Barriers to Providing Nutrition Counseling by Physicians: A Survey of Primary Care Practitioners
Abstract
Background Previous surveys have shown that there is a disparity between physicians' beliefs about the importance of diet and nutrition in health maintenance and disease prevention and the actual delivery of nutrition counseling. The primary objective of this study was to assess the current attitudes, practice behavior, and barriers to the delivery of nutrition counseling by primary care physicians.Methods A random-sample-mailed questionnaire was sent to 2,250 primary care physicians selected from the AMA masterfile from general practice, internal medicine, and pediatrics, representing self-employed, group, hospital, and HMO practices. Participants were stratified by age, gender, geographical region, and present employment. The main outcome measures were to determine time spent by physicians providing and percentage of patients receiving dietary counseling and to identify barriers to the delivery of nutrition counseling.Results A 49% response rate (n = 1,103) was obtained. Results are presented for the 1,030 physicians (70% private practice) with complete data. Over two-thirds of physicians provide dietary counseling to 40% or less of patients and spend 5 or fewer min discussing dietary changes. Despite this pattern, nearly three-quarters of respondents feel that dietary counseling is important and is the responsibility of the physician. Ranking of perceived barriers to delivery of dietary counseling were lack of time, patient noncompliance, inadequate teaching materials, lack of counseling, training, lack of knowledge, inadequate reimbursement, and low physician confidence.Conclusions This survey suggests that multiple barriers exist that prevent the primary care practitioner from providing dietary counseling. A multifaceted approach will be needed to change physician counseling behavior.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
An increase in the frequency of PCP counseling does not appear to be feasible.
“Given the demands on providers’ time, an increase in the frequency of PCP counseling does not appear to be feasible.8”
From A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice (2011) · cites this paper as [8]
Cited by
Sorted by citations
ESPEN guidelines on nutrition in cancer patients
Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Fearon, K., Hütterer, E., Isenring, E., Kaasa, S., et al. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.07.015 · Cited by 3,114 · see citing works
Are Health Care Professionals Advising Obese Patients to Lose Weight?
Galuska, D. A. (1999) · JAMA · doi:10.1001/jama.282.16.1576 · Cited by 640 · see citing works
Story, M. T., Neumark-Stzainer, D., Sherwood, N. E., Holt, K., Sofka, D., Trowbridge, F. L., & Barlow, S. E. (2002) · PEDIATRICS · doi:10.1542/peds.110.s1.210 · Cited by 502 · see citing works
A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice
Wadden, T. A., Volger, S., Sarwer, D. B., Vetter, M. L., Tsai, A. G., Berkowitz, R. I., Kumanyika, S., Schmitz, K. H., Diewald, L. K., Barg, R., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1109220 · Cited by 487 · see citing works
Nutrition Education in U.S. Medical Schools: Latest Update of a National Survey
Adams, K. M., Kohlmeier, M., & Zeisel, S. H. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181eab71b · Cited by 335 · see citing works
Vetter, M. L., Herring, S. J., Sood, M., Shah, N. R., & Kalet, A. L. (2008) · Journal of the American College of Nutrition · doi:10.1080/07315724.2008.10719702 · Cited by 330 · see citing works
“However, less than half of primary care physicians routinely discuss weight loss with obese patients or provide dietary counseling [4,5].”
BackgroundInfluentialPhysicians’ Weight Loss Counseling in Two Public Hospital Primary Care Clinics
Huang, J., Yu, H., Marin, E., Brock, S., Carden, D. L., & Davis, T. C. (2004) · Academic Medicine · doi:10.1097/00001888-200402000-00012 · Cited by 287 · see citing works
“A prominent barrier identified in our study and in studies conducted in university or community settings was that primary care physicians often feel inadequately prepared to provide this counseling.(24,25,27,28) To remove this and other barriers, providing training in brief weight loss counseling for resident and prim…”
BackgroundFrank, E. (2000) · Archives of Family Medicine · doi:10.1001/archfami.9.4.359 · Cited by 254 · see citing works
Integrating Technology Into Standard Weight Loss Treatment: A Randomized Controlled Trial
Spring, B., Duncan, J. M., Janke, E. A., Kozak, A. T., McFadden, H. G., DeMott, A., Pictor, A., Epstein, L. H., Siddique, J., Pellegrini, C. A., et al. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.1221 · Cited by 234 · see citing works
“Many physicians describe lack of time and training as barriers to providing behavioral treatment.(6) The Institute of Medicine suggests that interprofessional health care teams have the diverse expertise needed for integrated care.”
INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES
Baru, P. C. R. (2014) · ADVANCED SCIENCES INDEX · Cited by 236 · see citing works
Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review
Tsai, A. G., & Wadden, T. A. (2009) · Journal of General Internal Medicine · doi:10.1007/s11606-009-1042-5 · Cited by 223 · see citing works
Barriers to obesity management: a pilot study of primary care clinicians
Forman-Hoffman, V., Little, A., & Wahls, T. (2006) · BMC Family Practice · doi:10.1186/1471-2296-7-35 · Cited by 217 · see citing works
“These barriers include lack of formal training of primary care practitioners in nutrition, obesity, and counseling on weight-related topics [7-12], perceived inability to change patient behaviors [12], lack of known effectiveness of treatments [8,13,14], negative attitudes toward obese patients [15-17], beliefs that p…”
BackgroundResultImpact of Physician BMI on Obesity Care and Beliefs
Bleich, S. N., Bennett, W. L., Gudzune, K. A., & Cooper, L. A. (2012) · Obesity · doi:10.1038/oby.2011.402 · Cited by 218 · see citing works
“, weight stigma (7–9), doubt that counseling will have an effect on patient behavior (10,11), and feeling that obesity is the responsibility of the patient (12).”
Barriers to Providing Nutrition Counseling Cited by Physicians
Kolasa, K. M., & Rickett, K. (2010) · Nutrition in Clinical Practice · doi:10.1177/0884533610380057 · Cited by 204 · see citing works
Family Physicians' Practices and Attitudes Regarding Care of Extremely Obese Patients
Ferrante, J. M., Piasecki, A. K., Ohman‐Strickland, P., & Crabtree, B. F. (2009) · Obesity · doi:10.1038/oby.2009.62 · Cited by 204 · see citing works
Web-based weight loss in primary care: a randomized controlled trial
Bennett, G. G., Herring, S. J., Puleo, E., Stein, E. K., Emmons, K. M., & Gillman, M. W. (2010) · Obesity · doi:10.1038/oby.2009.242 · Cited by 202 · see citing works
“Although providerdelivered weight loss counseling is trusted by patients (5), most providers acknowledge having inadequate confidence, training, and time for such counseling during the typical outpatient visit (6).”
BackgroundBlock, J. P., DeSalvo, K. B., & Fisher, W. P. (2003) · Preventive Medicine · doi:10.1016/s0091-7435(03)00055-0 · Cited by 201 · see citing works
Jallinoja, P. T., Absetz, P., Kuronen, R., Nissinen, A. M., Talja, M. T., Uutela, A. K., & Patja, K. (2007) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813430701691778 · Cited by 199 · see citing works
“Healthcare professionals refer to low patient compliance [21] and lack of patient interest [22,23] as barriers to disease prevention.”
