When physicians tell patients directly that they are overweight, it raises the odds that the patients will perceive their weight realistically, will want to lose weight, and will try to lose weight, according to a report in the Feb. 28 issue of Archives of Internal Medicine.
However, fewer than half of overweight patients and fewer than two-thirds of obese patients say they have been told by their physicians that they are overweight.
"This is an important intervention point that is being missed by many physicians. Physicians need to tell more overweight and obese patients that they are overweight because this may help encourage them to change their behavior to lose weight and lower their risk for many diseases," said Dr. Robert E. Post of the department of family medicine, Medical University of South Carolina, Charleston, and his associates.
Today’s overweight and obese patients are more likely to consider themselves to be of normal weight than their counterparts of 20 years ago were, in part because the current obesity epidemic has made higher weights and larger sizes seem more normal. Patients who don’t perceive their weight accurately won’t recognize their health risks and won’t work to reduce them, the investigators said.
They analyzed data from the 2005-2008 National Health and Nutrition Examination Survey in a cross-sectional study to assess the effect of physician acknowledgment of weight status on patient behavior. The study included data for 7,790 men and women aged 20-64 years who constituted a nationally representative sample of the U.S. population.
A total of 5,474 of these subjects qualified as overweight, with a BMI of 25 kg/m2 or greater, including 2,874 who qualified as obese, with a BMI of 30 or greater.
Of the overweight subjects, 45% reported that their physicians had told them they were overweight, as did 66% of the obese subjects. These subjects were much more likely to identify themselves as overweight (94%) or obese (97%) than were overweight subjects whose physicians had not so informed them (63% and 81%, respectively). They also were much more likely to report that they wanted to lose weight and had attempted to lose weight during the preceding year.
However, about 37% of overweight and 19% of obese subjects had not been told they were overweight by their physicians and did not consider themselves to be. In comparison, only 6% of overweight and 3% of obese subjects who had been told by their physicians that they were overweight continued to consider themselves to be of normal weight.
"This speaks strongly to the influence that physicians’ words have on their patients," Dr. Post and his colleagues said (Arch. Intern. Med. 2011;171:316-21).
Extrapolating this finding to the general U.S. adult population, "this equates to more than 74 million overweight individuals, including nearly 23 million obese individuals, who have never been told that they are overweight," they added.
Telling patients that they are overweight was associated with an eightfold increase in the odds that they would accurately see themselves as overweight and a sixfold increase in the odds that they would accurately see themselves as obese. This recognition is essential because being aware of the problem is the first step in changing behavior to overcome it, the investigators noted.
This study could not assess why physicians fail to identify patients as overweight. It is possible that some patients didn’t "hear" this even though their physicians did tell them.
Alternatively, some physicians may not bother to inform patients of weight status because they see patients as lacking in self-control or motivation to change. Some may feel that labeling patients as overweight or obese is simply stating the obvious and won’t make much difference. Still others may cite time constraints, feeling that if they don’t have the time, they should "avoid starting a potentially long conversation" during a patient visit.
The strong association found in this study between physicians’ remarks and patients’ beliefs "should help to change these negative perceptions among physicians and encourage incorporating extra time into visits to discuss weight management with their patients," Dr. Post and his associates said.
No financial conflicts of interest were reported.