Effects of counseling techniques on patients' weight-related attitudes and behaviors in a primary care clinic.
OBJECTIVE: Examine primary care physicians' use of counseling techniques when treating overweight and obese patients and the association with mediators of behavior change as well as change in nutrition, exercise, and weight loss attempts. METHODS: We audio recorded office encounters between 40 physicians and 461 patients. Encounters were coded for physician use of selected counseling techniques using the Motivational Interviewing Treatment Integrity (MITI) scale. Patient motivation and confidence as well as Fat and Fiber Diet score (1-4), Framingham physical activity questionnaire (MET-minutes), and weight loss attempts (yes/no) were assessed by surveys. Generalized linear models were fit, including physician, patient, and visit level covariates. RESULTS: Patients whose physicians were rated higher in empathy improved their Fat and Fiber intake 0.18 units (95% CI 0, 0.4). When physicians used "MI consistent" techniques, patients reported higher confidence to improve nutrition (OR 2.57, 95% CI 1.2, 5.7). CONCLUSION: When physicians used counseling techniques consistent with MI principles, some of their patients' weight-related attitudes and behaviors improved. PRACTICE IMPLICATIONS: Physicians may not be able to employ formal MI during a clinic visit. However, use of counseling techniques consistent with MI principles, such as expression of empathy, may improve patients' weight-related attitudes and behaviors.
Cox, ME; Yancy, WS; Coffman, CJ; Ostbye, T; Tulsky, JA; Alexander, SC; Brouwer, RJN; Dolor, RJ; Pollak, KI
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