Physician communication techniques and weight loss in adults: Project CHAT

Abstract

Background Physicians are encouraged to counsel overweight and obese patients to lose weight. Purpose It was examined whether discussing weight and use of motivational interviewing techniques (e.g., collaborating, reflective listening) while discussing weight predicted weight loss 3 months after the encounter. Methods Forty primary care physicians and 461 of their overweight or obese patient visits were audio recorded between December 2006 and June 2008. Patient actual weight at the encounter and 3 months after the encounter (n=426); whether weight was discussed; physicians' use of motivational interviewing techniques; and patient, physician, and visit covariates (e.g., race, age, specialty) were assessed. This was an observational study and data were analyzed in April 2009. Results No differences in weight loss were found between patients whose physicians discussed weight or did not. Patients whose physicians used motivational interviewingconsistent techniques during weight-related discussions lost weight 3 months post-encounter; those whose physician used motivational interviewinginconsistent techniques gained or maintained weight. The estimated difference in weight change between patients whose physician had a higher global motivational interviewingSpirit score (e.g., collaborated with patient) and those whose physician had a lower score was 1.6 kg (95% CI=-2.9, -0.3, p=0.02). The same was true for patients whose physician used reflective statements: 0.9 kg (95% CI=-1.8, -0.1, p=0.03). Similarly, patients whose physicians expressed only motivational interviewingconsistent behaviors had a difference in weight change of 1.1 kg (95% CI=-2.3, 0.1, p=0.07) compared to those whose physician expressed only motivational interviewinginconsistent behaviors (e.g., judging, confronting). Conclusions In this observational study, use of motivational interviewing techniques during weight loss discussions predicted patient weight loss. © 2010 American Journal of Preventive Medicine.