Visual Prompt Poster for Promoting Patient-Physician Conversations on Weight Loss

INTRODUCTION

Sixty-five percent of the adult US population is overweight (body mass index [BMI] = 25.0–29.9 kg/m²) or obese (BMI =30.0 kg/m²).¹ Obesity is the second leading cause of preventable death in the United States,² yet primary care physicians are not discussing weight loss with their patients.³

Patient-initiated discussions about weight loss are more likely to lead to a combination of advice and assistance than are physician-initiated discussions.⁴ In addition, patients are more likely to try to lose weight if they have been advised to do so by their health care professional.⁵ Few patients schedule appointments specifically to discuss weight loss,⁵ and multiple factors have been found to impede the quality and length of patient-physician weight loss discussions in the primary care setting.^6–9

Since the early 20th century, posters have been used to bring attention to public health issues and to promote behavior change.^10,11 Studies evaluating the influence of signs on behavior change have had mixed results,^12–15 and it remains unclear if posters displayed in primary care offices are successful in promoting patient behavior change.

Our study aimed to determine if a simple visual prompt, in the form of a poster directed at patients in a primary care office, might increase the occurrence of weight loss conversations between patients and their physicians.

METHODS

RESULTS

There were 283 and 386 patients in the preintervention and postintervention groups, respectively. A total of 5 patients in the preintervention and 7 patients in the postintervention groups declined to complete the questionnaire and were included in the analyses.

The preintervention and postintervention groups were equivalent with respect to mean BMI (31 vs 32 kg/m², respectively; P = .21). The proportion with a BMI of at least 25 kg/m² (indicating that they were overweight or obese) was 73% in the preintervention group and 75% in the postintervention group. The proportion of patients desiring to lose weight did not differ significantly between groups (65% vs 67%, P=.63) (Table 1⇓).

There was no significant difference in the percentage of patients who both wanted to lose weight and discussed weight loss with their physician between the preintervention and postintervention groups (26% vs 23%, P = .41). Among those patients who had weight loss conversations with their physicians, the perceived usefulness of information did not differ between groups (82% vs 77%, P = .23) (Table 1⇑).

Fully 60% of patients in the postintervention group reported seeing the poster during their visit (Table 1⇑). There was no difference, however, between the percentages of preintervention and postintervention patients who reported having weight loss discussions overall (29% vs 27%, P = .59), or between the percentage of preintervention patients who discussed weight loss and the percentage of postintervention patients who both saw the poster and discussed weight loss (29% vs 29%, P = .84).

Given our null findings for differences in the occurrence of weight loss conversations between groups, we conducted a power analysis. We found that with the number of participants in our study, we had a greater than 95% power to detect a 20% difference in the reported rate of weight loss conversations between the preintervention and postintervention groups. In addition, we had a greater than 80% power to detect a 10% difference in the reported rate of such conversations between the groups.

DISCUSSION

We found that in a primary care outpatient clinic, a simple visual prompt in the form of a poster did not increase the proportion of patients reporting that they wanted to lose weight or the proportion of patients reporting that patient-physician conversations about weight loss took place. Large percentages of patients in this clinic, however, were interested in losing weight (66%) and noticed the poster (60%).

A review of the BMI data showed that about 75% of the study patients visiting the clinic were overweight or obese, compared with the 65% nationwide prevalence. This result is consistent with findings from other work on obesity in primary care, which has indicated that obese patients have more comorbidities (eg, hypertension, coronary artery disease, diabetes mellitus, and/or sleep apnea) for which they seek medical care.¹

A total of 281 patients (42% of those surveyed) reported an interest in weight loss but did not discuss it with their physician during a routine office visit. This represents a large number of missed opportunities to influence behavior change. The 5 A’s—ask, assess willingness to change, advise, assist, and arrange follow-up—are a familiar approach to assist patients with smoking cessation.¹⁶ This model calls for repetition and reevaluation at every medical encounter. Similar techniques could be adapted to promote weight loss among overweight and obese patients, as has been called for by the US Preventive Services Task Force.¹⁷

One limitation to our study is the possibility that our null findings were simply due to inadequacy of the poster. We could have performed pretesting to determine whether patients had a positive or negative response to the poster and to determine physician attitudes toward the poster. Additional limitations to our study were that we did not determine whether the patient or the physician initiated the weight loss conversation, whether the poster motivated patients to initiate the discussion, or whether physicians were skilled at discussing weight loss with their patients.

Our simple poster prompt may prove effective at promoting weight loss conversations if the poster was part of a longer, multifaceted study that would include resources such as physician education, prompts in the electronic medical record system, printed materials, computer-based information, audiovisual materials, nutritional counseling, support groups, and exercise classes for patients.