30 min
Home
Practical tips and audio clips for delivering very brief weight loss interventions
Overview
Evidence
Starting off
Giving advice
Health issues
Start
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
5 min
2 min
Home
Introduction
Overview
Obesity is a growing public health challenge, and our GP practices can be great places to support people with weight management. Evidence shows that offering referral to specialist services are most likely to benefit your patient, however, these are not always available. One thing you can do to help is offer very brief advice, but practice staff often find it tricky to talk about weight with their patients or even to start the conversation. We used communication science – analysing hundreds of real world recordings between clinicians and patients – to understand and share the best ways to share brief advice with patients who would like to lose weight.
Evidence
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
5 min
2 min
Home
Objectives
Overview
Based on these findings, this 30-minute training will provide you with:
Evidence
- An understanding of the evidence-base for very brief weight loss advice.
- Knowledge of the most effective ways to provide brief weight loss advice.
- The skills to talk about weight loss confidently and effectively in your consultations.
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
5 min
Home
How to navigate
Place your mouse over each pink highlight for an explanation of the interactive elements.When you're ready to move on, click the 'next' arrow.
Overview
Evidence
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Demo page
Resources
Our research
5 min
3 min
Home
Evidence supporting brief weight loss advice
Overview
There are many myths about brief advice, but they are rarely based on evidence. You might even have been taught some of these myths. Here we present 10 myths and the counter-evidence...
Evidence
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
5 min
Home
Myths
Research findings
Overview
Giving brief advice is not effective for weight loss
You don’t need long to talk about weight loss. A recent trial showed that very brief advice (about 30 seconds) was associated with weight loss
Evidence
Starting off
Giving advice
I should wait until the patient asks me about weight, rather than offer brief advice and support opportunistically
Most people find opportunistic advice helpful and appropriate. Many people are not sure how to bring the topic up with a healthcare professional, so value the opportunity for advice
Health issues
Tricky talks
Ending well
Most people want more support with weight loss than they are currently receiving and are happy to talk to a healthcare professional. It's very unlikely someone will become upset
Giving brief advice for weight loss will upset people
Summary
Test your skills
Resources
Our research
5 min
Home
Myths
Research findings
Overview
Advising someone to ‘eat less and move more’ is helpful
Most people have already tried this, and it does not work for everyone. Giving weight loss advice is more complex than explaining 'calories in' and 'calories out'
Evidence
Starting off
Giving advice
Advising patients that increasing exercise alone will lead to weight loss
Increasing exercise is good for all sorts of reasons, but increasing exercise alone is unlikely to lead to weight loss. It can help with weight maintenance though
Health issues
Tricky talks
One specific diet will work for everyone and I should advise people to try that
What works for one person may not work for someone else
Ending well
Summary
Test your skills
Resources
Our research
5 min
Home
Myths
Research findings
Overview
‘Scare tactics’ (for example telling people their risk of disease has increased) will motivate action
Scare tactics are unlikely to help and can demotivate people
Evidence
Starting off
I need to do motivational interviewing
There is no evidence that motivational interviewing increases the effectiveness of brief advice
Giving advice
Health issues
Effective brief weight loss advice must include goal setting
You do not need to set goals for advice to be helpful
Tricky talks
Ending well
I’ve given advice before and this person has not lost weight… it means they aren’t interested in losing weight
Obesity is a relapsing condition that requires lifelong support. Just because someone has not lost weight doesn’t mean they haven’t tried. Simply offering to talk can let people know you’re there to help
10
Summary
Test your skills
Resources
Our research
Home
Brief weight loss conversations: best practice
Overview
This learning tool provides evidence from analysis of real world consultations, which show best practice on:
Evidence
- Starting weight loss conversations
- Giving advice
- When and how to link weight loss with a patient’s health conditions
- Troubleshooting (during uncomfortable conversations)
- Ending conversations
Starting off
Giving advice
Health issues
Tricky talks
We provide helpful hints and tips, but remember to respect your patient’s decision if they do not want to talk about their weight.
Ending well
Summary
Test your skills
Resources
Our research
4 min
Home
Setting the right ‘tone’ for your conversation is key. This page uses audio clips to explain how to introduce weight loss advice in consultations. Listen to different approaches by pressing the audio buttons.
Overview
Evidence
Starting off
Practical tips
Audio clips
Giving advice
Aim to be delicate and personal
Delicate and personalised
- Use your patient’s name
- Connect to what’s happened today
- Talk about an issue that’s relevant to them
Health issues
Direct
Tricky talks
Delicate but depersonalised
Ending well
Summary
Test your skills
Resources
Our research
4 min
Home
You can give advice in different ways, but some are more effective than others. This page explains how to make the benefits of weight loss clear without telling your patient what to do.
Overview
Evidence
Starting off
Practical tips
Audio clips
Being vague about the benefits of weight loss
Giving advice
Be clear about the benefits of weight loss:
- Place advice in sequence by assessing their weight and giving positive risk information
- Recommend that your patient attempts to lose weight by highlighting the positive benefits
Health issues
Being clear about the benefits of weight loss
Tricky talks
Telling the patient what to do
Ending well
Summary
Test your skills
Resources
Our research
2 min
Home
How weight loss is linked to patients’ health conditions influences patient engagement. Using audio clips, this page shows when and how to effectively link weight loss and health conditions.
Overview
Evidence
Starting off
Practical tips
Audio clips
Indiscriminately linking to other health conditions
Giving advice
- Avoid implying that your patient’s lifestyle is the cause of their health conditions
- Avoid implying that they should only lose weight to fix their current health condition
- Do link weight and health conditions if the patient has already mentioned their weight
Health issues
Effectively linking to other health conditions
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
4 min
Home
Talking about your patient’s weight can feel negative. Listen to the audio clips to see how to avoid and navigate uncomfortable conversations.
Overview
Evidence
Starting off
Practical tips
Audio clips
Presuming that your patient didn’t know something
- Assume that your patient:
- is doing something about their weight
- understands
- can do things differently
Giving advice
Health issues
Presuming what will or won’t be easy for your patient
- Manage reticence by:
- acknowledging their perspective
- minimising the impact of your conversation
- offering future support
Tricky talks
Being dismissive if you’re patient is interested
Ending well
Carefully responding if your patient doesn’t want to talk about weight loss
- It’s best to avoid diet and exercise advice
Summary
Test your skills
Resources
Our research
2 min
Home
It can be tricky to end discussions about weight loss, especially when it is in addition to a standard consultation. Listen to the audio clips of different approaches to completing a conversation about weight loss
Overview
Evidence
Starting off
Practical tips
Audio clips
Giving advice
Everyday closing
Set a good closing environment by:
- positively evaluating your conversation
- making a follow up arrangement if appropriate
- checking in with your patient
Health issues
Closing weight loss advice
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
Listen to this page
1 min
Home
Summary Delivering very brief, evidence-based, weight loss advice in under 30 seconds:
Overview
Downloadable? Could add learning box into the page download? Or into the cert?
Evidence
- Be delicate and personalise – slow down your speech, use your patient’s name and refer back to what has happened in the consultation.
- Be positive when explaining and advising – focus on the benefits of weight loss.
- Avoid assuming that your patient doesn’t know about simple diet and exercise changes, or isn’t doing something about their weight.
- Manage reticence by acknowledging your patient’s perspective, minimising the impact of your conversation and offering future support.
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
8 min
Home
Test your skills by answering the following questions
Overview
Evidence
1 / 6
Starting off
Myth busterWhy should you avoid giving generic diet and exercise advice?
Giving advice
Health issues
It makes assumptions about what people currently are (or are not doing)
Tricky talks
Ending well
Exercise doesn’t really help with weight loss
Summary
Test your skills
An ‘eat less, do more’ approach is unlikely to be effective for the general population of people living with obesity
Resources
All of the above
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
1 / 6
Starting off
You’re right, well done
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
2 / 6
Starting off
EvidenceWhich of these statements is true?
