Physician Recommendations for Diet and Physical Activity:

doi:10.1006/pmed.1997.0216

Preventive Medicine

Volume 26, Issue 6, November 1997, Pages 825-833

https://doi.org/10.1006/pmed.1997.0216 Get rights and content

Abstract

Background.National objectives and guidelines call upon physicians to help reduce the population burden of chronic diseases by advising patients to eat less fat and get more physical activity. However, studies show physicians are most likely to provide behavioral recommendations to patients who are already sick. Understanding factors that influence physicians' advising decisions can help broaden the reach of these activities.

Methods.Subjects were 915 adult patients and 27 physicians from four community-based family medicine clinics in southeastern Missouri. To participate, patients completed a self-administered behavioral and health questionnaire while waiting to see their doctor.

Results.Having a high body mass index was the strongest predictor of receiving advice to increase physical activity (OR = 1.6; 95% CI 1.3, 2.0), and having a high cholesterol level was the strongest predictor of receiving advice to eat less fat (OR = 1.9; 95% CI 1.5, 2.4). Neither the actual content of patients' diets nor their levels of physical activity were associated with receiving advice.

Conclusions.Physicians' advising may be guided by quick but fallible heuristics that systematically exclude patients whose needs are not easily visible. This pattern misses the opportunity to reduce future needs for therapeutic counseling by taking preventive action now.

References (52)

AS Ford et al.
Health education and the primary care physician: the practitioner's perspective
Soc Sci Med
(1983)
CM Valente et al.
Health promotion: physicians, beliefs, attitudes and practices
Am J Prev Med
(1986)
TE Kottke et al.
Nutrition counseling in private practice: attitudes and activities of family physicians
Prev Med
(1984)
C Friedman et al.
Physician advice to reduce chronic disease risk factors
Am J Prev Med
(1994)
G Block et al.
A brief dietary screen for high fat intake
J Nutr Educ
(1989)
DH Gemson et al.
Prevention in primary care: variability in physician practices in New York City
Am J Prev Med
(1986)
E Frank
Osler was wrong, you are a preventionist
Am J Prev Med
(1991)
B Maheux et al.
Factors influencing physicians' prevention practices
Am J Prev Med
(1989)
RC Brownson et al.
Chronic disease epidemiology and control
(1993)
U.S. Department of Health and Human Services, 1996, Physical activity and health: a report of the Surgeon General, U.S....

M, A, McDowell, R, R, Briefel, K, Alaimo, C, R, Caughman, A, L, Bischof, M, D, Carroll, et al. 1994, Energy and...

U.S. Department of Health and Human Services, 1990, Healthy People 2000: national health promotion and disease...

AS Leon et al.

Physical activity and 10.5 year mortality in the Multiple Risk Factor Intervention Trial (MRFIT)

Int J Epidemiol

(1991)

Guide to clinical preventive services

(1996)

National Center for Health Statistics, 1990, Health, United States, 1989, U.S. Department of Health and Human Services,...

MH Becker et al.

Practicing health promotion: the doctor's dilemma

Ann Intern Med

(1990)

PD Mullen et al.

Settings as an important dimensionin health education/promotion policy, programs, and research

Health Educ Q

(1995)

H Wechsler et al.

The physicians, role in health promotion—a survey of primary care practitioners

N Engl J Med

(1983)

KB Wells et al.

The practices of general and subspecialty internists in counseling about smoking and exercise

Am J Public Health

(1986)

KB Wells et al.

Do physicians preach what they practice? A study of physicians, health habits and counseling practices

JAMA

(1984)

CE Lewis et al.

The counseling practices of internists

Ann Intern Med

(1991)

SE Sherman et al.

Exercise counseling: how do general internists do?

J Gen Intern Med

(1993)

U.S. Department of Health and Human Services, 1995, Progress report for: clinical preventive services. Data from the...

E Gilpin et al.

Trends in physicians, giving advice to patients to stop smoking, United States, 1974–1987

Tobacco Control

(1992)

JK Ockene et al.

