Initiating discussions about weight in a non-weight-specific setting: What can we learn about the interactional consequences of different communication practices from an examination of clinical consultations?

Abstract

Objectives: Effective clinical communication is fundamental to tackling overweight and obesity. However, little is known about how weight is discussed in non-weight-specific settings where the primary purpose of the interaction concerns clinical matters apparently unrelated to weight. This study explores how mental health clinicians initiate discussions about a patient's possible weight problem in the non-weight-specific setting of a UK NHS Gender Identity Clinic (GIC), where weight is topicalized during discussions about the risks of treatment.

Design: A conversation analytic study.

Methods: A total of 194 recordings of routine clinician-patient consultations were collected from the GIC. Weight talk was initiated by four clinicians in 43 consultations. Twenty-one instances contained reference to a possible weight problem. Transcripts were analysed using conversation analysis.

Results: Clinicians used three communication practices to initiate discussion of a possible weight problem with patients: (1) announcing that patients are overweight; (2) asking patients whether they are overweight; and (3) deducing that patients are overweight or obese via a body mass index (BMI) calculation. Announcing that patients are overweight is the least aligning practice that denies patient's agency and grammatically constrains them to agree with a negative label. Asking patients whether they are overweight treats them as having limited agency and generates comparatively aligning, but occasionally resistant, responses. Jointly deducing that patients are overweight or obese via a BMI calculation is the most aligning practice, which deflects responsibility for labelling the patient onto an objective instrument.

Conclusions: Small differences in the wording of turns that initiate discussions about a possible weight problem can have significant consequences for interactional alignment. Clinicians from different specialities may benefit from considering the interactional consequences of different practices for initiating discussions about weight during the kinds of real-life discussions considered here. Statement of contribution What is already known on this subject? There is a correlation between clinical communication about weight and patient weight loss. Clinicians from all specialties are encouraged to discuss diet and exercise with patients, but communication about weight remains problematic. Health psychologists have identified an urgent need for communication training to raise sensitive topics like weight without damaging the doctor-patient relationship. What does this study add? Clinicians in a non-weight-specific setting use three communication practices to introduce the possibility that a patient's weight may be a problem. These practices have varying consequences for the interaction and doctor-patient relationship. Conversation analytic findings may be useful in training clinicians how to initiate discussions about weight with patients.

Keywords: clinical communication; conversation analysis; medical interaction; obesity; overweight; psychiatry; weight.