Giving advice
Health issues
You need a long time to talk about weight
Tricky talks
Ending well
Weight management advice can be brief and effective
Summary
You should only talk about weight loss if your patient asks about it
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
You do not need a long time to talk about weight loss. A recent trial showed that very brief advice (less than 30 seconds) was associated with weight loss.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Many people are not sure how to raise the topic of weight with healthcare professionals, and find opportunistic advice helpful and appropriate.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
2 / 6
Starting off
You’re right, well done
Giving advice
A recent trial showed that very brief advice (less than 30 seconds) was associated with weight loss.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
3 / 6
Starting off
Starting off Which of these recordings is delicate and personalised?
Giving advice
Health issues
Tricky talks
Ending well
Recording 1
Recording 2
Recording 3
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
In this response, the clinician is directive stating their opinion and focusing on the risks of being overweight.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
While the clinician is delicate, the information they provide is depersonalised.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
3 / 6
Starting off
You’re right, well done
Giving advice
The clinician is delicate and personalises the information.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
4 / 6
Starting off
Giving advice Which of these ways of giving advice is recommended?
Giving advice
Health issues
Highlight the problems if they don’t lose weight
Tricky talks
Ending well
Highlight the benefits of losing weight
Summary
Give advice before you assess your patient’s weight
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Scare tactics can demotivate people.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Giving advice before you assess your patient’s weight can result in depersonalised advice, which is not in context.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
4 / 6
Starting off
You’re right, well done
Giving advice
Patients are more likely to respond positively to personalised advice, which emphasises the benefits of losing weight.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
5 / 6
Starting off
Health issuesLinking health issues to weight loss when giving advice can cause problems. How can you avoid these:
Giving advice
Health issues
Avoid implying that your patient’s lifestyle has caused any health issues
Tricky talks
Ending well
Positively emphasise the benefits of weight loss for general health
Summary
Test your skills
Do link weight and health issues if the patient has already mentioned their weight
Resources
All of the above
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
5 / 6
Starting off
You’re right, well done
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
6 / 6
Starting off
Giving adviceWhen giving advice you should:
Giving advice
Health issues
Tell people what to do
Tricky talks
Ending well
Tentatively raise the topic of weight
Summary
Raise the topic confidently, and highlight the positive benefits of weight loss (moderation)
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
When patients are told what to do, they tend to remain silent, not acknowledging the advice.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Patients may not recognise that you are advising on weight or your clinical knowledge about the links between weight and health.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
Home
Overview
Congratulations!
Evidence
You have completed the training, click the link below to download the certificate where you can fill in your name and today’s date
Starting off
Giving advice
Download certificate
Health issues
Tricky talks
Ending well
Summary
To help us evaluate and improve the training, please complete this very short survey in the link below:
Test your skills
Feedback survey
Resources
Our research
Being clear about the benefits of weight loss
so, with regards to your weight your BMI, your body mass index... is just slightly, it is too high at the moment and it would be really would be in your best okay interests to consider losing a little bit of weight okay and um and it you know there’s really good evidence that it will definitely help your back pain, okay and help with your joint pain if you’re getting any osteoarthritis of your knees and your feet and things like that and your hips it will help that, yep and obviously it majorly reduces your risk of developing heart disease and diabetes okay so it would definitely, definitely be in your best interest to consider losing a bit of weight okay
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient
This audio clip shows the most effective way to provide weight loss advice. The clinician does provide explicit advice about the possible benefits of losing weight and suggests the patient “consider losing a bit of weight”, which avoids telling the patient what to do.
Being vague about the benefits of weight loss
you’ve just been weighed and it showed that your body mass index is thirty one point eight, mm and er what we know, for people that are er overweight and that puts you into an obese... category is that mm er that increases your risk of er heart disease and diabetes and other conditions like that. right. and that if you address that weight problem and are able to bring it down... then so your risks mm also reduce. right. okay, so what I want you to do after today is to take that message on board, okay?
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor
Telling the patient what to do
Now the other thing to talk about with there is obviously the weight, which... would be helpful to get a bit off you. And I think it’s part of... the control with the diabetes. Really, is if you can try to sort of maintain, and keep your weight down... it would make a big difference with any risk of diabetes getting worse in the future. Um and er but you know, just try and lose a bit of weight... and see if it is, see how you get on with that okay. Make quite a difference I think.
Doctor
Everyday closing
The repeated responses by the clinician and patient show how we typically end a conversation in everyday talk and clinical consultations. However, for effective weight loss advice more is required.
Okay?
Okay then, thanks very much
Buh-bye then
Buh-bye
Clinician Patient Clinician Patient
Indiscriminately linking to other health conditions
In addition to a direct introduction to the topic of weight loss and a lack of positive framing about how losing weight may impact the patient’s blood pressure and arthritis, in this less effective audio clip, the clinician links ‘indiscriminately’ between the patient’s weight and other potential health conditions. This can evoke ‘worst case health scenarios’ and imply the patient is to blame for developing other health conditions, as is seen in her response “well yeah but I got arthritis”
um, you are overweight and do you realise that is er going... to impact your health particularly things like arthritis, and blood pressure
well yeah but I got arthritis. yeah.
so thank you
yeah
Doctor Patient Doctor Patient
Everyday closing
The repeated responses by the clinician and patient show how we typically end a conversation in everyday talk and clinical consultations. However, for effective weight loss advice more is required.
Okay?
Okay then, thanks very much
Buh-bye then
Buh-bye
Doctor Patient Doctor Patient
Delicate but depersonalised
In this less effective audio clip, the clinician starts the conversation with delicacy, hesitating and softening what she says. However, the information provided “there are some good health benefits” is not personalised – meaning it’s not necessarily relevant for this particular patient. The patient’s mm..yes shows that indeed this information is not relevant for him – it is already known and redundant.
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Doctor Patient
Being clear about the benefits of weight loss
This audio clip shows the most effective way to provide weight loss advice. The clinician does provide explicit advice about the possible benefits of losing weight and suggests the patient “consider losing a bit of weight”, which avoids telling the patient what to do.
so, with regards to your weight your BMI, your body mass index... is just slightly, it is too high at the moment and it would be really would be in your best okay interests to consider losing a little bit of weight okay and um and it you know there’s really good evidence that it will definitely help your back pain, okay and help with your joint pain if you’re getting any osteoarthritis of your knees and your feet and things like that and your hips it will help that, yep and obviously it majorly reduces your risk of developing heart disease and diabetes okay so it would definitely, definitely be in your best interest to consider losing a bit of weight okay
Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient
Effectively linking to other health conditions
This audio clip shows the most effective method for linking weight loss and health conditions. Notice how the clinician refers to previous talk about weight, before suggesting that losing weight would help the patient’s back pain. She frames the conversation positively, saying weight loss will ‘help’ her back, rather than the negative framing in the previous example. Notice how each step by the clinician follows a positive response from the patient.
as you know you spoke to the lady earlier and you
yeah, yeah.
mentioned a bit about your weight. yeah.
as we’ve been talking about your back, one of the things that... would really help your back is to lose some weight
lose some weight
Doctor Patient Doctor Patient Doctor Patient
Effectively linking to other health conditions
This audio clip shows the most effective method for linking weight loss and health conditions. Notice how the clinician refers to previous talk about weight, before suggesting that losing weight would help the patient’s back pain. She frames the conversation positively, saying weight loss will ‘help’ her back, rather than the negative framing in the previous example. Notice how each step by the clinician follows a positive response from the patient.
as you know you spoke to the lady earlier and you
yeah, yeah.
mentioned a bit about your weight. yeah.
