Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Physician weight loss advice and patient weight loss behavior change: a literature review and meta-analysis of survey data

Abstract

Primary care providers (PCPs) can empower their patients to make health-promoting behavior changes. Many guidelines recommend that PCPs counsel overweight and obese patients about weight loss, yet few studies examine the impact of provider weight loss counseling on actual changes in patient behavior. We performed a systematic review and meta-analysis of published studies of survey data examining provider weight loss counseling and its association with changes in patient weight loss behavior. We reviewed the published literature using keywords related to weight loss advice. We used meta-analytic techniques to compute and aggregate effect sizes for the meta-analysis. We also tested variables that had the potential to moderate the responses. A total of 32 studies met criteria for the literature review. Of these, 12 were appropriate for the meta-analysis. Most studies demonstrated a positive effect of provider weight loss advice on patient weight loss behavior. In random effects meta-analysis, the overall mean weighted effect size for patient weight loss efforts was odds ratio (OR)=3.85 (95% confidence interval (CI) 2.71, 5.49; P<0.01), indicating a statistically significant impact of weight loss advice. There was no significant difference in the effectiveness of advice in studies using obese patients alone versus mixed samples (obese alone OR=3.44, 95% CI 2.37, 5.00; mixed sample OR=3.98, 95% CI 2.53, 6.26, P=0.63). PCP advice on weight loss appears to have a significant impact on patient attempts to change behaviors related to their weight. Providers should address weight loss with their overweight and obese patients.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2

References

  1. Bray G . Risks of obesity. Endocrinol Metab Clin North Am 2003; 32: 787–804.

    Article  Google Scholar 

  2. Flegal KM, Graubard BI, Williamson DF, Gail MH . Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298: 2028–2037.

    Article  CAS  Google Scholar 

  3. Will JC, Williamson DF, Ford ES, Calle EE, Thun MJ . Intentional weight loss and 13-year diabetes incidence in overweight adults. Am J Public Health 2002; 92: 1245–1248.

    Article  Google Scholar 

  4. Williamson DF, Pamuk E, Thun M, Flanders D, Byers T, Clark H . Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40–64 years. Am J Epidemiol 1995; 141: 1128–1141.

    Article  CAS  Google Scholar 

  5. Smith P, Sellick S, Brink P, Edwardson A . Brief smoking cessation interventions by family physicians in northwestern Ontario rural hospitals. Can J Rural Med 2009; 14: 47–53.

    PubMed  Google Scholar 

  6. Fiore M, Jaén C, Baker T, Bailey WC, Benowitz NL, Curry SJ et al. Treating Tobacco Use and Dependence: 2008 Update.. Publisher: United States Department of Health and Human Services, Public Health Service: Rockville, MD, 2008. Available at: www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.chapter.28163.

    Google Scholar 

  7. HEDIS 2009 Public Comment, 2008. (Accessed 30 July 2008, at http://www.ncqa.org/tabid/661/Default.aspx ).

  8. US Preventive Services Task Force. Screening for obesity in adults: recommendations and rationale. Ann Int Med 2003; 139: 930–932.

    Article  Google Scholar 

  9. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults, 1998. (Accessed 29 May 2007, at http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf ).

  10. Brotons C, Björkelund C, Bulc M, Ciurana R, Godycki-Cwirko M, Jurgova E et al. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. Prev Med 2005; 40: 595–601.

    Article  Google Scholar 

  11. Screening and interventions to prevent obesity in adults, 2003. (Accessed 14 May 2008, at http://www.ahrq.gov/clinic/USpstf/uspsobes.htm ).

  12. Body mass index (BMI) assessment for adults (BAA), 2008. (Accessed 25 April 2008, at http://www.ncqa.org/Portals/0/PublicComment/HEDIS2009/BAA_Specs_and_Workup_PDF.pdf ).

  13. Jackson J, Doescher M, Saver B, Hart L . Trends in professional advice to lose weight among obese adults. J Gen Intern Med 2005; 20: 814–818.

    Article  Google Scholar 

  14. Epstein L, Ogden J . A qualitative study of GPs’ views of treating obesity. Br J Gen Pract 2005; 55: 750–754.

    PubMed  PubMed Central  Google Scholar 

  15. Whittemore R, Melkus G, Wagner J, Dziura J, Northrup V, Grey M . Translating the diabetes prevention program to primary care: a pilot study. Nurs Res 2009; 58: 2–12.

    Article  Google Scholar 

  16. Douglas F, Torrance N, van Teilingen E, Meloni S, Kerr A . Primary care staff's views and experiences related to routinely advising patients about physical activity. A questionnaire survey. BMC Public Health 2006; 6: 138.

    Article  Google Scholar 

  17. Hudon E, Beaulieu M, Roberge D . Integration of the recommendations of the Canadian Task Force on preventive health care. Fam Pract 2004; 24: 11–17.