The physician-delivered smoking intervention project: factors that determine how much the physician intervened with smokers

J Gen Intern Med

(1994)

Cited by (84)

Dietary advice in chronic care: Comparing traditional Chinese and western medicine practiced in mainland China
2022, Social Science and Medicine
Citation Excerpt :
This number is higher in hypertension (35%) and cancer encounters (45%) (Demark-Wahnefried et al., 2000; Mellen, 2004). As Kreuter et al. (1997) stated, the provision of dietary advice is strongly predicted by the patient's health conditions rather than the actual health-related behaviours. Some studies suggest that health professionals may not have sufficient confidence or competency to offer dietary advice (Lockyer et al., 2016).
The study examines dietary advice-giving in regular consultations for patients with chronic conditions in two types of clinical practices: Traditional Chinese Medicine and Western Medicine practiced in mainland China. Dietary habits are unanimously considered relevant to the patient's health, particularly in chronic conditions. This article reports the differences in where and how dietary advice is occasioned and co-constructed by participants in two settings. One significant finding of this paper is that while Traditional Chinese Medicine doctors take dietary talk to instruct patients and put it into the treatment recommendation, WM doctors may treat it as incidental and only valuable for diagnostic assessment, leaving its treatment opaque and not discussed with the patient. Data are in Mandarin Chinese. Using Conversation Analysis, the article describes the interactional organisation of dietary advice delivery in different medical practices and ascribes their differences to clinical pathology.
Trends in Lifestyle Counseling for Adults With and Without Diabetes in the U.S., 2005–2015
2019, American Journal of Preventive Medicine
Strong evidence shows that lifestyle change and weight loss stimulated by counseling improve glycemic control and lower comorbidities for patients with diabetes, but it is unclear whether diet or physical activity counseling for patients with diabetes in ambulatory settings has actually been responsive to this evidence.
Data from the 2005–2015 National Ambulatory Medical Care Surveys were used to assess trends in provider-reported diet or exercise counseling during ambulatory care visits. The data were pooled and multivariate logistic regression models were built, adjusting for patient-, provider-, and practice-level characteristics to examine whether the provision of counseling varied by these characteristics. Data were analyzed from September 2018 to December 2018.
There were 42,234 adults with diabetes and 272,094 adults without diabetes. The proportions of patients with provider-reported Type 2 diabetes who received any diet or exercise counseling were no different over time, 30% in 2005 (95% CI=25%, 35%) and 25% in 2015 (95% CI=18%, 31%). Lower proportions of those without diabetes received any counseling, 17% in 2005 (95% CI=14%, 19%) and 15% in 2015 (95% CI=11%, 18%). Adjusted models showed that Hispanic patients had a higher likelihood of receiving diet or exercise counseling, compared with whites (OR=1.38, 95% CI=1.09, 1.75). Those aged 30–49 years were more likely to receive diet or exercise counseling than those aged >75 years (OR=1.51, 95% CI=1.27, 1.80). Compared with rural areas and other providers, visits in a metropolitan area (OR=1.27, 95% CI=1.09, 1.47) or with an advanced practice provider (OR=1.66, 95% CI=1.00, 2.75) had a higher likelihood of any diet or exercise counseling delivery.
Less than 30% of Americans with diabetes receive diet or exercise counseling in ambulatory visits, and this proportion has not changed significantly in a decade. Future interventions should focus on addressing this gap in counseling.
Prevalence and Correlates of Receiving Medical Advice to Increase Physical Activity in U.S. Adults: National Health and Nutrition Examination Survey 2013–2016
2019, American Journal of Preventive Medicine
Citation Excerpt :
Other professional organizations have released position statements that have addressed the importance of PA counseling, including the American Academy of Family Physicians, the American College of Sports Medicine, and the American Heart Association.6–9 Despite these national priorities and recommendations, there is limited recent information on the association between patient health and demographic characteristics and receiving PA counseling in healthcare settings.10–12 Therefore, the aim of the current study is to examine health and demographic characteristics of U.S. health care–utilizing adults associated with receipt of medical advice to increase their PA.
National objectives recommend healthcare professionals provide physical activity advice. This study examined health and demographic characteristics associated with receipt of medical advice to increase physical activity among U.S. health care–utilizing adults and differences in associations by age group.
Analyses included 8,410 health care–utilizing adults aged ≥20 years from the 2013–2016 National Health and Nutrition Examination Surveys (analyzed in 2018). Logistic regression was used to examine associations between receipt of medical advice to increase physical activity in the past year and measured health conditions, reported health behaviors, and demographic characteristics. Models were stratified by age group (20–39, 40–59, and ≥60 years).
Physical activity medical advice was received by 42.9% (95% CI=40.8, 44.9) of adults overall. By age group, 32.7% of younger adults, 46.7% of middle-aged adults, and 48.9% of older adults received advice. Among all adults and across all age groups, receipt of advice was higher among adults with chronic health conditions: obesity (63.0%, 95% CI=60.3, 65.7), hypertension (56.5%, 95%=CI 53.8, 59.2), diabetes (69.8%, 95% CI=66.5, 72.8), hypercholesterolemia (55.6%, 95% CI=52.3, 59.0), and low high-density lipoprotein cholesterol (53.8%, 95% CI=50.1, 57.4). Among all adults, those with obesity, hypertension, and diabetes had significantly greater odds of receipt of advice after adjustment. Stronger associations between diabetes and hypercholesterolemia and receiving physical activity advice were observed among younger adults.
Receipt of physical activity medical advice was highest among adults with specific chronic health conditions, and this pattern was stronger among younger adults with diabetes and hypercholesterolemia. However, most health care–utilizing adults did not receive physical activity medical advice.
Trends and disparities in the prevalence of physicians’ counseling on exercise among the U.S. adult population, 2000–2010
2017, Preventive Medicine