as we’ve been talking about your back, one of the things that... would really help your back is to lose some weight
lose some weight
Clinician Patient Clinician Patient Clinician Patient
Being clear about the benefits of weight loss
This audio clip shows the most effective way to provide weight loss advice. The clinician does provide explicit advice about the possible benefits of losing weight and suggests the patient “consider losing a bit of weight”, which avoids telling the patient what to do.
so, with regards to your weight your BMI, your body mass index... is just slightly, it is too high at the moment and it would be really would be in your best okay interests to consider losing a little bit of weight okay and um and it you know there’s really good evidence that it will definitely help your back pain, okay and help with your joint pain if you’re getting any osteoarthritis of your knees and your feet and things like that and your hips it will help that, yep and obviously it majorly reduces your risk of developing heart disease and diabetes okay so it would definitely, definitely be in your best interest to consider losing a bit of weight okay
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Indiscriminately linking to other health conditions
In addition to a direct introduction to the topic of weight loss and a lack of positive framing about how losing weight may impact the patient’s blood pressure and arthritis, in this less effective audio clip, the clinician links ‘indiscriminately’ between the patient’s weight and other potential health conditions. This can evoke ‘worst case health scenarios’ and imply the patient is to blame for developing other health conditions, as is seen in her response “well yeah but I got arthritis”
um, you are overweight and do you realise that is er going... to impact your health particularly things like arthritis, and blood pressure
well yeah but I got arthritis. yeah.
so thank you
yeah
Clinician Patient Clinician Patient
Telling the patient what to do
In this less effective consultation, the clinician provides advice about the benefits of weight loss but in a way that suggests she is telling the patient what to do. Notice the number of times the clinician tells the patient to lose weight and the patient's lack of response throughout.
Now the other thing to talk about with there is obviously the weight, which... would be helpful to get a bit off you. And I think it’s part of... the control with the diabetes. Really, is if you can try to sort of maintain, and keep your weight down... it would make a big difference with any risk of diabetes getting worse in the future. Um and er but you know, just try and lose a bit of weight... and see if it is, see how you get on with that okay. Make quite a difference I think.
Doctor
Being dismissive if your patient is interested
Notice how, in this audio clip, the clinician is not making assumptions about what the patient knows or what she has or has not done. The patient talks about what she has done, and the clinician responds positively – “That’s good that you did”. This response encourages the patient to ask for help. The clinician offers to provide further help at another appointment. While this is effective, given how interested the patient is, could the clinician have offered more at this appointment?
…And things like that so
Sure
I’m well aware that I need to be on that journey, and largely I was.
Yeah.
I lost like a stone in- in the summer and then, I didn’t… ha ha
Yeah
I didn’t continue it so
That’s g- that that’s good that you did.
I’m not - I’m well aware of the situation, and what I should be doing, Sure
But any help,
Sure
I’m more than happy to take so-
Okay yeah so- so what- we won’t use today’s consultation for that because that’s not what you’re here for
Yeah, okay
Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient
Delicate and personalised
This audio-clip shows the most effective way to introduce weight loss advice. The clinician personalises the consultation - using the patient’s name, referring to what has happened before and the patient’s health. The doctor also gently hesitates showing a ‘delicate’ way to start off the conversation. Throughout the patient responds positively with “yeahs” and, at the end, the patient joins in with the clinician’s “lose some weight” suggesting that they are on board.
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Doctor Patient Doctor Patient Doctor Patient
Delicate but depersonalised
In this less effective audio clip, the clinician starts the conversation with delicacy, hesitating and softening what she says. However, the information provided “there are some good health benefits” is not personalised – meaning it’s not necessarily relevant for this particular patient. The patient’s mm..yes shows that indeed this information is not relevant for him – it is already known and redundant.
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Doctor Patient
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Delicate but depersonalised
In this less effective audio clip, the clinician starts the conversation with delicacy, hesitating and softening what she says. However, the information provided “there are some good health benefits” is not personalised – meaning it’s not necessarily relevant for this particular patient. The patient’s mm..yes shows that indeed this information is not relevant for him – it is already known and redundant.
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Doctor Patient
Direct
As I’m sure you’re aware, you are, overweight... Um and it is bad for your health
Doctor
Being vague about the benefits of weight loss
In this less effective audio clip, notice the information the clinician provides is vague and tentative - “if you address that weight problem and are able to bring it down ….”. Finally, the advice the doctor provides is to “take that message on board”. In effect, explicit weight loss advice is not provided.
you’ve just been weighed and it showed that your body mass index is thirty one point eight, mm and er what we know, for people that are er overweight and that puts you into an obese... category is that mm er that increases your risk of er heart disease and diabetes and other conditions like that. right. and that if you address that weight problem and are able to bring it down... then so your risks mm also reduce. right. okay, so what I want you to do after today is to take that message on board, okay?
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor
Carefully dealing with your patient if they aren’t keen
This audio clip shows how to effectively avoid uncomfortable moments in the conversation, when patients indicate they do not want to talk about their weight. While the clinician does make assumptions about what the patient knows about weight loss, when the patient says “I do know that”, the clinician stops stating “so I will leave it there”. He also leaves the door open for future advice with “if you do want more advice … come back and see me.” The patient’s “okay that’s fine” suggests agreement with the plan.
Do you realise there are some good health benefits about losing some weight
Yes
And it greatly reduces… if -even if you lost a stone you, greatly reduce your chances of getting diabetes and reduces your risk of heart disease and strokes diabetes and strokes, and it can actually reduce your blood pressure. I do know that. So I will leave it there. But if you do want some more advice about practical things about losing weight then obviously come back and see me and we can go though it in detail, at another time. Okay that’s fine.
Doctor Patient Doctor Patient Doctor Patient
Delicate and personalised
This audio-clip shows the most effective way to introduce weight loss advice. The clinician personalises the consultation - using the patient’s name, referring to what has happened before and the patient’s health. The doctor also gently hesitates showing a ‘delicate’ way to start off the conversation. Throughout the patient responds positively with “yeahs” and, at the end, the patient joins in with the clinician’s “lose some weight” suggesting that they are on board.
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Clinician Patient Clinician Patient Clinician Patient
Direct
In this less effective audio clip, the clinician introduces the topic of weight loss by negatively assessing the patient’s weight – “you are, overweight”. Notice how the patient does not say anything.
As I’m sure you’re aware, you are, overweight... Um and it is bad for your health
Doctor
Direct
In this less effective audio clip, the clinician introduces the topic of weight loss by negatively assessing the patient’s weight – “you are, overweight”. Notice how the patient does not say anything.
As I’m sure you’re aware, you are, overweight... Um and it is bad for your health
Clinician
Closing weight loss advice
In this effective closing, the clinician starts by offering further support if the patient wants it. If a patient is interested, this support could be an appointment or referral. The clinician then checks in with the patient – “Is that alright?”. After the patient’s assessment “it’s fine”, the clinician positively evaluates the conversation, ending with “fabulous”.
Perhaps what we should do is- is- if you want some further help and some advice on how to try and do that then, perhaps we sh- come back and see me Okay
And we’ll have a chat and you know I’ll help you as much as we can. Is that alright?
Yeah, it’s fine
Fabulous alright
Clinician Patient Clinician Patient Clinician
Presuming that your patient didn’t know something
In this less effective consultation, notice how, through the use of “did you know”, the clinician assumes that the patient didn’t know why weight loss is important. The patient’s response shows she is well aware of these risks, having been told “probably a hundred times”.
According to this, did you know that if you were... to lose weight,
Yes
that it would help you with um your risk factors as far as... heart attacks, strokes, blood pressure control, and diabetes development
Yes. I’ve been told, probably a hundred times I’ve been told
Doctor Patient Doctor Patient
Presuming that your patient didn’t know something
In this less effective consultation, notice how, through the use of “did you know”, the clinician assumes that the patient didn’t know why weight loss is important. The patient’s response shows she is well aware of these risks, having been told “probably a hundred times”.