    Article  Google Scholar 

  18. Galuska D, Will J, Serdula M, Ford E . Are health care professionals advising obese patients to lose weight? JAMA 1999; 282: 1576–1578.

    Article  CAS  Google Scholar 

  19. Huang J, Yu H, Marin E, Brock S, Carden D, Davis T . Physicians’ weight loss counseling in two public hospital primary care clinics. Acad Med 2004; 79: 156–161.

    Article  Google Scholar 

  20. Kant A, Miner P . Physician advice about being overweight: association with self-reported weight loss, dietary and physical activity behaviors of US adolescents in the National Health and Nutrition Examination Survey, 1999–2002. Pediatrics 2007; 119: e142–e147.

    Article  Google Scholar 

  21. Mehotra C, Naimi T, Serdula M, Bolen J, Pearson K . Arthritis, body mass index, and professional advice to lose weight: implications for clinical medicine and public health. Am J Prev Med 2004; 27: 16–21.

    Article  Google Scholar 

  22. Thande N, Hurstak E, Sciacca R, Giardina E . Management of obesity: a challenge for medical training and practice. Obesity 2009; 17: 107–113.

    Article  Google Scholar 

  23. Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med 2009; 6: e1000097.

    Article  Google Scholar 

  24. Zaza S, Wright-De Agüero LK, Briss PA, Truman BI, Hopkins DP, Hennessy MH et al. Data collection instrument and procedure for systematic reviews in the guide to community preventive services. Task force on community preventive services. Am J Prev Med 2000; 18 (1 Suppl): 44–74.

    Article  CAS  Google Scholar 

  25. Lipsey M, Wilson D . Practical Meta-Analysis (Chapter 6). Sage Publications Inc.: Thousand Oaks, CA, 2001.

    Google Scholar 

  26. Singh S, Lopez-Jimenez F . Medically diagnosed overweight and weight loss in a US national survey. Prev Med 2010; 51: 24 .

    Article  Google Scholar 

  27. Nawaz H, Adams M, Katz D . Weight loss counseling by health care providers. Am J Public Health 1999; 89: 764–767.

    Article  CAS  Google Scholar 

  28. Pollak K, Ostbye T, Alexander S, Gradison M, Bastian L, Brouwer R, Lyna P . Empathy goes a long way in weight loss discussions. J Fam Pract 2007; 56: 1031–1036.

    PubMed  Google Scholar 

  29. Saelens B, Jelalian E, Kukene D . Physician weight loss counseling for adolescents. Clin Pediatr 2002; 41: 575–585.

    Article  Google Scholar 

  30. Abid O, Galuska D, Kettel Khan L, Gillespie C, Ford E, Serdula M . Are healthcare professionals advising obese patients to lose weight? A trend analysis. Med Gen Med 2005; 7: 10.

    Google Scholar 

  31. Felix H, West D, Bursac Z . Impact of USPSTF practice guidelines on clinician weight loss counseling as reported by obese patients. Prev Med 2008; 47: 394–397.

    Article  Google Scholar 

  32. Fontaine K, Haez S, Bartlett S . Are overweight and obese adults with arthritis being advised to lose weight? J Clin Rheumatol 2007; 13: 12–15.

    Article  Google Scholar 

  33. Wang A, Kinsinger L, Kahwati L, Das S, Gizlice Z, Harvey R et al. Obesity and weight control practices in 2000 among veterans using VA facilities. Obes Res 2005; 13: 1405–1411.

    PubMed  Google Scholar 

  34. Kabeer N, Simoes E, Murayi T, Brownson R . Correlates of overweight and weight loss practices in Missouri. Am J Health Behav 2001; 25: 125–139.

    Article  CAS  Google Scholar 

  35. Evans E . Why should obesity be managed? The obese individual's perspective. Int J Obes 1999; 23 (Suppl 4): S3–S6.

    Article  Google Scholar 

  36. Fallon E, Wilcox S, Laken M . Health care provider advice for African American adults not meeting health behavior recommendations. Prev Chronic Dis 2006; 3: 1–11.

    Google Scholar 

  37. Wee C, Davis R, Phillips R . Stage of readiness to control weight and adopt weight control behaviors in primary care. J Gen Int Med 2005; 20: 410–415.

    Article  Google Scholar 

  38. Himmel W, Stolpe C, Kochen M . Information and communication about overweight in family practice. Fam Pract Res J 1994; 14: 339–351.

    CAS  Google Scholar 

  39. Rodondi N, Humair J, Ghali W, Ruffieux C, Stoianov R, Seematter-Bagnoud L et al. Counselling overweight and obese patients in primary care: a prospective cohort study. Eur J Cardiovasc Prev Rehabil 2006; 13: 222–228.

