. In their ABCDEF framework, they provide a perfectly specific framework for clinical providers.

It starts with Asking permission to discuss weight. It continues with Being systematic in the clinical workup. Next is the importance of sound and specific Counseling and support. Then Determining health status is essential. How is weight affecting health and quality of life? Recognize that Escalating treatment may be essential for a good outcome. Many patients require more than simple behavioral strategies. Finally, Followup is always critical. Obesity is a chronic condition. One and done is simply not going to be the least bit adequate.

Skilled Clinicians, Good Results

The bottom line here is all about specific skills. Helping patients with obesity can be daunting. It’s a chronic problem, driven by physiology that favors storing excess fat. But a skilled clinician offering specific help can make a big difference.

Good providers can no longer afford to avoid the subject.

Click here for the study in JGIM and here for the ABCDEF framework in JAMA.

Today’s Apple, photograph © Selma Broeder/ flickr

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March 28, 2019