Patients more likely to lose weight if physicians offer advice using optimistic tone

Embargoed for release until 5:00 p.m. ET on Monday 6 November 2023
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Patients more likely to lose weight if physicians offer advice using optimistic tone  

Abstract: https://www.acpjournals.org/doi/10.7326/M22-2360   

Editorial: https://www.acpjournals.org/doi/10.7326/M23-2568   
URL goes live when the embargo lifts  
An analysis of  patient encounters at 38 primary care clinics found that patients were more likely to participate in a recommended weight loss program and lose weight successfully if physicians presented treatments for obesity as good news and as an “opportunity” rather than emphasizing the negative consequences of obesity or using neutral language. The findings are published in Annals of Internal Medicine.  

International guidelines recommend that primary care clinicians screen for overweight and obesity and offer treatment opportunistically. Patients have reported that clinicians’ words and tone matter to them and can motivate or demotivate weight loss. However, evidence is lacking on effective strategies for discussing  weight and offering treatment.  

Researchers from the University of Oxford analyzed recordings of conversations physicians had with their patients regarding a 12-week no-cost behavioral weight loss intervention to examine relationships between language used in the clinical visit and patient behaviors, including participation in the program and weight loss outcomes. Interaction patterns were characterized one of three approach types.

The “good news” approach, which was the least common language style observed, communicated positivity and optimism, focused on the benefits of weight loss, and presented the weight loss program as an “opportunity,” with very little mention of obesity, body mass index, or weight as a problem. Paralinguistic style was smooth and fast-paced and conveyed excitement. The “bad news” approach emphasized the “problem” of obesity, with physicians asserting themselves as the expert and focused on challenges of weight control, with a delivery that conveyed regret and pessimism. The “neutral” news delivery, the most common observed, lacked either positive or negative features.  

The researchers found that patients who received counseling via the good news approach had the highest observed weight loss at the end of 12 months, losing approximately 4.8 kg (10.6 lb) on average compared with 2.7 kg (6.0 lb) among those in the bad news group and 1.2 kg (2.6 lb) among those in the neutral news group. The greater weight loss in the good news group seemed to be driven by higher enrollment in the 12-week weight loss program, with 87% of participants in this group attended the program compared with less than half of those in the neutral news and bad news groups. Among those enrolled, weight loss outcomes did not vary substantially regardless of how the initial counseling was delivered. 

Media contacts: For an embargoed PDF or to speak to editorial author, Christina Wee, MD, MPH, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Charlotte Albury, DPhil, please contact Jo Gearing at jo.gearing@phc.ox.ac.uk.

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2. Home monitoring associated with improved outcomes in hypertension

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1182
URL goes live when the embargo lifts 
A study of nearly 20,000 patients with hypertension found that receiving care in a practices with a high use of remote patient monitoring (RPM) was associated with improved outcomes but an overall net increase in hypertension spending. The study is published in Annals of Internal Medicine.

RPM is the remote transmission of physiologic measurements from patients to their clinicians. The use of RPM has grown rapidly since the COVID-19 pandemic, with its use increasing six-fold between February 2020 and September 2021. RPM may improve the care of chronic conditions by enabling more adjustment of medications and decreases spending by substituting for outpatient visits and reducing emergency department (ED) visits and hospitalizations. However, there are concerns that RPM may increase health care spending without commensurate improvements in outcomes.

Researchers from Harvard Business School and Harvard Medical School compared outcomes among 19,978 persons at 192 high-RPM practices and 95,029 persons with hypertension at 942 low-RPM practices. They found that patients at high-RPM practices had a 3.3 percent relative increase in hypertension medication fills, a 1.6 percent increase in days’ supply, and a 1.3 percent increase in unique medications received. Patients at high-RPM practices also had fewer hypertension-related acute care encounters and reduced testing use. However, these patients also saw increases in primary care outpatient visits increase and a $274 increase in total hypertension-related spending. According to the authors, time-varying reimbursement and targeted patient eligibility could be explored as ways to help mitigate the higher costs associated with home monitoring.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Ateev Mehrotra, MD, MPH, please contact mehrotra@hcp.med.harvard.edu.

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3. Patients with higher fecal hemoglobin concentration at FIT may benefit from shorter CRC screening intervals

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1358   

URL goes live when the embargo lifts 

Stratifying colorectal cancer (CRC) risk based on hemoglobin concentration at fecal immunochemical test, or FIT, could help to determine whether patients could benefit from shorter screening intervals. A brief research report is published in Annals of Internal Medicine.

Screening could prevent a large proportion of colorectal cancer cases and deaths. FITs for hemoglobin are increasingly used but time intervals after which a negative FIT should be repeated are a source of debate.

Researchers from German Cancer Research Center studied 7,398 persons undergoing CRC screening to provide a dose-response analysis of the association between fecal hemoglobin concentrations and the presence of advanced neoplasia. For all participants, a quantitative FIT was done before colonoscopy to measure fecal hemoglobin concentrations. Most of the participants had fecal hemoglobin concentrations below the recommended FIT cutoff. However, 10 percent had positive test results with fecal hemoglobin concentrations greater than 17 µg/g. Prevalence of advanced neoplasia increased from 6 percent among those with hemoglobin concentrations less than 1.7 µg/g to 24 percent in the highest group of participants with FIT-negative results, and to up to 51 percent among participants with FIT-positive results. These findings suggest that those in the upper range of negative FIT values are at higher risk for CRC than those in the lower range. This data can be used to determine personalized FIT-based screening intervals based on patient risk for CRC.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Tobias Niedermaier, PhD, please contact t.niedermaier@dkfz-heidelberg.de.

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