Obesity as a Barrier to Patient-Physician Communication

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DESCRIPTION (provided by applicant): The obesity epidemic poses serious health risks for Americans by contributing to rising rates of diabetes, hypertension, and also, although less well known, cancer morbidity and mortality rates. Physicians play an integral role in addressing obesity through weight loss, nutrition, and physical activity counseling; however, only 40 percent of overweight or obese patients report receiving such counseling. Our multidisciplinary team of investigators with expertise in social psychology, patient-physician communication, and epidemiology, and a track record in examining disparities, obesity, and communication proposes to explore how patients and physicians discuss weight loss. "The specific aims of this study are to determine (1) whether the way physicians and patients discuss weight loss leads to actual weight loss among overweight and obese patients; (2) whether patient-physician discussions about weight loss affect patients' readiness, self-efficacy, outcome expectancies, and motivation to lose weight, and (3) whether physicians communicate differently when they discuss weight loss than when they discuss other topics. To accomplish these aims, we propose to audio record 480 patient-physician primary care encounters (40 family medicine and internal medicine physicians practicing in the Durham community; 12 patients each, 6 with overweight and 6 with obese patients). Coders will assess the frequency with which primary care physicians use patient-centered techniques or motivational interviewing techniques as a measure of the quality of the weight loss counseling. As a measure of the quantity of weight loss discussions, coders will rate what patients and physicians discuss (e.g., caloric restriction, physical activity, referral to nutritionists, prescription weight loss medication, etc.). In addition to the objective measures from the audio recorded visits, we will assess patients' weight loss three months after the visit as well as their immediate perceptions of the content of the visit, their physicians' communication, their relationship with their physician, and psychosocial mediators of weight loss (e.g., readiness, self-efficacy, outcome expectancies, and motivation to lose weight). Results of this study will expand the field of patient-physician communication by examining how physicians and patients discuss weight loss; this information can be used to develop interventions targeted toward patients and physicians to improve weight-related communication and thus help curb the obesity epidemic.