title: Speaking of weight: how patients and primary care clinicians initiate weight loss counseling.
abstract: BACKGROUND
  Obesity is epidemic in the US and other industrialized countries and contributes significantly to population morbidity and mortality. Primary care physicians see a substantial portion of the obese population, yet rarely counsel patients to lose weight.
  
  
  METHODS
  Descriptive field notes of outpatient visits collected as part of a multimethod comparative case study were used to study patterns of physician-patient communication around weight control in 633 encounters in family practices in a Midwestern state.
  
  
  RESULTS
  Sixty-eight percent of adults and 35% of children were overweight. Excess weight was mentioned in 17% of encounters with overweight patients, while weight loss counseling occurred with 11% of overweight adults and 8% of overweight children. In weight loss counseling encounters, patients formulated weight as a problem by making it a reason for visit or explicitly or implicitly asking for help with weight loss. Clinicians did so by framing weight as a medical problem in itself or as an exacerbating factor for another medical problem.
  
  
  CONCLUSIONS
  Strategies that increase the likelihood of patients identifying weight as a problem, or that provide clinicians with a way to "medicalize" the patient's obesity, are likely to increase the frequency of weight loss counseling in primary care visits.
authors.affiliation: Department of Family Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA. scottjg@umdnj.edu
authors.forename: John G
authors.initials: JG
authors.lastname: Scott
authors.forename: Deborah
authors.initials: D
authors.lastname: Cohen
authors.forename: Barbara
authors.initials: B
authors.lastname: DiCicco-Bloom
authors.forename: A John
authors.initials: AJ
authors.lastname: Orzano
authors.forename: Patrice
authors.initials: P
authors.lastname: Gregory
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
authors.forename: Lisa
authors.initials: L
authors.lastname: Maxwell
authors.forename: Benjamin
authors.initials: B
authors.lastname: Crabtree
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003376:Counseling; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D010817:Physician-Patient Relations; D015431:Weight Loss