Specific phrases about weight management programmes help GPs make successful referrals

In this video, a narrator explains the background and results of the study, and animations are used to illustrate the narrative. The narrative is included below, along with any text displayed on the screen.

[Narrator] Guidelines say we should be opportunistically intervening on our patient’s weight. You will achieve the best outcome for your patients if you offer them a free referral to a weight management service.

Evidence shows that commercial services, like slimming world and weight watchers are more effective than trying to lose weight without support, and are not only cost-effective but cost-saving even if people put the weight back on.

In many areas these are available on the NHS, although no weight management service or other services might be available where you work.

We’ve analyzed hundreds of recorded consultations between GPs and patients, where the GP opportunistically offers referral to commercial weight management services, like Slimming World or Weight Watchers.

We found these conversations can easily fit at the end of a typical consultation, and that if you are positive about them your patient is likely to be too.

We identified what you can say that is likely to be well received by your patients, and is also likely to lead to attendance at weight management services. We’ve found you can have positive helpful conversations in around 30 seconds.

Offering a referral doesn’t need to be complicated. Simply,

[Text on screen] Raise the topic, Establish services are effective, Offer a free referral, Acknowledge the patient’s response, Outline next actions.

Let’s look at an example:

“The evidence about the best way to lose weight shows that commercially run weight management organizations like Weight Watchers have the best results. I can actually offer you the opportunity for a free referral to a local one today for 12 weeks. Would you be interested in going along to one of those?”

“Yes, I would”

“Brilliant! I would really encourage that. I can make a referral today, and you’ll get a call from the weight management service soon.”

Here are some techniques you can use at each of these stages, that will support you to have effective, brief and well-received conversations.

Conversation toolkit

1. Raising the topic
It may feel strange to raise the topic out of the blue, but it’s easier than you might imagine.
“While you’re here can I check your weight please?”
When stating the patient’s weight don’t say obese or BMI but mention that their weight is higher than you would like it to be, and immediately mention that some support is available.
“Your weight is a little bit higher than we’d like, and I can actually offer you some support to lose weight today”

2. Established Commercial Weight Management services are effective
Before offering a referral, it’s important to first say that commercial weight management services like Weight Watchers or like Slimming World are the best way to lose weight.
“Did you know that commercial weight management services like Slimming World are the best way to lose weight? People do really well with that, they’re far more successful than trying on your own.”
If you don’t do this patients are unlikely to agree, as they may not know they are effective.

3. Offer a free referral
There are five important features of the referral, which should be simple, short and jargon free:
Be confident
Confidence is key. Remember you’re offering something that normally costs a lot of money for free.
We found no evidence that patients are upset or offended by this, but if you sound reluctant or nervous they are unlikely to want to attend.
Don’t talk about other conditions
It may seem like a good idea to talk about the benefits of weight loss for a patient’s existing condition, like diabetes or asthma [infertility, heart disease, high blood pressure, joint pain].
However, our research has shown that this is one thing that can make patients upset or defensive. So this strategy is best avoided.
Offer an opportunity
Simply say, “I can offer you the opportunity of a free 12-week referral at a service like Weight Watchers or Slimming World, these are local and will support you to lose weight”.
Our research has shown that saying the words offer, opportunity, support and local are well received, and address questions patients may otherwise ask later.
Saying the word free is very important.
[Text on screen] Would you be interested in that?
Would you be interested
After you’ve outlined the offer, ask the patient directly “Would you be interested in that?”
The way you make the offer is important, don’t use if or or as this is likely to open discussion further and take a longer time.

4. Acknowledge the patient’s response
Here’s how to reply to patients in ways which are likely to keep the conversation brief and motivational. Remember, it is very unlikely your patient will be upset or offended by these conversations.
Your patient may say they’re already losing weight, acknowledge and congratulate these current or past efforts. If they’re already losing weight they can still attend a weight management service, and this could be really helpful to support them to keep up the good work.
“That’s brilliant!”
If patients are unsure or on the off chance they’re upset, saying “I think this will be a really good thing” can support them in making their decision. It’s unusual to be offered these referrals at the doctors and patients may be unsure about accepting, but knowing that their doctor thought this was good and helpful, really supports patients in making their decisions.
Surprisingly we found that when a patient said “Yes?” or “Yeah?” in response to an offer they weren’t always agreeing, they were actually requesting more information. If your patient says “Yes?” or “Yeah?” try telling them a little more about what you’re offering.
However, our research showed that a positive response like “Yes definitely!” or “That sounds good” indicated enthusiastic receipt of the offer. If your patient responds this way, be positive too and move to the next steps.
Listen for the word “Oh!” this shows an offer is well received, and you can stop persuading and move to make the referral right away.
“I can actually refer you for free today.”
“Oh right!”
Some people don’t want to accept the referral, and trying to convince or persuade people that had declined an offer doesn’t work, and is likely to make people frustrated, and could sound like you aren’t listening to them.
If your patient does say no, acknowledge their decision but remind them you’re there to talk if they ever want to discuss their weight again.
“Would you be interested in doing something like that?”
“No, not really. No.”
“Okay that’s fair enough. Please do come back if you want to talk more about it.”

5. Next steps
It may seem obvious that a person who’s motivated enough to lose weight, is also motivated enough to make their own appointment. But that’s simply wrong. Clinical trials show the reverse.
Simply taking the onus of initial contact out of the patient’s hands and leaving it in your hands, as would be true of all other referrals you make, is the single most important thing you can do to facilitate engagement with the weight loss program and encourage long-term weight loss. And ask them to come back in a month to see how they’re getting on.

Remember, even if you don’t follow all of our advice, it’s very unlikely you will cause offence as long as you sound positive, confident and respect the patient’s decision. By offering a referral, you are offering your patient the best opportunity for a supportive and effective way to lose weight.

If you have more questions, check out the Public Health England guidelines available on the gov.uk website: Let’s talk about weight.
Visit https://doi.org/10.1093/fampra/cmaa121 for the full research study.

[Text on screen] Let’s talk about weight gov.co.uk
Get in touch with your local authority Public Health team for information on free weight management services available in your area.

Logo: Nuffield Department of Primary Care Health Sciences, University of Oxford