Weight-related Advice Research Articles

Consequences of receiving weight-related advice from a healthcare provider: Understanding the varied experiences of people with higher weight

Healthcare providers regularly give weight-related advice (e.g., behavioral weight loss counseling) to patients with higher weight (BMI ≥30 kg/m2). The U.S. Preventive Services Task Force recommends this practice on the basis that behavioral weight-related advice can motivate patients to attempt weight loss; however, it is also possible that this advice has adverse consequences (e.g., negative psychological reactions). In this study, we examined people's reported reactions to a recent experience of receiving weight-related advice from a healthcare provider. U.S. adults (N = 189) with higher weight who reported having received weight-related advice completed an online survey via Prolific. They answered questions about their most recent experience of receiving weight-related advice, including the purpose of the visit, characteristics of their provider, and characteristics of the advice itself. They also provided demographic information and indicated their trust in healthcare providers and the healthcare system. 90.5% of participants (n = 171) reported having one of three types of reactions to their provider's weight-related advice. Participants (1) felt motivated to change their behaviors and weight; (2) felt bad or guilty about their behaviors and weight; or (3) felt both motivated to change and bad or guilty. Using chi-square tests of independence and one-way ANOVAs, we examined how various participant characteristics and characteristics of the visit, provider, and advice itself differed across these three groups. We found significant demographic differences across the groups and found that a disproportionate amount of people in the “motivated” group reported having requested the weight-related advice and having had a two-way discussion about weight with their provider. Whereas some people feel motivated after receiving weight-related advice from a healthcare provider, others are left feeling bad about themselves or ambivalent. Understanding these varied reactions may provide insights into how healthcare providers can deliver advice that is motivating without eliciting negative psychological reactions.

Interaction between patient and general practitioner according to the patient body weight: a cross-sectional survey.

To analyse whether patient-general practitioner (GP) interaction, measured by their disagreement, varies among overweight or obese patients compared with normal-weight patients. Twenty-seven GPs and 585 patients participated in the quantitative phase of the multidisciplinary INTERMEDE project and answered "mirrored" questionnaires collecting both GPs and patients' perceptions on information and advice given at the end of the consultation. Multilevel logistic regressions were performed to explore associations between patient body mass index (BMI) and patient-GP disagreement on information and advice given during the consultation. Disagreement increased with the patients' excess weight, and it was particularly pronounced for advice given by GPs on weight and lifestyle issues. Compared with patients with a "normal" BMI, overweight patients were more likely to disagree with their GP regarding advice given on weight loss (odds ratio [OR] = 10.7, 95% confidence interval [CI] = 4.1-27.3), advice given on doing more physical activity (OR = 1.9, 95% CI = 1.1-3.4), and nutritional advice (OR = 2.9, 95% CI = 1.5-5.6). These disagreements could degrade the quality of patient-physician relationship. Our study provides an opportunity for GPs to reflect on how they communicate with overweight and obese patients, particularly with regard to lifestyle and weight-related advice and interventions taking into account the patient's representations.

Factors associated with improving diet and physical activity among persons with excess body weight.

As overweight and obesity are highly prevalent in Eastern Europe, the study examined the trends and factors associated with self-reported weight reducing behaviours among individuals with excess body weight in Estonia. Study used nationally representative cross-sectional data from 2006 to 2016 including 4302 men and 3627 women aged 20-64 years with excess body weight (BMI ≥ 25). Trends in the prevalence of changing eating habits and physical activity and their sociodemographic and health-related correlates were studied using descriptive statistics and multivariable logistic regression. Among overweight or obese respondents, 41% of men and 48% of women reported improvements in dietary habits and 19% of men and women reported increase in physical activity during the past 12 months in 2016. Positive trend for 2006-2016 regarding both outcomes was observed for men whereas no statistically significant differences were found for women. Women and those with lower than tertiary education had higher odds for reporting change in eating habits whereas older age and smoking or excessive alcohol consumption reduced the odds. Improvement in physical activity was more likely among younger respondents, women, ethnic Estonians and those with tertiary education, whereas poorer health and smoking reduced the odds. Weight-related advice from health professionals or family had strong effect on both outcomes. Socio-demographic and health profiles differentiate the self-reported behavioural change among persons with excess body weight. Advice from either health professionals or family may have a potential to facilitate positive changes in eating habits and physical activity among those individuals.

