Speaking of weight: how patients and primary care clinicians initiate weight loss counseling

Prev Med. 2004 Jun;38(6):819-27. doi: 10.1016/j.ypmed.2004.01.001.


Background: Obesity is epidemic in the US and other industrialized countries and contributes significantly to population morbidity and mortality. Primary care physicians see a substantial portion of the obese population, yet rarely counsel patients to lose weight.

Methods: Descriptive field notes of outpatient visits collected as part of a multimethod comparative case study were used to study patterns of physician-patient communication around weight control in 633 encounters in family practices in a Midwestern state.

Results: Sixty-eight percent of adults and 35% of children were overweight. Excess weight was mentioned in 17% of encounters with overweight patients, while weight loss counseling occurred with 11% of overweight adults and 8% of overweight children. In weight loss counseling encounters, patients formulated weight as a problem by making it a reason for visit or explicitly or implicitly asking for help with weight loss. Clinicians did so by framing weight as a medical problem in itself or as an exacerbating factor for another medical problem.

Conclusions: Strategies that increase the likelihood of patients identifying weight as a problem, or that provide clinicians with a way to "medicalize" the patient's obesity, are likely to increase the frequency of weight loss counseling in primary care visits.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Counseling*
  • Diet
  • Exercise
  • Female
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Obesity / therapy*
  • Physician-Patient Relations*
  • Weight Loss*