The Executive Suite: Delivering ‘good news’ or ‘bad news’ about weight can influence patients

Conveying a sense of “good news” about better health could be more effective than “bad news” about the dangers of obesity when physicians talk about patients’ weight.

Research has linked overweight and obesity with health conditions such as type 2 diabetes, cardiovascular disease and cancer. What’s less clear is the best way for physicians to discuss weight loss with patients who could have better health if they lose weight, according to a new study, “Relationship Between Clinician Language and the Success of Behavioral Weight Loss Interventions,” in Annals of Internal Medicine.

The researchers found a positive style of conversation inspired more patients to lose weight compared with patients who received a bad or neutral approach.

That’s good news for patients and physicians, Annals editors Christina C. Wee, MD, MPH, and John E. Cornell, PhD, said in an editorial about the study. The findings, “although preliminary, suggest a promising path forward for physicians to engage with patients about weight and treatment in an effective yet respectful way,” they said.

Difficult discussions

While more than 40% of American adults meet the definition of having obesity, weight remains a touchy topic for physicians and patients, Wee and Cornell said.

“Many patients with obesity may experience weight bias in their everyday life. Interactions with physicians and staff in the health care arena are no exception,” they wrote.

Patients who have bad experiences may be less likely to follow through with care plans. And “despite strong evidence to the contrary, many clinicians still ascribe to the notion that a person’s weight is largely within the person’s control and that patients are to blame for their obesity,” Wee and Cornell said.

What you say and how you say it

For the study, researchers listened to 246 audio recordings of physician-patient interactions in 38 primary care practices to consider words and grammar, along with paralinguistic features such as pitch, intonation, timing, speed, volume, and vocal tone. The goal was to identify an association between physician language and patient agreement to attend a weight management program, actual attendance or use of a 12-week program, weight loss after a year, and patient satisfaction.

The researchers identified the interactions as “good news” (62), “bad news” (82), and “neutral” (102).

The good news delivery had a short introduction or preannouncement, with optimistic projections to present weight loss positively and words to convey positivity. Physicians sounded excited or eager as they described benefits of weight loss, minimized effort patients would need, and framed referrals as a “chance” or “good opportunity,” the study said.

The bad news delivery had longer preannouncements. Physicians described a patient’s body mass index as a problem, emphasized health consequences, and presented weight loss as a necessary solution to a medical condition. Their delivery was slower, quieter, or in a “creaky voice” that emphasized negativity.

The neutral approach was just that, with no positive or negative terms or tonality.

Patients who received a good news approach had greater agreement to attend, more actual attendance, and they lost “significantly more” weight, compared with patients who received the bad news or neutral news styles.

Just a quick mention

In all three approaches, the physician-patient discussions were relatively short, with a median duration of 78 seconds. That suggests “that when physicians are supported with appropriate resources, even brief counseling can be effective,” Wee and Cornell said. It also contrasts with results of an earlier study about motivational interviewing, which can be time-intensive as physicians help patients clarify their goals and motivations, they said.