An analysis of directly observed weight communication processes between primary care practitioners and overweight patients

Calum McHale* (Corresponding Author), Joanne Cecil, Anita Laidlaw

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Objective: To analyse weight-related communication prevalence and processes (content/context) between primary care practitioners (PCPs) and overweight patients within routine primary healthcare consultations.
Methods: Consultations between 14 PCPs and 218 overweight patients (BMI ≥25 kg/m2) were video recorded. Weight communication was coded using the Roter Interaction Analysis System (RIAS) and the novel St Andrews Issue Response Analysis System (SAIRAS). Communication code frequencies were analysed.Results: Weight discussion occurred in 25% of consultations with overweight patients; 26% of these had weight-related consultation outcomes (e.g. weight-related counselling and referrals, stated weight-related intention from patients). Weight discussions were more likely to occur if PCPs provided space to patient attempts to discuss weight (p = 0.013). Longer weight discussions (p < 0.001) and contextualising weight as problematic when PCP/patient-initiated weight discussion (p < 0.001) were associated with weight-related consultation outcomes.
Conclusion: Weight was rarely discussed with overweight patients, however PCP space provision to patient weight-discussion initiation attempts increased weight discussion. When weight was discussed, increased time and/or contextualising weight as a problem increased the likelihood of weight-related consultation outcomes.
Practical implication: PCP use of specific communication approaches when discussing, contextualising and responding to patient weight may facilitate weight-related discussion and consultation outcomes and could lead to more effective patient weight management.
Original languageEnglish
Pages (from-to)2214-2222
Number of pages9
JournalPatient Education and Counseling
Issue number12
Early online date8 Nov 2019
Publication statusPublished - Dec 2019

Bibliographical note

The authors would like to thank all primary care patients and PCPs who participated and the practice teams for supporting and facilitating the research.


  • Overweight
  • Communication coding
  • Obesity
  • Direct observation
  • Primary healthcare
  • Weight management
  • Primary care communication
  • Weight-related communication


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