Recognizing the undisputed health benefits of exercise, physicians' counseling has been included in the Healthy People Objectives since 2000. To address the paucity of data on such counseling at the national level, we examined changing trends and disparities in receiving physicians' counseling on exercise among the physically-able, non-institutionalized U.S. adult population. Data from the 2000, 2005, and 2010 National Health Interview Surveys (NHIS) were examined using logistic regression that included race/ethnicity, age, gender, education, insurance status, number of physician visits in the past year, and body mass index. In 2000, only 22.9% of NIHS respondents had received counseling on exercise, increasing to 33.6% in 2010. Compared with non-Hispanic Whites, non-Hispanic Blacks were 27% less likely to receive exercise advice in 2000 (adjusted odds ratio [AOR] 0.73, 95% confidence interval [CI] 0.61–0.87). In later years, they were equally likely to receive advice. Although decreased over the years, male respondents were significantly (34% to 23%) less likely to report receipt of exercise counseling than female patients (in 2010: AOR 0.77, CI 0.72–0.83). Uninsured respondents were 35% less likely to report receiving exercise advice from their provider in all study years (2010: AOR 0.64, CI 0.59–0.72). Patients with increasing levels of education were increasingly more likely to report receipt of counseling in each successive survey year. The overall prevalence of physicians' counseling on exercise increased moderately between 2000 and 2010. Some disparities narrowed and even reversed but significant disparities continue to exist across gender, insurance status, and education level.
Student pharmacist perceptions of therapeutic lifestyle change (TLC) counseling abilities and personal health status
2016, Currents in Pharmacy Teaching and Learning
Citation Excerpt :
Unfortunately, the literature shows there is still a disconnect between patients and providers in regards to effectiveness and availability of provided services. Only 39% of primary care office visits were found to adequately address TLC topics such as weight, diet, and physical activity, indicating a need for improved services.4–7 In addition, a study by Bleich et al.8 revealed that only one-third of obese patients receive a formal diagnosis of obesity or lifestyle counseling from a physician.
Although prevalent in medical literature, there are limited data on student pharmacists’ ability to provide therapeutic lifestyle change (TLC) counseling. The objective of this study is to evaluate student pharmacists’ perceived abilities for TLC counseling and to determine if there was any correlation related to the students’ perceived personal health status.
A survey containing Likert questions about perceptions regarding TLC counseling, assessment questions on guidelines, and perceptions about personal health status was distributed electronically in February 2015 to all student pharmacists from first to fourth year at two pharmacy schools. Data analysis was completed using descriptive statistics and logistic regression. The project was approved by both universities’ institutional review boards.
The survey was distributed to 1050 student pharmacists and 234 responded for a response rate of 22.3%. Greater than 70% of students reported confidence in providing general TLC counseling and this was not affected by weight of the patient; however, fewer students, 50%, were confident in providing tailored, patient-specific recommendations. Students performed well on assessment questions related to exercise and saturated fat intake; however, fewer students were able to correctly select recommended carbohydrate or sodium intake. Results show the majority of students (50–60%) report exercising and healthy eating; however, almost all students expressed a desire to improve personal health, weight, exercise, and eating habits. One correlation was significant, students with a higher BMI were associated with a greater desire to improve eating habits (p = 0.015).
The subjective data from this research show the need to further objectively evaluate student health status as well as ability to provide appropriate TLC counseling. Student pharmacists need to be adequately trained to meet Healthy People 2020 and CAPE 13 objectives.
Preceptor perceptions of fourth year student pharmacists' abilities regarding patient counseling on therapeutic lifestyle changes
2016, Currents in Pharmacy Teaching and Learning
Citation Excerpt :
However, other studies indicate patients having a different perception of the availability and utility of such services. Current research shows only 39% of office visits adequately addressed topics such as weight, diet, and other therapeutic lifestyle change (TLC) care, indicating a need for improved services.4–7 The U.S. Preventative Services Task Force (USPSTF) also advocates that implementation of services and programs for subsequent achievement of the Healthy People 2020 objectives be carried out via a collaborative health care team including primary care clinicians, nutritionists, dietitians, and other specialists.8
Advanced pharmacy practice experiences (APPEs) provide an opportunity for students to showcase health and wellness knowledge and skills attained during didactic education. The primary objective of this study was to assess preceptor perceptions of how well pharmacy year four (PY4) students are prepared to provide guideline-based and patient-specific therapeutic lifestyle change (TLC) counseling at onset of an APPE rotation. A secondary objective included assessment of differences in counseling abilities if the preceptor considered the student normal weight versus overweight or obese, or if they were a known smoker.
A questionnaire containing Likert questions about perceptions regarding TLC counseling was distributed electronically in October 2014 to 708 PY4 preceptors from two pharmacy schools. Only preceptors who routinely provided TLC counseling were included in data analysis that were done using descriptive statistics. The project was approved by both universities’ institutional review boards.
The survey was completed by 165 PY4 preceptors (response rate = 23.3%), and 67 met inclusion criteria. Regarding nutrition counseling, a greater percentage of preceptors agreed that students more adequately provided counseling per guidelines (79.1%) versus individual patient needs (62.6%). Preceptors perceived students of normal weight were more likely to provide adequate lifestyle-modification counseling to overweight/obese patients (81%) compared to students that were overweight/obese themselves (69%). Students of normal weight were perceived to be more likely to adequately counsel normal weight patients on lifestyle modifications (81%) compared to students that were overweight/obese (64%). Students who smoked were perceived to adequately counsel about not smoking, though, to a lesser degree than students who were non-smokers.
While students are perceived as adequately equipped to provide guideline-based recommendations, there is room for improvement in providing patient-specific counseling. Additionally, it is perceived that student health status related to weight impacts TLC counseling.

