Want to Change Patient Health Behavior? Change How You Talk To Your Patients

[tweetmeme source=”Healthmessaging” only_single=false]According to Marshall Becker, PhD, MPH, a one-time professor of mine and prime mover behind the Health Belief Model (HBM), four things must be in place for health behavior change to occur.  I am paraphrasing here:

  1. A person has to know that they have a particular health condition
  2. A person has to believe that having said health condition is bad
  3. A person must perceive the benefits of behavior change to outweigh the difficulties of behavior change
  4. There must be a “call to action” to spark the change

Absent any one of these steps the likelihood that behavior change will occur is diminished.

Now consider the problem of obesity and behavior change.

A series of recent Harris Polls looked at people’s perceptions and experiences regarding their weight. The polls, which confirm similar findings from numerous medical journals, found that:

  • 39% of morbidly obese people (BMI >40) think they are overweight but not obese.
  • 70% of obese people (BMI >30) believe they are merely overweight.
  • 61% of “technically obese” adults had never been told by a health care professional that they were obese…or that they needed to do anything about their weight.

Following the logic of the Health Belief Model several critical behavior change “prerequisites” are missing.    First, many obese and overweight people do not believe they have a real problem with their weight.   Other people are obese – not them.   Sure they know they need to lose weight.   Many are probably trying on their own.

Second, since their physicians hasn’t told them they are obese, there is no reason for them to believe they have a problem or that carrying a few extra pounds poses a serious health risk.

At this point, according to the HBM, the likelihood of behavior change falters. There’s no reason for the patient to seriously consider the barriers or benefits to significant weight loss.

Poor physician-patient communication enables obesity…and probably many other chronic conditions

The evidence shows that patients who receive physician counseling about weight loss are up to 2 times more likely to report that they are currently trying to lose weight.  Yet such conversations reportedly do not occur in some two-thirds of physician visits by obese patients.


From the physician’s perspective, key barriers to weight loss counseling are self-perceived low competence in treating obesity, lack of treatment effectiveness, and poor patient motivation.   Don’t underestimate the importance of physician attitudes toward obese patients.   One study found that physician believed that 40% of their obese patients were capable of achieving a normal weight…but that most patients were not sufficiently motivated to lose the weight.

The therapeutic value of talking to patients

Physicians have more a lot more influence with patients than they seem to give themselves credit for.  If patients have a health problem, they expect their physician to tell them.

One has to wonder how many patients suffer needlessly from obesity, diabetes, heart disease and so on simply because their physicians did not take the time to impress upon them:

  1. the fact that they have a condition
  2. that having the condition is serious
  3. that there are treatment options
  4. here are the benefits and challenges
  5. together we can solve the problem

It certainly makes me wonder.


Befort, C., et. al., Weight-Related Perceptions Among Patients and Physicians.  How Well do Physicians Judge Patients’ Motivation to Lose Weight?  Journal of General Internal Medicine. 2006 October; 21(10): 1086–1090.

Greiner, K., et. al., Discussing Weight with Obese Primary Care Patients: Physician and Patient Perceptions.  Journal of General Internal Medicine. 2008 May; 23(5): 581–587.

Overweight? Obese? Or Normal Weight? Americans Have A Hard Time Gauging Their Weight  http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/mid/1508/articleId/558/ctl/ReadCustom%20Default/Default.aspx.


6 responses to “Want to Change Patient Health Behavior? Change How You Talk To Your Patients

  1. Excellent post – physicians may believe that most consumers already know the risks of poor health choices. But many consumers feel invincible until told otherwise. Direct but respectful communication is essential particularly as the population ages.

  2. Stephen,
    I am so glad to have come across your blog. As a writer/editor in the medical and science fields, I specialize in plain language and health literacy. Much of the work I do is communicating health and science to the general public, which means I write information a 6th to 8th grade level or less. I am also a patient with a chronic illness, so I use the healthcare system a lot. My doctors know what I do for a living, and they know I research everything. I have worked in hospital health literacy programs. I have worked with patients with low literacy skills. I have tutored adult new readers and helped them navigate the health care system. Doctor/patient communication is central to everything I do in life and work, and it drives me crazy when a doctor brushes off my request for more information or treats me as though I won’t understand the most basic explanation. I’m lucky to have a great medical team, but when I see a doctor who does not meet my standards, I find another doctor. I worry about the patients who can’t advocate for themselves and for that reason, am considering volunteering as a patient advocate. Thank you for your work. Kristina

  3. I appreciate this post, and as someone with several family members who are morbidly obese, I think another key component that’s missing from physician-patient communications is confidence-building. While the people I know and love understand the importance of weight loss, they have low self efficacy based on their lifelong battles with obesity. Having a physician not only talk through a treatment plan but overtly express that long-term weight loss is not only possible but realistic might make a difference.

  4. I have been on both sides and think that there is not a black and white issue
    remember when a child and young girl my family wordshiped our GP but at the same time they have a paralel medical world who doctors never could imagine. Paralele medical world is different among families, locations, races
    fo example: proteinuria was believed to be produced by constipation
    asthma was not asthma but bronchitis….alzheimer could be cured by certain injections that someone had received…if the doctor s comments didnot agree with their beliefs … it was very dissapointing, Advice was often required to nurses they were thouht to be more reliable…
    it is a problem of years of miscommunication.we doctors do not know the foreign lenguaje of our patientes

  5. Excellent Blog. I look forward to reading often. From a physical therapists perspective…
    I think that is is difficult for doctors to sit down and have heart to heart talks because of the time they have with each patient. I think that many of them pass the torch to PT’s, when it comes to exercise, wight loss. Unfortunately PT is only indicated (outpatient) when pain or injury is involved. Luckily most clinics are involving wellness into their business to help transition these “under confident” people into changing their lifestyle.
    I definitely think that in order for it to work it needs to be a team approach (between MD, PT and exercise / wellness).
    Thanks for the blog!

  6. Excellent post. As always communication is important between the doctor and the patient. And it needs to be done very cautiously and with lots of respect and understanding.

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