What advice do general practitioners give to people living with obesity to lose weight? A qualitative content analysis of recorded interactions

Fam Pract. 2022 Dec 13;cmac137. doi: 10.1093/fampra/cmac137. Online ahead of print.


Background: Guidelines recommend general practitioners (GPs) take every opportunity to talk to people living with obesity about their weight, and evidence shows even very brief advice is associated with weight loss. However, little is known about what GPs say when giving brief behavioural advice, and if it reflects evidence-based recommendations for people living with obesity. To understand what behavioural advice GPs give, we categorized the content and delivery of GPs' advice during brief interventions.

Methods: Qualitative content analysis was applied to 159 audio recordings of consultations from the Brief Interventions for Weight Loss (BWeL) trial, where GPs gave brief weight-loss advice to patients with a body mass index ≥30 kg/m2 (or ≥25 kg/m2 if Asian) in 137 UK surgeries. Similar content was grouped into descriptive clusters.

Results: The results comprised 4 clusters, illuminating different aspects of the advice given: (i) Content of diet and physical activity advice, showing this was highly varied; (ii) Content of "implementation tips" given to support changes, e.g. using smaller plates; (iii) Content of signposting support, either towards further clinician support, or other resources, e.g. information booklets; (iv) Style of advice delivery, showing GPs rarely gave personalized advice, or reasons for their advice.

Conclusions and implications: Weight-loss advice from GPs to patients with obesity rarely included effective methods, mostly communicating a general "eat less, do more" approach. Advice was mostly generic, and rarely tailored to patients' existing knowledge and behaviours. Effectiveness of brief weight-loss advice could be improved if GPs were given clearer guidance on evidence-based recommendations.

Keywords: diet; doctor–patient relationship; lifestyle modification/health behavior change; obesity; physical activity/exercise; primary care.

Plain language summary

Current guidelines strongly encourage general practitioners (GPs) to talk to people living with obesity about weight loss. Evidence has shown that conversations with a doctor about weight management can be highly effective, as even very brief advice has been associated with weight loss. In order to understand what GPs actually say when offering weight-loss advice to patients with obesity, we analysed 159 audio recordings of conversations between GPs and patients. We found that GPs gave mainly generic diet and exercise messages for example “reduce your carbohydrates” and “move more.” Furthermore, weight-loss advice was often not tailored to patients’ existing knowledge and behaviours. Obesity is a chronic and relapsing condition, but patients were not given specific or evidence-based advice to support them to manage this. The findings suggest that the brief weight-loss advice from GPs could be more effective if they were given clearer guidance on which methods of weight-loss evidence has shown actually works.