Medically managing obesity: Offering hope or a disincentive to change?

Highlights

• GPs often medically manage obesity risk factors (eg. Blood pressure/cholesterol).

• It is unclear whether this offers hope or demotivates obese patients.

• This study used a vignette experimental design.

• Successful medical management (improvement in risk factors) enhanced intentions to lose weight and changed beliefs.

• Successful medical management could be a teachable moment to offer hope to patients.

Abstract

Objective

As weight loss in primary care remains minimal, Health Professionals are advised to medically manage obesity-related risk factors including blood pressure and cholesterol. This experimental study evaluated the impact of medically managing risk factors on obese patients’ motivation to change their behaviour.

Methods

A vignette study with two arms: successful medical management (ie risk factors have improved) vs failed medical management (ie no change) set in three General Practices in the South of England. Overweight and obese patients (n = 170) rated their behavioural intentions and beliefs after reading a vignette describing an overweight patient who had received either successful or failed medical management of their risk factors (blood pressure and cholesterol).

Results

Following successful medical management overweight and obese patients reported increased intentions to lose weight and a greater understanding of their condition.

Conclusion

Medical management may change patient’s understanding of their weight problem and motivate them to lose weight.

Practice implications

Successful management relating to improvements in blood pressure and cholesterol may offer renewed hope and motivate obese patients to change their behaviour. This could be used as a teachable moment to encourage patients to see that obesity need not be an inevitable part of their lives.

Introduction

Overweight and obese individuals are often managed in primary care as this can be their first port of call for symptom presentation or the location for opportunist management following a routine health check [1], [2], [3]. Research shows, however, that although some interventions in primary care can produce weight loss [4] many patients do not follow the advice they are given and weight loss remains minimal [5]. As a result of the failure to promote weight loss

the primary care management of overweight and obesity has recently shifted from the recommendation of behaviour change alone towards a management of weight-related risk factors in response to two new forms of evidence [1], [2]. Primarily, research has consistently shown that behaviour change interventions may only produce small and unsustainable changes in behaviour and subsequent weight [4], [5]. Second, large scale epidemiological data illustrate that the impact of obesity on coronary heart disease and stroke may be due more to metabolic risk factors rather than weight per se [6]. In line with this, GPs are now being encouraged to address a patient's blood pressure and cholesterol levels through medication as a means to manage their risk factors for disease as well as their body weight per se [1], [2]. This finds reflection in the move towards the medical management of smoking cessation through nicotine replacement therapy, the use of drugs such as Orlistat for weight loss and pharmacological approaches to the treatment of alcohol addiction [7], [8], [9], [10]. This shift in management approach has implications for patient outcomes. For example, by focusing on risk factors the patient may feel that their obesity is being ‘cured’ or at least ‘managed' and therefore requires no further input from themselves. Accordingly, being told that their risk factors have improved may paradoxically encourage a patient to make less effort to change their behaviour and lose weight. Such a response would be in line with research exploring the importance of an internal locus of control for behaviour change [11], the role of self efficacy and perceived behavioural control which are central to most models of behaviour [12] and evidence that a medical model of obesity is linked to poor weight loss and weight loss maintenance [13], [14], [15]. In contrast, however, it is possible that the successful medical management of risk factors may offer an incentive to the patient thereby increasing their motivation for the future. This reflects the notion of a teachable moment and the ways in which reinforcement and encouragement at specific times in a patients’ life can engender hope and subsequent change [13], [16]. To date, however, although doctors continue to medically manage risk factors there remains no evidence as to whether this process is either harmful or of benefit to the patient's motivation to self manage their weight problems in the future.

The present study therefore explored the impact of successful versus failed medical management of obesity risk factors (blood pressure and cholesterol) on patients’ intentions to lose weight and change their diet and activity levels. In addition, the study also explored any associated changes in the patients' beliefs about obesity in terms of their understanding of the condition, its consequences and whether it can be controlled by treatment or the patient themselves drawing upon Leventhal’s Self-Regulatory Model emphasizing components of illness representations [17].