According to this, did you know that if you were... to lose weight,
Yes
that it would help you with um your risk factors as far as... heart attacks, strokes, blood pressure control, and diabetes development
Yes. I’ve been told, probably a hundred times I’ve been told
Clinician Patient Clinician Patient
Delicate and personalised
This audio-clip shows the most effective way to introduce weight loss advice. The clinician personalises the consultation - using the patient’s name, referring to what has happened before and the patient’s health. The doctor also gently hesitates showing a ‘delicate’ way to start off the conversation. Throughout the patient responds positively with “yeahs” and, at the end, the patient joins in with the clinician’s “lose some weight” suggesting that they are on board.
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Doctor Patient Doctor Patient Doctor Patient
Telling the patient what to do
Now the other thing to talk about with there is obviously the weight, which... would be helpful to get a bit off you. And I think it’s part of... the control with the diabetes. Really, is if you can try to sort of maintain, and keep your weight down... it would make a big difference with any risk of diabetes getting worse in the future. Um and er but you know, just try and lose a bit of weight... and see if it is, see how you get on with that okay. Make quite a difference I think.
Doctor
Being vague about the benefits of weight loss
In this less effective audio clip, notice the information the clinician provides is vague and tentative - “if you address that weight problem and are able to bring it down ….”. Finally, the advice the doctor provides is to “take that message on board”. In effect, explicit weight loss advice is not provided.
you’ve just been weighed and it showed that your body mass index is thirty one point eight, mm and er what we know, for people that are er overweight and that puts you into an obese... category is that mm er that increases your risk of er heart disease and diabetes and other conditions like that. right. and that if you address that weight problem and are able to bring it down... then so your risks mm also reduce. right. okay, so what I want you to do after today is to take that message on board, okay?
Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician
Direct
In this less effective audio clip, the clinician introduces the topic of weight loss by negatively assessing the patient’s weight – “you are, overweight”. Notice how the patient does not say anything.
As I’m sure you’re aware, you are, overweight... Um and it is bad for your health
Doctor
Being clear about the benefits of weight loss
so, with regards to your weight your BMI, your body mass index... is just slightly, it is too high at the moment and it would be really would be in your best okay interests to consider losing a little bit of weight okay and um and it you know there’s really good evidence that it will definitely help your back pain, okay and help with your joint pain if you’re getting any osteoarthritis of your knees and your feet and things like that and your hips it will help that, yep and obviously it majorly reduces your risk of developing heart disease and diabetes okay so it would definitely, definitely be in your best interest to consider losing a bit of weight okay
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient
This audio clip shows the most effective way to provide weight loss advice. The clinician does provide explicit advice about the possible benefits of losing weight and suggests the patient “consider losing a bit of weight”, which avoids telling the patient what to do.
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Doctor Patient Doctor Patient Doctor Patient
Being dismissive if your patient isn’t keen
Notice how, in this audio clip, the clinician is not making assumptions about what the patient knows or what she has or has not done. The patient talks about what she has done, and the clinician responds positively – “That’s good that you did”. This response encourages the patient to ask for help. The clinician offers to provide further help at another appointment. While this is effective, given how interested the patient is, could the clinician have offered more at this appointment?
…And things like that so
Sure
I’m well aware that I need to be on that journey, and largely I was.
Yeah.
I lost like a stone in- in the summer and then, I didn’t… ha ha
Yeah
I didn’t continue it so
That’s g- that that’s good that you did.
I’m not - I’m well aware of the situation, and what I should be doing, Sure
But any help,
Sure
I’m more than happy to take so-
Okay yeah so- so what- we won’t use today’s consultation for that because that’s not what you’re here for
Yeah, okay
Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient
Closing weight loss advice
In this effective closing, the clinician starts by offering further support if the patient wants it. If a patient is interested, this support could be an appointment or referral. The clinician then checks in with the patient – “Is that alright?”. After the patient’s assessment “it’s fine”, the clinician positively evaluates the conversation, ending with “fabulous”.
Perhaps what we should do is- is- if you want some further help and some advice on how to try and do that then, perhaps we sh- come back and see me Okay
And we’ll have a chat and you know I’ll help you as much as we can. Is that alright?
Yeah, it’s fine
Fabulous alright
Doctor Patient Doctor Patient Doctor
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Carefully dealing with your patient if they aren’t keen
This audio clip shows how to effectively avoid uncomfortable moments in the conversation, when patients indicate they do not want to talk about their weight. While the clinician does make assumptions about what the patient knows about weight loss, when the patient says “I do know that”, the clinician stops stating “so I will leave it there”. He also leaves the door open for future advice with “if you do want more advice … come back and see me.” The patient’s “okay that’s fine” suggests agreement with the plan.
Do you realise there are some good health benefits about losing some weight
Yes
And it greatly reduces… if -even if you lost a stone you, greatly reduce your chances of getting diabetes and reduces your risk of heart disease and strokes diabetes and strokes, and it can actually reduce your blood pressure. I do know that. So I will leave it there. But if you do want some more advice about practical things about losing weight then obviously come back and see me and we can go though it in detail, at another time. Okay that’s fine.
Clinician Patient Clinician Patient Clinician Patient
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Telling the patient what to do
In this less effective consultation, the clinician provides advice about the benefits of weight loss but in a way that suggests she is telling the patient what to do. Notice the number of times the clinician tells the patient to lose weight and the patient's lack of response throughout.
Now the other thing to talk about with there is obviously the weight, which... would be helpful to get a bit off you. And I think it’s part of... the control with the diabetes. Really, is if you can try to sort of maintain, and keep your weight down... it would make a big difference with any risk of diabetes getting worse in the future. Um and er but you know, just try and lose a bit of weight... and see if it is, see how you get on with that okay. Make quite a difference I think.
Clinician
Presuming what will or won’t be easy for your patient
In this less effective audio clip, the clinician makes assumptions that while the patient will be more active on holiday, managing his diet will be harder. Notice how the patient corrects these assumptions – “I’m not eating too much, I’m not moving too often”.
try I mean I’m sure you’ll be more active when you’re abroad and, and doing things and... just sort of watch that you’re, you know, eating eating, yes, er which probably you’re (laughs) will be difficult when you’re on holiday yeah an- an- no it’s not difficult I’m not eating too much I’m not moving too often yeah I’m moving in the morning and afternoon I just collapse on the sofa and that,
end of story are tired, yeah and plus my hips which were very painful okay
Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician
Being vague about the benefits of weight loss
you’ve just been weighed and it showed that your body mass index is thirty one point eight, mm and er what we know, for people that are er overweight and that puts you into an obese... category is that mm er that increases your risk of er heart disease and diabetes and other conditions like that. right. and that if you address that weight problem and are able to bring it down... then so your risks mm also reduce. right. okay, so what I want you to do after today is to take that message on board, okay?
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor
Delicate but depersonalised
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Doctor Patient
Delicate but depersonalised
In this less effective audio clip, the clinician starts the conversation with delicacy, hesitating and softening what she says. However, the information provided “there are some good health benefits” is not personalised – meaning it’s not necessarily relevant for this particular patient. The patient’s mm..yes shows that indeed this information is not relevant for her – it is already known and redundant.
