This is a plain English summary of an original research article
Specific words and phrases help GPs make successful referrals to weight management programmes in brief consultations. Research found that people who are overweight are more likely to accept a referral when GPs describe a ‘programme’ or ‘service’ – rather than a ‘club’ or ‘group’. Stating early on that the programme is both free of charge and local is important; mentioning well-known brands such as Slimming World also helps explain what it is.
GPs may be reluctant to start these conversations, partly through concern about the time they can take. The research found that making a series of clear points avoided lengthy discussions. Lack of clarity in a consultation can leave people who wish to lose weight confused and can derail conversations about the help on offer.
In this study, researchers explored details of GP consultations about weight management programmes. They wanted to identify the elements of conversations that prompt smooth progress to a referral, and those that result in confusion or misunderstanding.
They conclude that when GPs use certain key phrases, more people are inclined to attend weight management programmes.
What’s the issue?
In England, GPs are encouraged to refer people living with obesity to 12-week weight management programmes. The programmes offer behavioural support to follow a weight-reducing diet and increase physical activity. Free attendance is already available in some areas, and is being rolled out nationally as part of NHS England’s new plan for tackling obesity.
Previous research by the same group studied people who had a routine GP appointment for a reason unrelated to their obesity. GPs were asked to offer a weight management programme to everyone eligible; three in four (77%) accepted the GP’s offer of referral. Two in five (40%) attended and, after a year, they had lost 5kg on average. But almost one in four turned down the GP’s offer.
In addition, other evidence suggests that GPs rarely offer referral, especially when weight is irrelevant to the reason for the consultation.
Researchers wanted to find the best way to maximise the numbers of people accepting a referral. They looked in detail at conversations GPs had with patients, to work out what helps smooth the path to referral. They asked whether variations in the conversation could explain variations in acceptance.
The researchers analysed 246 consultations in which GPs offered referrals to commercial weight management services or programmes. The recordings were of 77 GPs in 37 practices. They ranged in length from 8 to 458 seconds; the average was 95 seconds.
There were no examples of people getting upset at the offer. Most seemed happy to discuss their weight and how it could be managed.
However, the researchers found key aspects which could smooth the discussion and increase the likelihood of a patient accepting a referral:
- Using brand names such as Slimming World helped people understand quickly what a ‘commercial weight management programme’ is. GPs did not always explain the term, and patients often did not know.
- Describing a ‘service’ or ‘programme’ increased people’s interest. Some were resistant to joining a ‘club’ or ‘group’ which sounds informal and social, as opposed to a structured service.
- Making clear that the programme is free for all 12 sessions, and not just the initial referral, was essential. This point needed to be made early on, otherwise concerns about cost could derail the conversation.
- Making clear that the programme is local made people more receptive.
GPs who made these points early on were able to avoid lengthy discussions to clear up misunderstandings about location, for example. They were able to move on quickly to ask if a patient wanted to attend.
Why is this important?
Most people in the UK attend their GP at least once a year. If all those with obesity or overweight were offered a referral to a weight management programme, the numbers of people who are overweight would be reduced. The researchers' previous work calculated it could reduce levels of heart disease in the population by 22% over 10 years.
The researchers say that the conversation can take place in around 30 seconds. There is currently general advice, but no guidelines to lead GPs through these consultations. This research shows that using specific words and phrases – and giving key information early – can smooth the conversation and improve patients’ understanding of what is on offer. It may help GPs to feel comfortable making the offer and increase the numbers of patients willing to accept it.
The researchers have produced a short video for clinicians. It explains how to make a brief offer of support with weight loss, and a referral to weight loss services, in the way most likely to succeed.
The team encourages all primary care staff to become familiar with the key points to make. It will help them refer people to free weight loss programmes in their area, when they are available.
You may be interested to read
The full paper: Albury C, and others. Discussing weight loss opportunistically and effectively in family practice: a qualitative study of clinical interactions using conversation analysis in UK family practice. Family Practice 2020;cmaa121.
A clinician training video based on this paper (featured here).
Further guidance on weight management referrals from the authors and Public Health England.
The trial carried out by this research group looking at the effectiveness and acceptability of offering weight management programmes: Aveyard P, and others. Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. Lancet 2016;388:10059.
Funding: This research was funded by the NIHR School for Primary Care Research and a Mildred Blaxter Fellowship from the Foundation for the Sociology of Health and Illness.
Conflicts of Interest: Slimming World and Rosemary Conley donated free weight management courses for NHS patients enrolled in this trial.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.