BackgroundStatus of nutrition education in medical schools
Adams, K. M., Lindell, K., Kohlmeier, M., & Zeisel, S. H. (2006) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/83.4.941s · Cited by 196 · see citing works
U.S. Primary Care Physicians' Diet-, Physical Activity–, and Weight-Related Care of Adult Patients
Smith, A. W., Borowski, L. A., Liu, B., Galuska, D. A., Signore, C. C., Klabunde, C. N., Huang, T. T. ‐., Krebs‐Smith, S. M., Frank, E., Pronk, N., et al. (2011) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2011.03.017 · Cited by 192 · see citing works
Cornuz, J. (2000) · Family Practice · doi:10.1093/fampra/17.6.535 · Cited by 187 · see citing works
Nutrition in Medicine: Nutrition Education for Medical Students and Residents
Adams, K. M., Kohlmeier, M., Powell, M., & Zeisel, S. H. (2010) · Nutrition in Clinical Practice · doi:10.1177/0884533610379606 · Cited by 186 · see citing works
“Overall, these surveys have found that physicians agree on the importance of nutrition in their medical practice but do not feel comfortable and adequately prepared to provide nutrition counseling to their patients.(1-4) In one examination of current practice behaviors, doctors engaged overweight adult patients in Pro…”
BackgroundAstrup, A., & Bügel, S. (2019) · International Journal of Obesity · doi:10.1038/s41366-018-0143-9 · Cited by 179 · see citing works
Physician practice patterns of obesity diagnosis and weight-related counseling
Bleich, S. N., Pickett‐Blakely, O., & Cooper, L. A. (2010) · Patient Education and Counseling · doi:10.1016/j.pec.2010.02.018 · Cited by 174 · see citing works
“Efforts to improve the care of obese patients in clinical practice will need to consider barriers which may undermine obesity care previously identified in the literature [16,28-30,33-34,40,42-43,51].”
BackgroundPrimary care nurses struggle with lifestyle counseling in diabetes care: a qualitative analysis
Jansink, R., Braspenning, J. C. C., van der Weijden, T., Elwyn, G. J., & Grol, R. P. T. M. (2010) · BMC Family Practice · doi:10.1186/1471-2296-11-41 · Cited by 174 · see citing works
“However, findings from other studies suggest that most providers of care experience similar barriers [11,18,21,32].”
Aspry, K. E., Van Horn, L., Carson, J. A. S., Wylie-Rosett, J., Kushner, R. F., Lichtenstein, A. H., Devries, S., Freeman, A. M., Crawford, A., & Kris-Etherton, P. (2018) · Circulation · doi:10.1161/cir.0000000000000563 · Cited by 171 · see citing works
Self-citationPhysicians build less rapport with obese patients
Gudzune, K. A., Beach, M. C., Roter, D. L., & Cooper, L. A. (2013) · Obesity · doi:10.1002/oby.20384 · Cited by 171 · see citing works
“whelmed by the multi-morbidity associated with obesity (18-20), so we found it surprising that physicians in our sample did not spend more time with obese patients or engage them in more biomedical communication to address multi-morbidity.”
BackgroundWhat's in a Name? Patients’ Preferred Terms for Describing Obesity
Wadden, T. A., & Didie, E. R. (2003) · Obesity Research · doi:10.1038/oby.2003.155 · Cited by 170 · see citing works
“I want to talk with you about your:” (1) weight; (2) heaviness; (3) obesity; (4) BMI; (5) excess weight; (6) fatness; (7) excess fat; (8) large size; (9) unhealthy body weight; (10) weight problem; and (11) unhealthy BMI.”
Direct observation of nutrition counseling in community family practice
Eaton, C. B., Goodwin, M. A., & Stange, K. C. (2002) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(02)00494-4 · Cited by 169 · see citing works
Barriers to physical activity promotion by general practitioners and practice nurses.
McKenna, J., Naylor, P.-J., & McDowell, N. (1998) · British Journal of Sports Medicine · doi:10.1136/bjsm.32.3.242 · Cited by 164 · see citing works
Jay, M., Gillespie, C., Schlair, S., Sherman, S., & Kalet, A. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-159 · Cited by 158 · see citing works
Jay, M. R., Kalet, A. L., Ark, T. K., McMacken, M. M., Messito, M. J., Richter, R., Schlair, S., Sherman, S. E., Zabar, S. R., & Gillespie, C. C. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-106 · Cited by 152 · see citing works
Diagnosis of Obesity by Primary Care Physicians and Impact on Obesity Management
Bardia, A., Holtan, S. G., Slezak, J. M., & Thompson, W. G. (2007) · Mayo Clinic Proceedings · doi:10.4065/82.8.927 · Cited by 150 · see citing works
Kennedy, T. J. T., Regehr, G., Rosenfield, J. D., Roberts, S. W., & Lingard, L. (2004) · Academic Medicine · doi:10.1097/00001888-200405000-00006 · Cited by 147 · see citing works
Abdalla, M., Bolen, S. D., Brettler, J. W., Egan, B. M., Ferdinand, K. C., Ford, C. D., Lackland, D. T., Wall, H. K., & Shimbo, D. (2023) · Hypertension · doi:10.1161/hyp.0000000000000232 · Cited by 152 · see citing works
Predictors of nutrition counseling behaviors and attitudes in US medical students
Spencer, E. H., Frank, E., Elon, L., Hertzberg, V., Serdula, M. K., & Galuska, D. A. (2006) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/84.3.655 · Cited by 143 · see citing works
American Heart Association Childhood Obesity Research Summit Report
Daniels, S. R., Jacobson, M. S., McCrindle, B. W., Eckel, R. H., & Sanner, B. M. (2009) · Circulation · doi:10.1161/circulationaha.109.192216 · Cited by 136 · see citing works
Nutrition in primary care: current practices, attitudes, and barriers.
