Explicit resistance within unsolicited conversations about weight in primary care: Presenter(s): Madeleine Tremblett, University of Oxford, United Kingdom

Conversations about weight are difficult for patients living with obesity (PLwO) and their clinicians. This is often attributed to stigma, and the topic is also anticipated, or experienced, as upsetting. Nonetheless, guidelines encourage clinicians to give PLwO brief weight loss advice as it has shown to be effective. Retrospective accounts suggest there is a strong potential that patients could respond with overt resistance. Yet, there are few examples of what this resistant looks like in consultations. We wanted to understand both how patients overtly resist to unsolicited weight loss advice, and how clinicians can manage this resistance. We had access to 45 examples of PLwO displaying overt resistance when general practitioners (GPs) gave unsolicited 'advice' on their weight. Using conversation analysis, we focused on what happened prior to overt resistance displays, the format of the displays, and the ways in which the GPs managed the resistance. Resistance often followed: (a) GPs framing their talk as a question, or (b) GPs giving some direction on how to lose weight through changes to diet or physical activity. Patients displayed resistance through asserting epistemic and deontic claims to knowledge that the GP 'could not' or 'did not' know. GPs rarely worked to overcome the resistance. Instead, progressivity was maintained when the patient’s perspective was acknowledged, and future support was offered. Our Findings: show two key implications for clinicians when talking to PLwO about weight. First, we demonstrate phrases to avoid. Second, we show what clinicians can do to manage resistance when it does occur. Providing unsolicited advice is particularly difficult as the issue is not on the patient’s agenda, and the entitlement of the doctor to give this type of advice may be low. However, we show what can be done in rare instances when it is overtly resisted.