Is weight an emotional issue? Direct observation of weight discussions in primary care consultations

Primary healthcare professionals (PHPs) frequently cite beliefs that body weight is an affective issue for many patients and concerns about upsetting patients with overweight and obesity present a barrier to weight discussion and management. Our direct observation research of weight-related communication processes in primary care consultations found that patients with overweight and obesity exhibited little explicit emotional expression during weight discussion, suggesting weight may not be an emotive issue for patients, however emotion is not always expressed explicitly. This study investigated the explicit and implicit expression of negative emotion during weight discussions between PHPs and patients with overweight and obesity. We applied the Verona Coding Definitions of Emotional Sequences (VR-CoDES) to 54 video recorded consultations between PHPs and patients with overweight (n=27) and obesity (n=27) that contained discussion about patient weight. Patient expressions of explicit (concerns) and implicit (cues) emotion, and the PHP communication response to each expression (providing/reducing space), were systematically coded using The Observer XT software. Code frequencies during weight discussion and all other consultation discussion were compared. The relationship between PHP response type and patient consultation satisfaction was examined. Patients expressed less explicit and implicit emotions during weight discussion than non-weight discussion. Cues a, b and d (vague/indirect or neutral emotional expression) were less frequently expressed during weight discussion (p<0.01). PHPs response to patient emotional expression were not related to patient consultation satisfaction. Emotion was rarely expressed, explicitly or implicitly, by patients with overweight and obesity when discussing their weight with a PHP, suggesting that weight was not considered an affective issue for these patients. PHP response to patient emotional expressions did not affect patient satisfaction, highlighting that PHP concerns about upsetting or offending patients may be unfounded.