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Clinician Patient
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you
yeah, yeah
mentioned a bit about your weight
yeah
as we’ve been talking about your back one of the things that would really help your back is to lose some weight
lose some weight
Presuming what will or won’t be easy for your patient
In this less effective audio clip, the clinician makes assumptions that while the patient will be more active on holiday, managing his diet will be harder. Notice how the patient corrects these assumptions – “I’m not eating too much, I’m not moving too often”.
try I mean I’m sure you’ll be more active when you’re abroad and, and doing things and... just sort of watch that you’re, you know, eating eating, yes, er which probably you’re (laughs) will be difficult when you’re on holiday yeah an- an- no it’s not difficult I’m not eating too much I’m not moving too often yeah I’m moving in the morning and afternoon I just collapse on the sofa and that,
end of story are tired, yeah and plus my hips which were very painful okay
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor
UOX_Weight loss resource
Design Science
Created on February 16, 2023
Start designing with a free template
Discover more than 1500 professional designs like these:
Explore all templates
Transcript
30 min
Home
Practical tips and audio clips for delivering very brief weight loss interventions
Overview
Evidence
Starting off
Giving advice
Health issues
Start
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
5 min
2 min
Home
Introduction
Overview
Obesity is a growing public health challenge, and our GP practices can be great places to support people with weight management. Evidence shows that offering referral to specialist services are most likely to benefit your patient, however, these are not always available. One thing you can do to help is offer very brief advice, but practice staff often find it tricky to talk about weight with their patients or even to start the conversation. We used communication science – analysing hundreds of real world recordings between clinicians and patients – to understand and share the best ways to share brief advice with patients who would like to lose weight.
Evidence
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
5 min
2 min
Home
Objectives
Overview
Based on these findings, this 30-minute training will provide you with:
Evidence
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
5 min
Home
How to navigate
Place your mouse over each pink highlight for an explanation of the interactive elements.When you're ready to move on, click the 'next' arrow.
Overview
Evidence
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Demo page
Resources
Our research
5 min
3 min
Home
Evidence supporting brief weight loss advice
Overview
There are many myths about brief advice, but they are rarely based on evidence. You might even have been taught some of these myths. Here we present 10 myths and the counter-evidence...
Evidence
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
5 min
Home
Myths
Research findings
Overview
Giving brief advice is not effective for weight loss
You don’t need long to talk about weight loss. A recent trial showed that very brief advice (about 30 seconds) was associated with weight loss
Evidence
Starting off
Giving advice
I should wait until the patient asks me about weight, rather than offer brief advice and support opportunistically
Most people find opportunistic advice helpful and appropriate. Many people are not sure how to bring the topic up with a healthcare professional, so value the opportunity for advice
Health issues
Tricky talks
Ending well
Most people want more support with weight loss than they are currently receiving and are happy to talk to a healthcare professional. It's very unlikely someone will become upset
Giving brief advice for weight loss will upset people
Summary
Test your skills
Resources
Our research
5 min
Home
Myths
Research findings
Overview
Advising someone to ‘eat less and move more’ is helpful
Most people have already tried this, and it does not work for everyone. Giving weight loss advice is more complex than explaining 'calories in' and 'calories out'
Evidence
Starting off
Giving advice
Advising patients that increasing exercise alone will lead to weight loss
Increasing exercise is good for all sorts of reasons, but increasing exercise alone is unlikely to lead to weight loss. It can help with weight maintenance though
Health issues
Tricky talks
One specific diet will work for everyone and I should advise people to try that
What works for one person may not work for someone else
Ending well
Summary
Test your skills
Resources
Our research
5 min
Home
Myths
Research findings
Overview
‘Scare tactics’ (for example telling people their risk of disease has increased) will motivate action
Scare tactics are unlikely to help and can demotivate people
Evidence
Starting off
I need to do motivational interviewing
There is no evidence that motivational interviewing increases the effectiveness of brief advice
Giving advice
Health issues
Effective brief weight loss advice must include goal setting
You do not need to set goals for advice to be helpful
Tricky talks
Ending well
I’ve given advice before and this person has not lost weight… it means they aren’t interested in losing weight
Obesity is a relapsing condition that requires lifelong support. Just because someone has not lost weight doesn’t mean they haven’t tried. Simply offering to talk can let people know you’re there to help
10
Summary
Test your skills
Resources
Our research
Home
Brief weight loss conversations: best practice
Overview
This learning tool provides evidence from analysis of real world consultations, which show best practice on:
Evidence
Starting off
Giving advice
Health issues
Tricky talks
We provide helpful hints and tips, but remember to respect your patient’s decision if they do not want to talk about their weight.
Ending well
Summary
Test your skills
Resources
Our research
4 min
Home
Setting the right ‘tone’ for your conversation is key. This page uses audio clips to explain how to introduce weight loss advice in consultations. Listen to different approaches by pressing the audio buttons.
Overview
Evidence
Starting off
Practical tips
Audio clips
Giving advice
Aim to be delicate and personal
Delicate and personalised
Health issues
Direct
Tricky talks
Delicate but depersonalised
Ending well
Summary
Test your skills
Resources
Our research
4 min
Home
You can give advice in different ways, but some are more effective than others. This page explains how to make the benefits of weight loss clear without telling your patient what to do.
Overview
Evidence
Starting off
Practical tips
Audio clips
Being vague about the benefits of weight loss
Giving advice
Be clear about the benefits of weight loss:
Health issues
Being clear about the benefits of weight loss
Tricky talks
Telling the patient what to do
Ending well
Summary
Test your skills
Resources
Our research
2 min
Home
How weight loss is linked to patients’ health conditions influences patient engagement. Using audio clips, this page shows when and how to effectively link weight loss and health conditions.
Overview
Evidence
Starting off
Practical tips
Audio clips
Indiscriminately linking to other health conditions
Giving advice
Health issues
Effectively linking to other health conditions
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
4 min
Home
Talking about your patient’s weight can feel negative. Listen to the audio clips to see how to avoid and navigate uncomfortable conversations.
Overview
Evidence
Starting off
Practical tips
Audio clips
Presuming that your patient didn’t know something
Giving advice
Health issues
Presuming what will or won’t be easy for your patient
Tricky talks
Being dismissive if you’re patient is interested
Ending well
Carefully responding if your patient doesn’t want to talk about weight loss
Summary
Test your skills
Resources
Our research
2 min
Home
It can be tricky to end discussions about weight loss, especially when it is in addition to a standard consultation. Listen to the audio clips of different approaches to completing a conversation about weight loss
Overview
Evidence
Starting off
Practical tips
Audio clips
Giving advice
Everyday closing
Set a good closing environment by:
Health issues
Closing weight loss advice
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
Listen to this page
1 min
Home
Summary Delivering very brief, evidence-based, weight loss advice in under 30 seconds:
Overview
Downloadable? Could add learning box into the page download? Or into the cert?
Evidence
Starting off
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
8 min
Home
Test your skills by answering the following questions
Overview
Evidence
1 / 6
Starting off
Myth busterWhy should you avoid giving generic diet and exercise advice?
Giving advice
Health issues
It makes assumptions about what people currently are (or are not doing)
Tricky talks
Ending well
Exercise doesn’t really help with weight loss
Summary
Test your skills
An ‘eat less, do more’ approach is unlikely to be effective for the general population of people living with obesity
Resources
All of the above
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
1 / 6
Starting off
You’re right, well done
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
2 / 6
Starting off
EvidenceWhich of these statements is true?
Giving advice
Health issues
You need a long time to talk about weight
Tricky talks
Ending well
Weight management advice can be brief and effective
Summary
You should only talk about weight loss if your patient asks about it
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
You do not need a long time to talk about weight loss. A recent trial showed that very brief advice (less than 30 seconds) was associated with weight loss.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Many people are not sure how to raise the topic of weight with healthcare professionals, and find opportunistic advice helpful and appropriate.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
2 / 6
Starting off
You’re right, well done
Giving advice
A recent trial showed that very brief advice (less than 30 seconds) was associated with weight loss.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
3 / 6
Starting off
Starting off Which of these recordings is delicate and personalised?
