• weight loss goals;
  • patient motivation;
  • patient-physician communication

BACKGROUND: Prior studies suggest that patients and physicians have different perceptions and expectations surrounding weight; however, few studies have directly compared patients' and physicians' perspectives.

OBJECTIVES: (1) To measure the extent to which obese patients and their physicians have discrepant weight-related perceptions, and (2) to explore patient and physician characteristics that may influence patient-physician discrepancy in motivation to lose weight.

DESIGN AND PARTICIPANTS: Four hundred and fifty-six obese patients (302 females; mean age=55.1 years; mean BMI=37.9) and their 28 primary care physicians (22 males, mean age=44.1 years) from nonmetropolitan practices completed an anonymous survey after an office visit.

MEASURES: Weight-related perceptions included perceived weight status, health impact of weight, 1-year weight loss expectations, and motivation to lose weight. Correlates included patient and physician sex, age, and BMI; physicians' reported frequency, perceived patient preference, and confidence for weight counseling; and practice characteristics (e.g., years in practice).

RESULTS: Physicians assigned patients to heavier descriptive weight categories and reported a worse health impact than patients perceived for themselves, whereas patients believed they could lose more weight and reported a higher motivation to lose weight than their physicians perceived for patients (P<.001). Physicians who believed patients preferred to discuss weight more often (P=.001) and who saw more patients per week (P=.04) were less likely to underestimate patient motivation.

CONCLUSIONS: Patients reported more optimistic weight-related perceptions and expectations than their physicians. Further research is needed to determine how these patient-physician discrepancies may influence weight loss counseling in primary care.