Lives on the Line: The Online Lives of Girls and Women With and Without a Lifetime Eating Disorder Diagnosis.

This study aimed to compare the scope, internet use patterns, and degree of online need satisfaction of girls and women with and without a lifetime eating disorder (ED) diagnosis. Participants were 122 females aged 12–30, 53 with a lifetime ED diagnosis recruited via a hospital-based treatment program, and 69 age-matched controls recruited via normative social media sites. Participants completed questionnaires assessing disordered eating, body image, positive and negative affect, general distress, and life satisfaction, and completed an online survey about the scope of their internet use, the frequency of watching and posting pictures and videos, online friendships and social comparison, fulfillment of needs online, and mood after internet use. All questionnaire scores differed significantly between groups in the expected directions. Whereas overall, ED and control groups spent similar amounts of time online (6.21, SD = 5.13), they spent this time differently. ED participants reported devoting 56.7% of their online time to eating, weight and body image, versus 29.1% for controls, and spent significantly more time than controls on forums and blogs (t = -5.3, p < 0.0001, Cohen’s d = 0.87). They also engaged more often in social comparison (t = 3.6, p < 0.005, Cohen’s d = 0.65), had a higher online–offline friend ratio (t = 3.7, p < 0.0001, Cohen’s d = 0.65), and more online friends with ED (t = 5.4, p < 0.0001, Cohen’s d = 0.89). In comparison to controls, ED participants reported that their use of forums and blogs gave them more eating- and weight-related advice, and a greater sense of belonging, social support, and safety resulting from anonymity, with effect sizes of 0.63–0.96. However, they also reported more negative affect after posting online. Most online behaviors and patterns correlated positively with measures of symptomatology and negatively with measures of psychological health, in both groups. Internet use was rarely addressed in therapy. Professionals, families and friends should help people with disordered eating and EDs to broaden the scope of their internet use. They should invest less in food- and weight-related forums/blogs, expand their “real life” social lives and develop their interpersonal skills, so that their legitimate needs can be satisfied face-to-face, rather than virtually. Clinicians should address the online lives of their ED clients in therapy.

Impact of weight-related advice from healthcare professionals on body mass index of patients in the USA

ObjectivesHealthcare professionals (HCPs) can help promote healthy eating and active living in patients. This study assessed the effects of weight-related advice from HCPs on change in body mass index (BMI) of patients in the USA. Study designA 1-year follow-up study of 20,002 adults who participated in a nationally representative survey between 2004 and 2008. MethodsUsing the 2004–2008 Medical Expenditure Panel Survey data, 1-year BMI and weight status changes were compared between patients who did and did not report receiving advice on exercise or on restricted intake of fat and cholesterol from their HCPs. ResultsPatients who received weight-related advice had a greater increase in BMI compared with those who did not receive weight-related advice. Stratified by the baseline weight status of patients (i.e. normal weight, overweight or obese), adverse direction of BMI change was only significantly associated with advice on exercise. Patients who received advice to exercise more were more likely to move to a higher weight status than remaining at the same weight status, compared with patients who did not receive advice to exercise more. ConclusionThis study did not find that weight-related advice from HCPs had a positive impact on BMI loss in patients. On the contrary, patients who reported receiving weight-related advice from HCPs had worse weight outcomes 1 year later than patients who did not report receiving weight-related advice. Further research is warranted to elucidate the role of weight-related advice from HCPs on lifestyle change and obesity prevention and control.

Community Mental Health Providers' Beliefs About Addressing Weight Loss Among Youth Clients with Serious Emotional Disturbance and Overweight/Obesity: An Elicitation Study.

Youth with Serious Emotional Disturbance (SED) have high rates of overweight/obesity. Factors influencing mental health provider intentions to deliver weight-related advice are unclear. This study used qualitative methodology and Theory of Planned Behavior (TPB) constructs to examine these factors. Community mental health providers serving youth with SED were recruited via convenience sampling and an online provider list. Participants completed an open-ended TPB-based questionnaire online. Content analysis identified thematic beliefs. Twenty-one providers completed the questionnaire. Providers identified behavioral beliefs (e.g., client defensiveness), normative beliefs (e.g., medical professionals), and control beliefs (e.g., limited resources) that impact decisions to provide weight-related advice. Knowledge of factors that may influence providers' delivery of weight-related advice may lead to more effective healthy lifestyle programming for youth with SED.

