title: Weight-loss talks: what works (and what doesn't).
abstract: BACKGROUND
  In primary care encounters, it is unknown whether physician advice on weight-related matters leads to patient weight loss. To examine this issue, we analyzed physician weight loss advice and measured corresponding changes in patients' dietary intake, physical activity, and weight.
  
  
  METHODS
  Using audio-recorded primary care encounters between 40 physicians and 461 of their overweight or obese patients, we coded weight-related advice as nonspecific, specific nutritional, specific exercise, or specific weight. Physicians and patients were told the study was about preventive health, not weight. We used mixed models (SAS ProcMixed), controlled for physician clustering and baseline covariates, to assess changes in diet, exercise, and measured weight, both pre-encounter and 3 months post-encounter.
  
  
  RESULTS
  When discussing weight, physicians typically provided a combination of specific weight, nutrition, and physical activity advice to their patients (34%). Combined advice resulted in patients reducing their dietary fat intake (P=.02). However, when physicians provided physical activity advice only, patients were significantly (P=.02) more likely to gain weight (+1.41 kg) compared with those who received no advice.
  
  
  CONCLUSIONS
  When giving weight-related advice, most physicians provided a combination of lifestyle recommendations. Combining advice may help patients reduce their fat intake. Physical activity advice alone may not be particularly helpful.
authors.affiliation: Durham VA Medical Center, North Carolina, Department of Medicine, NC, USA. Email: alexa045@mc.duke.edu.
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.affiliation: Durham VA Medical Center, North Carolina, Department of Medicine, NC, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Cox
authors.affiliation: Durham VA Medical Center, North Carolina, Department of Medicine, NC, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.affiliation: Duke University Medical Center, Durham; University of Texas at Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Christy
authors.initials: C
authors.lastname: Boling Turer
authors.affiliation: Durham VA Medical Center, North Carolina, Department of Medicine, Department of Community and Family Medicine, NC, USA.
authors.forename: Pauline
authors.initials: P
authors.lastname: Lyna
authors.affiliation: Durham VA Medical Center, North Carolina, Department of Medicine, Department of Community and Family Medicine, NC, USA.
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
authors.affiliation: Durham VA Medical Center, North Carolina, Department of Medicine, NC, USA.
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.affiliation: Durham VA Medical Center, North Carolina, Department of Medicine, NC, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.affiliation: Durham VA Medical Center, North Carolina, Department of Medicine, Department of Community and Family Medicine, NC, USA.
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
mesh_terms: D001168:Arthritis / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004032:Diet; D004041:Dietary Fats; D019587:Dietary Supplements; D004435:Eating; D015444:Exercise; D005260:Female; D019538:Health Care Surveys; D006293:Health Promotion / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D050177:Overweight / Q000453:epidemiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D040242:Risk Reduction Behavior; D015431:Weight Loss
chemical_list: D004041:Dietary Fats