Giving advice
Health issues
Tricky talks
Ending well
Recording 1
Recording 2
Recording 3
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
In this response, the clinician is directive stating their opinion and focusing on the risks of being overweight.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
While the clinician is delicate, the information they provide is depersonalised.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
3 / 6
Starting off
You’re right, well done
Giving advice
The clinician is delicate and personalises the information.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
4 / 6
Starting off
Giving advice Which of these ways of giving advice is recommended?
Giving advice
Health issues
Highlight the problems if they don’t lose weight
Tricky talks
Ending well
Highlight the benefits of losing weight
Summary
Give advice before you assess your patient’s weight
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Scare tactics can demotivate people.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Giving advice before you assess your patient’s weight can result in depersonalised advice, which is not in context.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
4 / 6
Starting off
You’re right, well done
Giving advice
Patients are more likely to respond positively to personalised advice, which emphasises the benefits of losing weight.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
5 / 6
Starting off
Health issuesLinking health issues to weight loss when giving advice can cause problems. How can you avoid these:
Giving advice
Health issues
Avoid implying that your patient’s lifestyle has caused any health issues
Tricky talks
Ending well
Positively emphasise the benefits of weight loss for general health
Summary
Test your skills
Do link weight and health issues if the patient has already mentioned their weight
Resources
All of the above
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
5 / 6
Starting off
You’re right, well done
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
6 / 6
Starting off
Giving adviceWhen giving advice you should:
Giving advice
Health issues
Tell people what to do
Tricky talks
Ending well
Tentatively raise the topic of weight
Summary
Raise the topic confidently, and highlight the positive benefits of weight loss (moderation)
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
When patients are told what to do, they tend to remain silent, not acknowledging the advice.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Patients may not recognise that you are advising on weight or your clinical knowledge about the links between weight and health.
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
10 min
Home
Test your skills by answering the following questions
Overview
Evidence
Starting off
Sorry that's not right, please try again
Giving advice
Health issues
Tricky talks
Ending well
Summary
Test your skills
Resources
Our research
Home
Overview
Congratulations!
Evidence
You have completed the training, click the link below to download the certificate where you can fill in your name and today’s date
Starting off
Giving advice
Download certificate
Health issues
Tricky talks
Ending well
Summary
To help us evaluate and improve the training, please complete this very short survey in the link below:
Test your skills
Feedback survey
Resources
Our research
Being clear about the benefits of weight loss
so, with regards to your weight your BMI, your body mass index... is just slightly, it is too high at the moment and it would be really would be in your best okay interests to consider losing a little bit of weight okay and um and it you know there’s really good evidence that it will definitely help your back pain, okay and help with your joint pain if you’re getting any osteoarthritis of your knees and your feet and things like that and your hips it will help that, yep and obviously it majorly reduces your risk of developing heart disease and diabetes okay so it would definitely, definitely be in your best interest to consider losing a bit of weight okay
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient
This audio clip shows the most effective way to provide weight loss advice. The clinician does provide explicit advice about the possible benefits of losing weight and suggests the patient “consider losing a bit of weight”, which avoids telling the patient what to do.
Being vague about the benefits of weight loss
you’ve just been weighed and it showed that your body mass index is thirty one point eight, mm and er what we know, for people that are er overweight and that puts you into an obese... category is that mm er that increases your risk of er heart disease and diabetes and other conditions like that. right. and that if you address that weight problem and are able to bring it down... then so your risks mm also reduce. right. okay, so what I want you to do after today is to take that message on board, okay?
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor
Telling the patient what to do
Now the other thing to talk about with there is obviously the weight, which... would be helpful to get a bit off you. And I think it’s part of... the control with the diabetes. Really, is if you can try to sort of maintain, and keep your weight down... it would make a big difference with any risk of diabetes getting worse in the future. Um and er but you know, just try and lose a bit of weight... and see if it is, see how you get on with that okay. Make quite a difference I think.
Doctor
Everyday closing
The repeated responses by the clinician and patient show how we typically end a conversation in everyday talk and clinical consultations. However, for effective weight loss advice more is required.
Okay? Okay then, thanks very much Buh-bye then Buh-bye
Clinician Patient Clinician Patient
Indiscriminately linking to other health conditions
In addition to a direct introduction to the topic of weight loss and a lack of positive framing about how losing weight may impact the patient’s blood pressure and arthritis, in this less effective audio clip, the clinician links ‘indiscriminately’ between the patient’s weight and other potential health conditions. This can evoke ‘worst case health scenarios’ and imply the patient is to blame for developing other health conditions, as is seen in her response “well yeah but I got arthritis”
um, you are overweight and do you realise that is er going... to impact your health particularly things like arthritis, and blood pressure well yeah but I got arthritis. yeah. so thank you yeah
Doctor Patient Doctor Patient
Everyday closing
The repeated responses by the clinician and patient show how we typically end a conversation in everyday talk and clinical consultations. However, for effective weight loss advice more is required.
Okay? Okay then, thanks very much Buh-bye then Buh-bye
Doctor Patient Doctor Patient
Delicate but depersonalised
In this less effective audio clip, the clinician starts the conversation with delicacy, hesitating and softening what she says. However, the information provided “there are some good health benefits” is not personalised – meaning it’s not necessarily relevant for this particular patient. The patient’s mm..yes shows that indeed this information is not relevant for him – it is already known and redundant.
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Doctor Patient
Being clear about the benefits of weight loss
This audio clip shows the most effective way to provide weight loss advice. The clinician does provide explicit advice about the possible benefits of losing weight and suggests the patient “consider losing a bit of weight”, which avoids telling the patient what to do.
so, with regards to your weight your BMI, your body mass index... is just slightly, it is too high at the moment and it would be really would be in your best okay interests to consider losing a little bit of weight okay and um and it you know there’s really good evidence that it will definitely help your back pain, okay and help with your joint pain if you’re getting any osteoarthritis of your knees and your feet and things like that and your hips it will help that, yep and obviously it majorly reduces your risk of developing heart disease and diabetes okay so it would definitely, definitely be in your best interest to consider losing a bit of weight okay
Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient
Effectively linking to other health conditions
This audio clip shows the most effective method for linking weight loss and health conditions. Notice how the clinician refers to previous talk about weight, before suggesting that losing weight would help the patient’s back pain. She frames the conversation positively, saying weight loss will ‘help’ her back, rather than the negative framing in the previous example. Notice how each step by the clinician follows a positive response from the patient.
as you know you spoke to the lady earlier and you yeah, yeah. mentioned a bit about your weight. yeah. as we’ve been talking about your back, one of the things that... would really help your back is to lose some weight lose some weight
Doctor Patient Doctor Patient Doctor Patient
Effectively linking to other health conditions
This audio clip shows the most effective method for linking weight loss and health conditions. Notice how the clinician refers to previous talk about weight, before suggesting that losing weight would help the patient’s back pain. She frames the conversation positively, saying weight loss will ‘help’ her back, rather than the negative framing in the previous example. Notice how each step by the clinician follows a positive response from the patient.
as you know you spoke to the lady earlier and you yeah, yeah. mentioned a bit about your weight. yeah. as we’ve been talking about your back, one of the things that... would really help your back is to lose some weight lose some weight
Clinician Patient Clinician Patient Clinician Patient
Being clear about the benefits of weight loss
This audio clip shows the most effective way to provide weight loss advice. The clinician does provide explicit advice about the possible benefits of losing weight and suggests the patient “consider losing a bit of weight”, which avoids telling the patient what to do.
so, with regards to your weight your BMI, your body mass index... is just slightly, it is too high at the moment and it would be really would be in your best okay interests to consider losing a little bit of weight okay and um and it you know there’s really good evidence that it will definitely help your back pain, okay and help with your joint pain if you’re getting any osteoarthritis of your knees and your feet and things like that and your hips it will help that, yep and obviously it majorly reduces your risk of developing heart disease and diabetes okay so it would definitely, definitely be in your best interest to consider losing a bit of weight okay
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Indiscriminately linking to other health conditions
In addition to a direct introduction to the topic of weight loss and a lack of positive framing about how losing weight may impact the patient’s blood pressure and arthritis, in this less effective audio clip, the clinician links ‘indiscriminately’ between the patient’s weight and other potential health conditions. This can evoke ‘worst case health scenarios’ and imply the patient is to blame for developing other health conditions, as is seen in her response “well yeah but I got arthritis”
um, you are overweight and do you realise that is er going... to impact your health particularly things like arthritis, and blood pressure well yeah but I got arthritis. yeah. so thank you yeah
Clinician Patient Clinician Patient
Telling the patient what to do
In this less effective consultation, the clinician provides advice about the benefits of weight loss but in a way that suggests she is telling the patient what to do. Notice the number of times the clinician tells the patient to lose weight and the patient's lack of response throughout.