Weight-Related Perceptions and Experiences of Young Adult Women in Southwest Georgia.

Young adulthood is a period of pronounced weight gain, though few weight management interventions exist for this population. This qualitative study explored how young adult women feel about their weight, what kinds of weight-related advice they have received, and concerns about future weight gain to inform the adaptation of a weight gain prevention intervention. Forty women completed semistructured, in-depth interviews, which were digitally recorded, transcribed verbatim, coded, and analyzed using thematic analysis. Participants were women aged 20 to 29 years, primarily overweight (12.5%) or obese (55.0%), and African American (65.0%). Participants expressed dissatisfaction with their current weight and reported receiving advice to lose weight from multiple sources. Direct, health-focused advice from health care professionals tended to be received more positively than indirect, appearance-focused advice from family members and romantic partners. Participants expressed concern about future weight gain, either as a result of a family history of obesity or chronic disease, pregnancy, and child-rearing, or unhealthy lifestyle patterns. Future weight gain was anticipated to impact chronic disease risk, changes in physical appearance, and interference with daily activities. Results suggest that young adult women may be receptive to participating in weight management interventions and that health care systems may be strategic implementation partners.

Is Gestational Weight Gain and Early Postpartum Weight Retention Associated with Clinician Advice in First Time Mothers?

Objective: Excess gestational weight gain (GWG) and postpartum weight retention increase risk for multiple maternal and child health complications. It is necessary to determine factors which influence maternal weight across the perinatal period. The aim of this study was to describe change in maternal body mass index (BMI) from prepregnancy to early postpartum, document weight advice provided by clinicians and assess associations of advice received with maternal weight gain during and following pregnancy. Methods: First-time mothers (n=448) and their newborns who attended first-time parent groups at their local Maternal and Child Health Centres were recruited to the InFANT Extend cluster randomised controlled trial. Baseline data collection occurred when women were approximately three months postpartum. Women completed a written questionnaire assessing their own health and the provision of weight-related advice received by clinicians. Prepregnancy weight and GWG were self-reported. Postpartum height and weight were objectively measured. Results: Mean GWG was 14.0 ± 6.08 kg and 41.0% of women experienced excess gestational weight gain. Mean PPWR was 4.3 ± 5.75 kg and mean BMI increased from 24.8 ± 4.9 kg/m² pre-pregnancy to 26.2 ± 4.9 kg/m² at three months postpartum. The proportion of women classified obese (BMI≥ 30kg/m2) almost doubled from prepregnancy (11.8%) to three months postpartum (21.7%) (p<0.001). 54.4% of all women reported receiving advice regarding how much weight to gain during pregnancy and 42.6% reported receiving advice to avoid excess GWG. During the postpartum period, just 5.8% of women reported receiving advice about how much they should weigh and 8.3% reported receiving advice about programs to support weight loss. No associations were found between provision of clinician advice with gestational weight gain or postpartum weight retention. Conclusion: More intensive approaches are required, opposed to provision of advice alone, to influence healthy maternal weight across the perinatal period in the interest of best maternal and child health outcomes.

Patient-health care professional gender or race/ethnicity concordance and its association with weight-related advice in the United States

ObjectiveExamine association between adult patients’ and health care providers’ (HCPs) gender or race/ethnicity concordance and patients’ reported receiving weight-related advice from HCP’s in USA. MethodsUsing Medical Expenditure Panel Survey (MEPS) 2004–2007 data, studied prevalence of weight-related advice (on exercise and diet) given to patients and its association with patients/HCPs concordance in gender (n=9,686) and race/ethnicity (n=8,825). ResultsOverall, 46% of patients received HCP advice on diet and 49% on exercise. Overweight females seeing female HCPs were more likely to receive exercise advice than those seeing male HCPs (OR=1.44 [95% CI: 1.10–1.89]). Race/ethnicity concordance was associated with lower odds of advice-receiving in certain populations (OR=0.80 [0.67–0.97] for exercise and OR=0.42 [0.19–0.91] for diet among white patients, OR=0.47 [0.23–0.98] for exercise among Hispanic overweight patients). ConclusionsPatient/HCP gender or race/ethnicity concordance was not positively associated with HCPs providing weight-related advice. Patients with female HCPs or with racial/ethnic discordant HCPs (especially black or Asian HCPs) were more likely to receive advice. Practice implicationsHealth care providers need be empowered, particularly white and male HCPs, to improve delivery of weight-related advice. It may reflect better of receiving weight-related advice based on patients’ recall.

