Patients need to be told they are overweight, study finds

Patients who have been told by a physician that they are overweight are significantly more likely to have attempted weight loss, according to a new study.

Researchers used data from the National Health and Nutrition Examination Survey, which included adults between 20 and 64 years old who had a BMI of at least 25. Patients' actual BMIs as well as their responses to questions about weight were collected and then analyzed using logistic regression. The results were published in the Feb. 28 Archives of Internal Medicine.

About 45% of patients who had a BMI of 25 or greater reported that a physician had told them they were overweight; among obese patients (BMI of 30 or more), the proportion was 66%. These patients were significantly more likely to consider themselves overweight than patients who hadn't discussed the subject with a doctor: Only 6% denied being overweight compared to 37% of those who hadn't been informed by their physicians. Among the obese subpopulation, the percentages were 3% and 19%, respectively. The patients were also twice as likely to report having attempted to lose weight in the past year if they had been told they were overweight (odds ratio, 2.51; 95% CI, 2.15 to 2.94).

Extrapolating from the data, study authors concluded that more than 74 million overweight Americans (including 23 million obese people) may never have been told that they are overweight by a doctor, although they noted that the self-reporting structure of the study doesn't account for patients who were told, but didn't listen or remember. The authors noted that physicians may fail to address this issue because they have limited time and low expectations about patients' ability to lose weight, but that the strong association found in this study between these conversations and weight-loss attempts should encourage physicians to talk to their patients about weight.

An accompanying commentary offered some strategies for these discussions. Physicians should inform patients that they are overweight in a straightforward manner by comparing their BMIs to standard definitions. Physicians should express concern rather than judgment and take measurement of other risk markers (lipids, glucose, blood pressure, abdominal circumference) in overweight patients, the commentary author advised. Although patients' ability to successfully lose weight without intensive interventions is uncertain, their awareness of the problem is a necessary first step, he concluded.