Now the other thing to talk about with there is obviously the weight, which... would be helpful to get a bit off you. And I think it’s part of... the control with the diabetes. Really, is if you can try to sort of maintain, and keep your weight down... it would make a big difference with any risk of diabetes getting worse in the future. Um and er but you know, just try and lose a bit of weight... and see if it is, see how you get on with that okay. Make quite a difference I think.
Doctor
Being dismissive if your patient is interested
Notice how, in this audio clip, the clinician is not making assumptions about what the patient knows or what she has or has not done. The patient talks about what she has done, and the clinician responds positively – “That’s good that you did”. This response encourages the patient to ask for help. The clinician offers to provide further help at another appointment. While this is effective, given how interested the patient is, could the clinician have offered more at this appointment?
…And things like that so Sure I’m well aware that I need to be on that journey, and largely I was. Yeah. I lost like a stone in- in the summer and then, I didn’t… ha ha Yeah I didn’t continue it so That’s g- that that’s good that you did. I’m not - I’m well aware of the situation, and what I should be doing, Sure But any help, Sure I’m more than happy to take so- Okay yeah so- so what- we won’t use today’s consultation for that because that’s not what you’re here for Yeah, okay
Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient
Delicate and personalised
This audio-clip shows the most effective way to introduce weight loss advice. The clinician personalises the consultation - using the patient’s name, referring to what has happened before and the patient’s health. The doctor also gently hesitates showing a ‘delicate’ way to start off the conversation. Throughout the patient responds positively with “yeahs” and, at the end, the patient joins in with the clinician’s “lose some weight” suggesting that they are on board.
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Doctor Patient Doctor Patient Doctor Patient
Delicate but depersonalised
In this less effective audio clip, the clinician starts the conversation with delicacy, hesitating and softening what she says. However, the information provided “there are some good health benefits” is not personalised – meaning it’s not necessarily relevant for this particular patient. The patient’s mm..yes shows that indeed this information is not relevant for him – it is already known and redundant.
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Doctor Patient
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Delicate but depersonalised
In this less effective audio clip, the clinician starts the conversation with delicacy, hesitating and softening what she says. However, the information provided “there are some good health benefits” is not personalised – meaning it’s not necessarily relevant for this particular patient. The patient’s mm..yes shows that indeed this information is not relevant for him – it is already known and redundant.
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Doctor Patient
Direct
As I’m sure you’re aware, you are, overweight... Um and it is bad for your health
Doctor
Being vague about the benefits of weight loss
In this less effective audio clip, notice the information the clinician provides is vague and tentative - “if you address that weight problem and are able to bring it down ….”. Finally, the advice the doctor provides is to “take that message on board”. In effect, explicit weight loss advice is not provided.
you’ve just been weighed and it showed that your body mass index is thirty one point eight, mm and er what we know, for people that are er overweight and that puts you into an obese... category is that mm er that increases your risk of er heart disease and diabetes and other conditions like that. right. and that if you address that weight problem and are able to bring it down... then so your risks mm also reduce. right. okay, so what I want you to do after today is to take that message on board, okay?
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor
Carefully dealing with your patient if they aren’t keen
This audio clip shows how to effectively avoid uncomfortable moments in the conversation, when patients indicate they do not want to talk about their weight. While the clinician does make assumptions about what the patient knows about weight loss, when the patient says “I do know that”, the clinician stops stating “so I will leave it there”. He also leaves the door open for future advice with “if you do want more advice … come back and see me.” The patient’s “okay that’s fine” suggests agreement with the plan.
Do you realise there are some good health benefits about losing some weight Yes And it greatly reduces… if -even if you lost a stone you, greatly reduce your chances of getting diabetes and reduces your risk of heart disease and strokes diabetes and strokes, and it can actually reduce your blood pressure. I do know that. So I will leave it there. But if you do want some more advice about practical things about losing weight then obviously come back and see me and we can go though it in detail, at another time. Okay that’s fine.
Doctor Patient Doctor Patient Doctor Patient
Delicate and personalised
This audio-clip shows the most effective way to introduce weight loss advice. The clinician personalises the consultation - using the patient’s name, referring to what has happened before and the patient’s health. The doctor also gently hesitates showing a ‘delicate’ way to start off the conversation. Throughout the patient responds positively with “yeahs” and, at the end, the patient joins in with the clinician’s “lose some weight” suggesting that they are on board.
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Clinician Patient Clinician Patient Clinician Patient
Direct
In this less effective audio clip, the clinician introduces the topic of weight loss by negatively assessing the patient’s weight – “you are, overweight”. Notice how the patient does not say anything.
As I’m sure you’re aware, you are, overweight... Um and it is bad for your health
Doctor
Direct
In this less effective audio clip, the clinician introduces the topic of weight loss by negatively assessing the patient’s weight – “you are, overweight”. Notice how the patient does not say anything.
As I’m sure you’re aware, you are, overweight... Um and it is bad for your health
Clinician
Closing weight loss advice
In this effective closing, the clinician starts by offering further support if the patient wants it. If a patient is interested, this support could be an appointment or referral. The clinician then checks in with the patient – “Is that alright?”. After the patient’s assessment “it’s fine”, the clinician positively evaluates the conversation, ending with “fabulous”.
Perhaps what we should do is- is- if you want some further help and some advice on how to try and do that then, perhaps we sh- come back and see me Okay And we’ll have a chat and you know I’ll help you as much as we can. Is that alright? Yeah, it’s fine Fabulous alright
Clinician Patient Clinician Patient Clinician
Presuming that your patient didn’t know something
In this less effective consultation, notice how, through the use of “did you know”, the clinician assumes that the patient didn’t know why weight loss is important. The patient’s response shows she is well aware of these risks, having been told “probably a hundred times”.
According to this, did you know that if you were... to lose weight, Yes that it would help you with um your risk factors as far as... heart attacks, strokes, blood pressure control, and diabetes development Yes. I’ve been told, probably a hundred times I’ve been told
Doctor Patient Doctor Patient
Presuming that your patient didn’t know something
In this less effective consultation, notice how, through the use of “did you know”, the clinician assumes that the patient didn’t know why weight loss is important. The patient’s response shows she is well aware of these risks, having been told “probably a hundred times”.
According to this, did you know that if you were... to lose weight, Yes that it would help you with um your risk factors as far as... heart attacks, strokes, blood pressure control, and diabetes development Yes. I’ve been told, probably a hundred times I’ve been told
Clinician Patient Clinician Patient
Delicate and personalised
This audio-clip shows the most effective way to introduce weight loss advice. The clinician personalises the consultation - using the patient’s name, referring to what has happened before and the patient’s health. The doctor also gently hesitates showing a ‘delicate’ way to start off the conversation. Throughout the patient responds positively with “yeahs” and, at the end, the patient joins in with the clinician’s “lose some weight” suggesting that they are on board.