Midwives' attitudes towards giving weight-related advice to obese pregnant women

It is estimated that 1 in 5 pregnant women are obese, this poses a significant risk to maternal, fetal and newborn mortality and morbidity and as such, maternal obesity is recognised as a challenge for contemporary and prospective maternity services. As key practitioners in maternity care, midwives are seen as frontline professionals delivering weight-related advice to obese pregnant women. This study aimed to explore midwives' attitudes towards offering obese pregnant women weight-related advice during pregnancy and the puerperium. Nine midwives were interviewed using an in-depth interview schedule. Data were analysed using Colaizzi's (1978) seven-stage thematic approach. Midwives' knowledge of risk associated with maternal obesity was good; advice giving was mainly confined to community practice; the amount and consistency of advice was determined by: women's responses, women's apparent motivation to change and midwives' self-perception as a role model. Four key themes emerged: challenges for practice; perceived proficiency; advice giving skills and midwives' perceived relationship with a woman. Midwives need to address personal issues around body image, as they appear to hinder advice giving, before they can develop effective communication techniques to be able to offer obese pregnant women weight-related advice. The recommendation is to investigate ways in which issues of body image influence midwives ability to offer weight-related advice.

Body Image and Dieting Attitudes: Among Preadolescents

Differences in body image and dieting concerns were assessed in preadolescent boys and girls across the body mass index (BMI) spectrum. The hypothesis was that girls would express more concern with body size, report more dieting, and receive more advice than boys. In this cross-sectional descriptive study, age-appropriate figure drawings, the Children's Eating Attitudes Test (ChEAT), the Restraint Scale, and the Body Esteem Scale were administered to participants in the Study of Asthma, Genes and Environment, Manitoba. Responses were compared between genders and correlated with BMI percentiles. A total of 565 10- and 11-year-old children (321 boys) completed questionnaires. Overall, 39% of participants wanted to be thinner, and no significant gender differences based on weight were found. However, the use of figure drawings indicated that girls desired greater changes in body size (p=0.006). Girls had higher Restraint Scale scores (p=0.003), but no statistically significant differences were found in self-reported dieting, ChEAT, or Body Esteem Scale scores. Approximately 25% of children reported receiving frequent weight-related advice. Girls did not report this more often than did boys. Children in the lowest BMI percentile desired the greatest change in body shape and had the highest Restraint Scale scores. Key gender differences underline the importance of understanding children's attitudes toward body image, weight, and dieting.

Weight, Perceived and Desired Body Size, and Self-Reported Medical Weight Loss Advice in Female Food Stamp Recipients Living in Southeast Louisiana

TEXT: Understanding the complex relationship among food insecurity, overweight/obesity, and body image is necessary to design and implement programs that address these problems in low-income individuals. Food security status of 66 female food stamp recipients (94% black) living in Southeast LA was determined using a modified USDA short-form. There was no difference among mean ages of food secure (FS, n 30) 44.03 15.26 years, food insecure (FIS, n 27) 40.26 13.44, or food insecure with hunger (FISH, n 9) 37.67 14.41 groups. Body mass indices (BMI) were calculated; perceived and desired BMIs were determined using a silhouette panel. Actual and perceived BMI of FS, FIS, and FISH women were 34.28 11.56, 28.28 7.59 (p 0.0002); 37.07 13.18, 28.32 7.9 (p 0.00001); and 34.66 10.44, 29.37 4.74 (p 0.05), respectively. The average BMI of all groups was in the obese range. On average, desired BMI was within normal weight range for FS (22.77 3.56), FIS (22.21 3.28), and FISH (23.11 2.77) groups. Women self-reported whether a physician had informed them of their overweight/obese status and if so, had the doctor given weightrelated advice or weight loss medication. In FS, FIS, and FISH groups, 11 (37%), 6 (22%), and 5 (56%) of the overweight/obese subjects, respectively, reported their doctor had never told them they were overweight. In the same groups, 7 (23%), 10 (37%), and 2 (22%) had been told that they had a weight problem, but were not given treatment for weight loss. Although some women recognized they were overweight/ obese, they did not fully understand the advantage of nutrition and exercise in weight loss and health promotion.