Major Finding: When physicians told patients that they were overweight or obese, patients were much more likely to accurately perceive that they were overweight (94%) or obese (97%), compared with patients who had not been given that information by their physicians (63% and 81%, respectively).
Data Source: A cross-sectional analysis of data from the nationally representative 2005–2008 NHANES study involving 7,790 men and women aged 20–64 years, of whom 5,474 were overweight.
Disclosures: No financial conflicts of interest were reported.
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 new report.
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.
“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, the investigators said.
They analyzed data from the 2005–2008 National Health and Nutrition Examination Survey in a cross-sectional study. 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/m
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.
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Intervention Is Not an Insult
Some patients may feel insulted when told they are overweight or obese, but “expressing concern rather than judgment, and normalizing the conversation by simply comparing measured weight with standard definitions is likely to be effective,” Dr. Robert B. Baron said.
Saying, “I am concerned about your weight. Today's measurement places you in the overweight (or obese) category, according to our medical definitions,” should minimize the patient's tendency to take offense, he said.
Physicians should inform patients of their weight status in a straightforward manner analogous to telling patients that their blood pressure or cholesterol level is elevated, he noted.
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DR. BARON is in the department of medicine at the University of California, San Francisco. He reported no financial conflicts of interest. These remarks were taken from his invited commentary that accompanied Dr. Post's report (Arch. Intern. Med. 2011;171: 321-2).