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Doctor Patient Doctor Patient Doctor Patient
Telling the patient what to do
Now the other thing to talk about with there is obviously the weight, which... would be helpful to get a bit off you. And I think it’s part of... the control with the diabetes. Really, is if you can try to sort of maintain, and keep your weight down... it would make a big difference with any risk of diabetes getting worse in the future. Um and er but you know, just try and lose a bit of weight... and see if it is, see how you get on with that okay. Make quite a difference I think.
Doctor
Being vague about the benefits of weight loss
In this less effective audio clip, notice the information the clinician provides is vague and tentative - “if you address that weight problem and are able to bring it down ….”. Finally, the advice the doctor provides is to “take that message on board”. In effect, explicit weight loss advice is not provided.
you’ve just been weighed and it showed that your body mass index is thirty one point eight, mm and er what we know, for people that are er overweight and that puts you into an obese... category is that mm er that increases your risk of er heart disease and diabetes and other conditions like that. right. and that if you address that weight problem and are able to bring it down... then so your risks mm also reduce. right. okay, so what I want you to do after today is to take that message on board, okay?
Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician
Direct
In this less effective audio clip, the clinician introduces the topic of weight loss by negatively assessing the patient’s weight – “you are, overweight”. Notice how the patient does not say anything.
As I’m sure you’re aware, you are, overweight... Um and it is bad for your health
Doctor
Being clear about the benefits of weight loss
so, with regards to your weight your BMI, your body mass index... is just slightly, it is too high at the moment and it would be really would be in your best okay interests to consider losing a little bit of weight okay and um and it you know there’s really good evidence that it will definitely help your back pain, okay and help with your joint pain if you’re getting any osteoarthritis of your knees and your feet and things like that and your hips it will help that, yep and obviously it majorly reduces your risk of developing heart disease and diabetes okay so it would definitely, definitely be in your best interest to consider losing a bit of weight okay
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient
This audio clip shows the most effective way to provide weight loss advice. The clinician does provide explicit advice about the possible benefits of losing weight and suggests the patient “consider losing a bit of weight”, which avoids telling the patient what to do.
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Doctor Patient Doctor Patient Doctor Patient
Being dismissive if your patient isn’t keen
Notice how, in this audio clip, the clinician is not making assumptions about what the patient knows or what she has or has not done. The patient talks about what she has done, and the clinician responds positively – “That’s good that you did”. This response encourages the patient to ask for help. The clinician offers to provide further help at another appointment. While this is effective, given how interested the patient is, could the clinician have offered more at this appointment?
…And things like that so Sure I’m well aware that I need to be on that journey, and largely I was. Yeah. I lost like a stone in- in the summer and then, I didn’t… ha ha Yeah I didn’t continue it so That’s g- that that’s good that you did. I’m not - I’m well aware of the situation, and what I should be doing, Sure But any help, Sure I’m more than happy to take so- Okay yeah so- so what- we won’t use today’s consultation for that because that’s not what you’re here for Yeah, okay
Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient
Closing weight loss advice
In this effective closing, the clinician starts by offering further support if the patient wants it. If a patient is interested, this support could be an appointment or referral. The clinician then checks in with the patient – “Is that alright?”. After the patient’s assessment “it’s fine”, the clinician positively evaluates the conversation, ending with “fabulous”.
Perhaps what we should do is- is- if you want some further help and some advice on how to try and do that then, perhaps we sh- come back and see me Okay And we’ll have a chat and you know I’ll help you as much as we can. Is that alright? Yeah, it’s fine Fabulous alright
Doctor Patient Doctor Patient Doctor
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Carefully dealing with your patient if they aren’t keen
This audio clip shows how to effectively avoid uncomfortable moments in the conversation, when patients indicate they do not want to talk about their weight. While the clinician does make assumptions about what the patient knows about weight loss, when the patient says “I do know that”, the clinician stops stating “so I will leave it there”. He also leaves the door open for future advice with “if you do want more advice … come back and see me.” The patient’s “okay that’s fine” suggests agreement with the plan.
Do you realise there are some good health benefits about losing some weight Yes And it greatly reduces… if -even if you lost a stone you, greatly reduce your chances of getting diabetes and reduces your risk of heart disease and strokes diabetes and strokes, and it can actually reduce your blood pressure. I do know that. So I will leave it there. But if you do want some more advice about practical things about losing weight then obviously come back and see me and we can go though it in detail, at another time. Okay that’s fine.
Clinician Patient Clinician Patient Clinician Patient
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Telling the patient what to do
In this less effective consultation, the clinician provides advice about the benefits of weight loss but in a way that suggests she is telling the patient what to do. Notice the number of times the clinician tells the patient to lose weight and the patient's lack of response throughout.
Now the other thing to talk about with there is obviously the weight, which... would be helpful to get a bit off you. And I think it’s part of... the control with the diabetes. Really, is if you can try to sort of maintain, and keep your weight down... it would make a big difference with any risk of diabetes getting worse in the future. Um and er but you know, just try and lose a bit of weight... and see if it is, see how you get on with that okay. Make quite a difference I think.
Clinician
Presuming what will or won’t be easy for your patient
In this less effective audio clip, the clinician makes assumptions that while the patient will be more active on holiday, managing his diet will be harder. Notice how the patient corrects these assumptions – “I’m not eating too much, I’m not moving too often”.
try I mean I’m sure you’ll be more active when you’re abroad and, and doing things and... just sort of watch that you’re, you know, eating eating, yes, er which probably you’re (laughs) will be difficult when you’re on holiday yeah an- an- no it’s not difficult I’m not eating too much I’m not moving too often yeah I’m moving in the morning and afternoon I just collapse on the sofa and that, end of story are tired, yeah and plus my hips which were very painful okay
Clinician Patient Clinician Patient Clinician Patient Clinician Patient Clinician
Being vague about the benefits of weight loss
you’ve just been weighed and it showed that your body mass index is thirty one point eight, mm and er what we know, for people that are er overweight and that puts you into an obese... category is that mm er that increases your risk of er heart disease and diabetes and other conditions like that. right. and that if you address that weight problem and are able to bring it down... then so your risks mm also reduce. right. okay, so what I want you to do after today is to take that message on board, okay?
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor
Delicate but depersonalised
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Doctor Patient
Delicate but depersonalised
In this less effective audio clip, the clinician starts the conversation with delicacy, hesitating and softening what she says. However, the information provided “there are some good health benefits” is not personalised – meaning it’s not necessarily relevant for this particular patient. The patient’s mm..yes shows that indeed this information is not relevant for her – it is already known and redundant.
Basically, d’you realise there are some good health benefits ‘bout losing some weight. mm..yes
Clinician Patient
Delicate and personalised
um Mr Williams as you know you spoke to the lady earlier and you yeah, yeah mentioned a bit about your weight yeah as we’ve been talking about your back one of the things that would really help your back is to lose some weight lose some weight
Presuming what will or won’t be easy for your patient
In this less effective audio clip, the clinician makes assumptions that while the patient will be more active on holiday, managing his diet will be harder. Notice how the patient corrects these assumptions – “I’m not eating too much, I’m not moving too often”.
try I mean I’m sure you’ll be more active when you’re abroad and, and doing things and... just sort of watch that you’re, you know, eating eating, yes, er which probably you’re (laughs) will be difficult when you’re on holiday yeah an- an- no it’s not difficult I’m not eating too much I’m not moving too often yeah I’m moving in the morning and afternoon I just collapse on the sofa and that, end of story are tired, yeah and plus my hips which were very painful okay
Doctor Patient Doctor Patient Doctor Patient Doctor Patient Doctor