Primary Care Physicians' Views on Nutrition Counseling

Theoretical Background and research questions/hypothesis:  With increasing prevalence of obesity and other nutrition-related chronic disease, such as cardiovascular disease and diabetes, it is now more important than ever to provide population nutrition information as one approach to protect public health and promote informed choices.  As health communicators, primary care physicians (PCPs) are among the most trustworthy sources of nutrition and health information.  They also are often the population’s gateway to disease prevention and healthcare.  Objective 19-17 of the Healthy People 2010 aims to “increase the proportion of physician office visits made by patients with a diagnosis of cardiovascular disease, diabetes, or hyperlipidemia that include counseling or education related to diet or nutrition.”  This study provides updated information to shed light on PCP’s attitude toward discussing nutrition or diet during office visits and the topics they discuss with their patients.

Methods:  The study uses proprietary cross-section data collected by Porter Novelli in its DocStyles survey, a Web-based survey with a main sample of PCPs, including both family/general practitioners and internists because they are more likely family physicians or the gateway of healthcare for many individuals in this country) and additional samples of other specialties. The samples were drawn from Epocrates Honors Panel. Eligible respondents were those who practiced in the United States, actively saw patients, worked in an individual group, or hospital practice, and who had been practicing for at least three years.  Of 2,175 PCPs invited to participate in the survey, 1,001 completed the survey.  Existing literature was consulted to develop the survey questions. Descriptive statistics such as proportions and correlations are reported. 

Results:  Average length of practicing was 16 years.  Compared to the American Medical Association’s national master file, the sample had more PCPs who were male or in the Northeast region.  All PCPs said they had discussed nutrition or diet with their patients in the three-month period prior to the survey, 19% rarely or sometime, 37% often, and 44% regularly.  The most common situations that initiated the discussion were a PCP’s own initiation, the patient was overweight or obese, and during sharing test results.  Frequency of discussing nutrition diet was higher with positive attitude toward time pressure during visits, self-confidence in providing nutrition advice, perceived level of training in nutrition advice, initiating discussing nutrition with patients, physician’s responsibility in patient’s nutrition status, and patient performance in following nutrition advice. Female PCPs more frequently discussed nutrition.  Most often discussed topics included foods to avoid or limit, exercise, weight, and portion size.

Conclusions:  The data suggest that there is still room for more frequent nutrition counseling by primary care physicians.  Consistent with the existing literature, perceived time pressure, self-confidence, and training were related to the frequency of engagement.   

Implications for research and/or practice:  To enhance the reach and effectiveness of health communication on nutrition issues, interventions should be identified, developed or enhanced to motivate and empower primary care physicians engage in more active nutrition counseling.