For patients who are overweight or obese, clinical visits are often characterized by negative interactions and dismissive advice, according to results of a systematic review published in Clinical Obesity.
To conduct their review, researchers searched 20 online databases for qualitative studies that involved interviews with people with overweight or obesity who had consulted a primary care physician (PCP) and discussed their weight or when the individual felt that weight was a relevant topic to the visit. The researchers used framework synthesis to analyze the studies by overarching themes.
Overall, the review included 21 studies with a total of 466 patients. Patients in all but 1 study had a body mass index of ≥25 kg/m2, although it was ≥30 kg/m2 in most studies. Based on the interviews, the researchers identified 9 main themes.
The most salient theme indicated by the studies was that interactions between patients and PCPs about being overweight and weight loss were rare. Patients attributed this to 2 main reasons. Many felt that the PCP was negatively judging them and felt stigmatized by their weight. Some patients felt that they were perceived as unworthy of care, while others thought it meant that being overweight was not a serious health risk.
Tone of voice was a contributor to negative experiences for patients with overweight or obesity. In more extreme cases, some women reported delaying consultations that involved exposing their bodies because of past inappropriate, negative comments from PCPs.
Often, patients reported that PCPs offered advice that assumed they ate unhealthily or were not trying to address their weight. Advice given was regarded as banal and did not take into consideration the patients’ actual daily activities. Patients who had tried unsuccessfully to lose weight felt that PCPs did not believe that they had made an effort. When PCPs commented on even a small weight loss, patients felt very motivated to continue efforts to lose weight.
When patients attended consultations with potentially weight-related symptoms, they reported that PCPs immediately attributed the symptoms to their weight, sometimes without even taking a history or examination. This left patients feeling dismissed and anxious about potential undetected conditions.
Patients reported very few consultations in which PCPs offered active weight-loss help.
The study had several limitations. Most of the included studies recruited patients using advertising, which could have attracted patients who felt they had a story to tell rather than a salient experience. In addition, the studies tended to have a broad scope of inquiry rather than focusing specifically on clinical encounters.
“Patients are likely to respond well to clinicians enquiring into current efforts to lose weight, even if this discussion is initiated unrelated to a current health problem,” the researchers wrote. “Weight loss discussions are more likely to be successful when they involve a trusted clinician, who gives time to share options for weight loss in a non-judgmental manner.”
Disclosure: One study author declared affiliations with the pharmaceutical industry unrelated to this research. Please see the original reference for a full list of authors’ disclosures.
Ananthakumar T, Jones NR, Hinton L, Aveyard P. Clinical encounters about obesity: systematic review of patients’ perspectives [published online December 2, 2019]. Clin Obes. doi:10.1111/cob.12347