Nutrition counseling in private practice: Attitudes and activities of family physicians

What can we generalize from research on patient education and clinical health promotion to physician counseling on diet?

“…They considered smoking the most important risk factor (McAlister et al, 1985). A survey on nutrition counseling in private practices in Minnesota reported that physicians believe it is important to educate their patients about health risks, but they devote little time to it because they do not think patients want or would follow their advice (Kottke et al, 1984). A survey of primary care physicians found that most believe they should modify patient behavior to minimize risk factors, but only a small percentage report success in helping patients achieve behavioral change .…”

Trends in professional advice to lose weight among obese adults, 1994 to 2000

“…Surveys of physicians support this picture; physicians report that they often fail to counsel patients regarding weight, 26 diet, [27][28][29] or exercise, 27,30 and often do not assess body mass during office visits. 26 Patients are more likely to be counseled about health behaviors like diet and exercise if the visit is long 31 or if other risk factors are present.…”

“…26 Patients are more likely to be counseled about health behaviors like diet and exercise if the visit is long 31 or if other risk factors are present. 27,[31][32][33] Physicians cite many factors, including lack of time during office visits, 27,28,30 inadequate training in preventive care, 27,28 no reimbursement for treatment and prevention, 28,34 and the belief that the advice would have little effect on patient behavior [27][28][29][30]35 as prominent barriers to counseling. However, studies reveal that patients counseled regarding their weight or strategies for improving diet and exercise are substantially more likely to report that they are working on these areas, 20,21,36,37 and may be more likely to lose weight.…”

Weight-related perceptions among patients and physicians

“…For example, obese patients typically have weight goals that represent a 24% to 38% loss of initial weight [22][23][24] compared with a 14% average weight loss that physicians believe is acceptable 12 and the 10% loss recommended by clinical guidelines. 2 In addition, many physicians perceive patients to lack motivation, [12][13][14][15][16] but large national surveys indicate that two-thirds of obese patients are actually attempting to lose weight. 25 The literature suggests that an individual's self-perceived motivation is critical to the initiation of behavior change 26 and that patients are more likely to make health behavior changes when they believe their providers are supportive and encouraging of their motivation and expectations for change.…”

“…10,11 Primary care physicians report that key barriers to weight loss counseling are self-perceived low competence in treating obesity, lack of treatment effectiveness, and poor patient motivation. [12][13][14][15][16][17] Time constraints and inadequate reimbursement may also hinder physician counseling, 12,18 but these barriers appear to be less crucial than physicians' frustration with treatment ineffectiveness and expectations that patients will be unmotivated and noncompliant with weight loss recommendations. 13,15,16,19 In a national survey of 620 primary care physicians, over 40% agreed that obese patients could reach a normal weight if they were motivated, but that most patients would not be motivated enough to lose a significant amount of weight.…”