View all citing articles on Scopus

^☆: This project was funded through the U.S. Centers for Disease Control and Prevention Contract U48/CCU710806 (Centers for Research and Demonstration of Health Promotion and Disease Prevention).

²: To whom correspondence should be addressed at Health Communication Research Laboratory, School of Public Health, Saint Louis University, 321 North Spring Avenue, St. Louis, MO 63108. Fax: (314) 977-4016. E-mail: [email protected].

View full text

Regular ArticlePhysician Recommendations for Diet and Physical Activity:☆

Abstract

Soc Sci Med

Am J Prev Med

Prev Med

Am J Prev Med

J Nutr Educ

Am J Prev Med

Am J Prev Med

Am J Prev Med

Chronic disease epidemiology and control

Physical activity and 10.5 year mortality in the Multiple Risk Factor Intervention Trial (MRFIT)

Int J Epidemiol

Guide to clinical preventive services

Practicing health promotion: the doctor's dilemma

Ann Intern Med

Settings as an important dimensionin health education/promotion policy, programs, and research

Health Educ Q

The physicians, role in health promotion—a survey of primary care practitioners

N Engl J Med

The practices of general and subspecialty internists in counseling about smoking and exercise

Am J Public Health

Do physicians preach what they practice? A study of physicians, health habits and counseling practices

JAMA

The counseling practices of internists

Ann Intern Med

Exercise counseling: how do general internists do?

J Gen Intern Med

Trends in physicians, giving advice to patients to stop smoking, United States, 1974–1987

Tobacco Control

The physician-delivered smoking intervention project: factors that determine how much the physician intervened with smokers

J Gen Intern Med

Regular Article
Physician Recommendations for Diet and Physical Activity:☆