    Article  Google Scholar 

  40. Sciammana C, Tate D, Lang W, Wing R . Who reports receiving advice to lose weight? Results from a multistate survey. Arch Intern Med 2000; 160: 2334–2339.

    Article  Google Scholar 

  41. Bish C, Blanck H, Serdula M, Marcus M, Kohl H, Khan L . Diet and physical activity behaviors among Americans trying to lose weight: 2000 behavioral risk factor surveillance system. Obes Res 2005; 13: 596–607.

    Article  Google Scholar 

  42. Ford E, Mannino D, Redd S, Mokdad A, Galuska D, Serdula M . Weight loss practices and asthma: findings from the behavioral risk factor surveillance system. Obes Res 2003; 11: 81–86.

    Article  Google Scholar 

  43. Levy B, Williamson P . Patient perceptions and weight loss of obese adults. J Fam Pract 1988; 27: 285–290.

    CAS  PubMed  Google Scholar 

  44. Zapka J, Lemon S, Estabrook B, Rosal M . Factors related to weight loss behavior in a multiracial/ethnic workforce. Ethn Dis 2009; 19: 154–160.

    PubMed  PubMed Central  Google Scholar 

  45. Post RE, Mainous AG, Gregorie SH, Knoll ME, Diaz VA, Saxena SK . The influence of physician acknowledgement of patients’ weight status on patient perceptions of overweight and obesity in the United States. Arch Intern Med 2011; 171: 316–320.

    Article  Google Scholar 

  46. Pollak KI, Alexander SC, Coffman CJ, Tulsky JA, Lyna P, Dolor RJ et al. Physician communication techniques and weight loss in adults: project CHAT. Am J Prev Med 2010; 39: 321–328.

    Article  Google Scholar 

  47. Singh S, Somers VK, Clark MM, Vickers-Douglas K, Hensrud DD, Korenfeld Y et al. Physician diagnosis of overweight status predicts attempted and successful weight loss in patients with cardiovascular disease and central obesity. Am Heart J 2010; 160: 934–942.

    Article  Google Scholar 

  48. Dorsey R, Songer T . Lifestyle behaviors and physician advice for change among overweight and obese adults with prediabetes and diabetes in the United States, 2006. Prev Chronic Dis 2011; 8: A132.

    PubMed  PubMed Central  Google Scholar 

  49. Jay M, Gillespie C, Schlaie S, Sherman S, Kalet A . Physicians’ use of the 5As in counseling obese patients: is the quality of counseling associated with patients’ motivation and intention to lose weight? BMC Health Serv Res 2010; 10: 159.

    Article  Google Scholar 

  50. Cox ME, Yancy WS, Coffman CJ, Ostbye T, Tulsky JA, Alexander SC et al. Effects of counseling techniques on patients’ weight-related attitudes and behaviors in a primary care clinic. Patient Educ Couns 2011; 85: 363–368.

    Article  Google Scholar 

  51. Alexander SC, Cox ME, Boling Turer CL, Lyna P, Ostbye T, Tulsky JA et al. Do the 5As work when physicians counsel about weight loss? Fam Med 2011; 43: 179–184.

    PubMed  PubMed Central  Google Scholar 

  52. Jay M, Schlair S, Caldwell R, Kalet A, Sherman S, Gillespie C . From the patient's perspective: the impact of training on resident physician's obesity counseling. J Gen Intern Med 2010; 25: 415–422.

    Article  Google Scholar 

  53. National health and nutrition examination survey, 2010. (Accessed 6 July 2010, at http://www.cdc.gov/nchs/nhanes.htm ).

  54. Walsh JM, Swangard DM, Davis T, McPhee SJ . Exercise counseling by primary care physicians in the era of managed care. Am J Prev Med 1999; 16: 307–313.

    Article  CAS  Google Scholar 

  55. Ward R . Talking with your patients about dietary cholesterol, diet and nutrition: best practices for family physicians. Int J Clin Pract 2009; 63 (Suppl 163): 22–26.

    Article  Google Scholar 

Download references

Acknowledgements

We thank James Meigs and Elisabeth Watkins for review and editing of this manuscript. We thank Heather Bush and Daisuke Sugimoto for assistance with biostatistical analysis and editing.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S A Rose.

Ethics declarations

Competing interests

Dr Anderson currently has research support from Health Management Resources (HMR), and is a consultant to HMR.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rose, S., Poynter, P., Anderson, J. et al. Physician weight loss advice and patient weight loss behavior change: a literature review and meta-analysis of survey data. Int J Obes 37, 118–128 (2013). https://doi.org/10.1038/ijo.2012.24

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2012.24

Keywords

  • physician
  • counseling
  • documentation
  • patient behavior
  • meta-analysis

This article is cited by

Search

Quick links