Why are conversations between healthcare professionals and people living with obesity important?

Obesity is a chronic, complex, relapsing condition which is influenced by range of factors including genetic and environmental elements¹.  International guidance encourages healthcare professionals to offer weight loss support to patients living with obesity. This support mostly occurs through communication – conversations - in a clinical setting. Evidence shows that even a brief supportive conversation is associated with weight loss², highlighting just how important and beneficial these conversations can be.

What are the challenges to having these conversations?

But here are some key challenges in having positive conversations. Healthcare professionals have shared concerns that they are unsure what to say, and feel they require more guidance. Many also have concerns that people with obesity may feel stigmatised, and so they avoid talking about weight with their patients³.  People living with obesity highlight that whilst they do want their healthcare professional to talk to them about weight, and weight management options⁴, these conversations can create feelings of shame and blame, contribute to weight stigma⁵, and be demotivating.  

People living with obesity say that the way these conversations are carried out including word choice and tone,  are crucial in differentiating  supportive, and helpful conversations from those which are stigmatising and demotivating.

Surely there’s information out there for healthcare professionals to support them to communicate in ways that are supportive and helpful?

Well yes…. And no. Yes – there is support out there with a wide variety of guidance, training, and communication ‘tips’ available. But –and here’s the ‘no’ – this is not as supportive or as useful as it could be. Communication guidance tends to be quite vague. Guidelines, for example, advise unspecific communication approaches  like ‘be helpful’.  We can assume that most (if not all⁶) healthcare professionals are trying to ‘be helpful’ when communicating offers of weight loss support to patients. It’s an important sentiment – but how can professionals enact this? This guidance really doesn’t give any specific detail about how to actually ‘be helpful’ when communicating in this context…what does that look like in practice? What words or phrases to use, and which to avoid?  It’s clear why professionals report needing more support.

So, we have a problem. We know these conversations are important, but professionals need more support about what to say, and guidance isn’t specific enough to meaningfully help with this.

How do we find out how professionals and patients living with obesity can have supportive and helpful conversations together?

 “Why don’t we just interview people?” you might think, “Ask them what they should say”. Well, interviews are great at finding out what people report thinking and feeling about a conversation. But they can’t access precisely what actually happened.  We might leave a consultation thinking ‘That was a great conversation with the doctor’ (they were ‘being helpful’) but recall bias limits our ability to pinpoint precisely, comprehensively, and empirically what contributed to that perception.

The answer then is surprisingly simple – investigate the conversations themselves.

Everyday, professionals and patients are having real conversations that are supportive and beneficial, and also interacting in ways that are not. These conversations contain specific words, phrases, tones, intonations, and other details, which have an effect on the consultation and influence whether approaches are commonly received positively, or negatively. The field of communication science  (specifically, conversation analysis) enables us to collect examples of real communication  and learn from them about precisely which ways of communicating actually work well in practice⁷.

How much does studying real communication actually matter though?

Long story short, a lot.  

Here’s an example. We conducted a study examining relationships between language used when healthcare professionals offered weight loss support to patients living with obesity, and patient weight loss. The crucial thing was that every healthcare professional in our study communicated the exact same information -an offer of referral for weight loss support. But the way that they communicated this, the words and tone they used, varied. We found that seemingly small changes in words and tone  were  not only positively received by patients in the consultations, but were also associated with significantly greater acceptance of offers of treatment, and patient weight loss one year later⁸. It was not what was said, but how it was communicated that really mattered.

 Importantly our study results generated information that could help overcome current limitations of training and guidance, showing evidence of specific communication practices that healthcare professionals can use in practice⁹. Specific practices such as  ‘include optimistic projections for the future’ and  ‘use explicitly positive words like “this will positively help”’; could offer more support for clinicians than general recommendations to ‘be helpful’. Analyses also revealed strategies professionals should avoid, including some that guidelines recommended. For example, whilst guidance advises that professionals should emphasise the ‘effort and commitment’ needed to lose weight, when this happened in practice this actually contributed to negative (not positive) conversations.

There is so much more to learn about clinical conversations between healthcare professionals and people living with obesity that could contribute to understanding how to improve experiences and outcomes. For example, how can new treatments best be communicated? How can the range of existing treatments be discussed and the benefits and risks clearly communicated? What happens when someone lives with multiple long-term conditions, how can all conditions be incorporated into the conversation?  There are many important questions to address, and we should work with people living with obesity to decide future research directions together. To answer important, communication-focussed, research questions empirically analysing real conversations should become standard practice. How can we carry out research which aims to understand and improve conversations, without analysing the conversations themselves, and finding out what actually works?

Conversations are a crucial part of healthcare, and there are many contexts like this where conversations are important but can be challenging. Contexts where general communication recommendations  just aren’t enough. We should look to communication science, specifically empirical analyses of real conversations  to actually ‘be helpful’.

If you’re a healthcare professional you can access:

• Information and training about obesity through The Strategic Centre for Obesity Professional Education
• Brief evidence training (developed using evidence from real communication) on Supportive and effective conversations about weight management referrals and  Practical tips and audio clips for delivering very brief weight loss interventions

With thanks to the group of six people living with obesity who reviewed drafts of this blog post.

Key references:

 Image: ‘Consultations’ by Libby Wilcox Pearce, inspired by analysis of real clinical conversations, and discussions with people living with obesity