Perceptions key for obesity counseling in blacks

Primary care doctors who counsel African American patients about obesity should remain sensitive to the perceptions of their patients, according to a report in the Journal of General Internal Medicine.

"Patients want and expect their physicians to initiate a discussion on weight management, and the manner in which they communicate does affect how patients receive these messages," Dr. Stephanie H. Ward from Temple University School of Medicine, Philadelphia, Pennsylvania told Reuters Health. "Messages need to be individualized, emphasize the benefits of weight loss, and be timed appropriately in order to motivate the behavior change necessary for weight loss."

Ward and colleagues used focus groups to better understand how obese African Americans perceive the role of physicians in the treatment of obesity, and to identify specific provider behaviors that are motivating versus those that may be counterproductive.

Most of the 43 participants strongly disliked the use of the term 'obese' and felt that it carried negative connotations and was associated with some form of discrimination.

Participants placed significant emphasis on the need for the physician to demonstrate respect, remain nonjudgmental, and express sincere concern for a patient's well-being. They also wanted positive feedback for even small weight losses and expressed frustration and anger at physicians who attributed all of their medical complaints to their weight.

Focus group members expressed a desire for their physicians to take time to explore their motivators and barriers to losing weight and wanted their physicians to set and discuss individual weight loss goals with them

"The other interesting finding from this study was the mixed response to the use of scare tactics," Ward said. "Some people stated they wanted and needed to be scared; others were more neutral; and others interpreted scare tactics as a means of 'threatening' patients and didn't think they should ever be used."

"Motivational interviewing techniques, which are employed by physicians for other behavioral issues, such as smoking, can be used to address barriers," Ward explained. "I would argue that while many physicians do feel inadequately trained, they are actually better prepared to counsel their patients than they might believe."

SOURCE: Journal of General Internal Medicine, March 10, 2009.