The way in which healthcare workers communicate with obese patients, including tone and choice of words, has been shown to have a significant impact on whether a patient successfully loses weight.
Researchers at the University of Oxford found that when a referral to weight loss services is delivered positively, the chances of a patient engaging in the programme and losing weight are much higher than when neutral or negative language is used.
Subtle changes in communication, such as presenting the referral as a positive opportunity and delivering the news confidently, cheerfully and fluently, were found to significantly influence patient outcomes one year later.
The findings are published in the journal Annals of Internal Medicine and illustrate how the vocabulary around weight loss matters in both a short and long-term medical context.
The Health Survey for England 2021 estimates that 25.9% of adults in England are obese, making it a significant public health problem. Healthcare workers are encouraged to discuss weight loss with patients and can offer them referrals to weight loss services where appropriate. However, on a yearly basis, referrals are only meaningful for 5 per cent of obese patients.
The researchers analysed data from 38 primary care clinics in England participating in the Brief Intervention for Weight Loss trial. They identified 246 patients with obesity who were seen by 87 clinicians. Using ‘conversation analysis’, the researchers determined how the words used by the clinicians and their tone of voice, known as ‘paralinguistic’ features, could impact obesity care, specifically whether patients agreed to attend the program, how often they attended and how much weight they lost.
Word choice and tone of voice were found to directly influence patient health outcomes. Clinicians were shown to communicate in three main ways: positively, negatively or neutrally.
One group of healthcare workers delivered the referral suggestion as ‘good news’, framing the referral as a positive opportunity whilst talking fluently and cheerfully. Other clinicians delivered the referral as ‘bad news’, highlighting health issues related to being overweight and stressing the effort needed from the patient for results. In this case, the referral is presented as a necessary medical solution, and the delivery is slower and often interrupted by hesitations. A final group of clinicians delivered the news in a neutral manner, with a steady, consistent voice tone and were neither overly focused on benefits or issues.
The researchers discovered that when the news was delivered positively, 83 per cent offered a referral to weight loss services attended. In addition, people who received the referral as ‘good news’ lost half a stone or more in weight.
Only half of the patients who received the referral as ‘bad news’ or ‘neutral news’ accepted the referral, and there was no significant difference in weight loss between them.
Dr Charlotte Albury, lead author and researcher within the Nuffield Department of Primary Care Health Sciences at the University of Oxford, said: ‘What we found was that when doctors framed the conversation as ‘good news’ – emphasising the benefits and opportunities of weight loss in a positive manner – patients were more likely to enrol in a weight loss programme, attend more sessions, and, importantly, lose more weight compared to a neutral or negative framing.’
Clinicians reported hesitancy about bringing up a patient’s weight for fear of causing offence or being uncertain about how to address the issue. Patients reported a strained rapport and negative feelings when an inappropriate tone or choice of words was used.
The researchers suggest that healthcare workers should be advised on how compassionate communication could aid weight loss efforts.
Dr Albury added: ‘We know words matter, and this research shows they really do -in the short and long term. Subtle changes in communication can significantly influence patient outcomes one year later.’
The researchers say that the findings could significantly alter how medical professionals approach conversations with patients and urge healthcare professionals to adopt the ‘good news’ approach in their communications with patients living with obesity to boost patients’ motivation to act.