Wynn, K., Trudeau, J. D., Taunton, K., Gowans, M. C., & Scott, I. (2010) · PubMed Central · Cited by 134 · see citing works
Do Internists, Pediatricians, and Psychiatrists Feel Competent in Obesity Care?
Jay, M. R., Gillespie, C. C., Ark, T. K., Richter, R., McMacken, M. M., Zabar, S. R., Paik, S., Messito, M. J., Lee, J. D., & Kalet, A. L. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0519-y · Cited by 133 · see citing works
Diet and physical activity counseling during ambulatory care visits in the United States
MA, J. (2004) · Preventive Medicine · doi:10.1016/j.ypmed.2004.03.006 · Cited by 132 · see citing works
“In addition, past research has identified a range of barriers to counseling in clinical settings, including lack of time, inadequate provider counseling skills and training, inadequate reimbursement, perceived ineffectiveness of counseling, low provider confidence, patient nonadherence, patient comorbidity, and lack o…”
BackgroundPersonal and professional nutrition-related practices of US female physicians
Frank, E., Wright, E. H., Serdula, M. K., Elon, L., & Baldwin, G. T. (2002) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/75.2.326 · Cited by 130 · see citing works
A new evidence‐based model for weight management in primary care: the Counterweight Programme
The Counterweight Project Team (2004) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.2004.00517.x · Cited by 126 · see citing works
Modifiable Cardiovascular Risk Factors in Adults With Diabetes
Egede, L. E., & Zheng, D. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.4.427 · Cited by 128 · see citing works
Chung, C.-F., Cook, J., Bales, E., Zia, J. K., & Munson, S. A. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4364 · Cited by 125 · see citing works
“Despite ample evidence supporting behavior change programs in treating obesity, primary care providers report that inadequate training and lack of time are significant barriers to providing counseling for weight-loss patients [10].”
Trends in professional advice to lose weight among obese adults, 1994 to 2000
Jackson, J. E., Doescher, M. P., Saver, B. G., & Hart, L. G. (2005) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.0172.x · Cited by 122 · see citing works
“There is a need for reimbursement mechanisms that allow providers to give their patients sufficient weight reduction counseling and that link this counseling with reimbursement for intensive, evidence-based, behavioral interventions to lose weight.(28,34) Also, training in nutrition and exercise guidelines would give…”
BackgroundUsing the Internet to Translate an Evidence-Based Lifestyle Intervention into Practice
McTigue, K. M., Conroy, M. B., Hess, R., Bryce, C. L., Fiorillo, A. B., Fischer, G. S., Milas, N. C., & Simkin‐Silverman, L. R. (2009) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2009.0036 · Cited by 119 · see citing works
“Number of days enrolled at time of final log-in [N (%)] ≤ 91 92–182 183–273 274–304 305–334 335–365 9 (18) 3 (6) 8 (16) 3 (6) 2 (4) 25 (50)”
Bleich, S. N., Bennett, W. L., Gudzune, K. A., & Cooper, L. A. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-001871 · Cited by 118 · see citing works
“…physician attitudes (eg, weight stigma, pessimism about patient ’ s desire/ability to lose weight; belief that weight-loss counselling is ineffective, 15 – 18 ) doubt that counselling will have an effect on patient behaviour, 19 20 and feeling that obesity is the responsibility of the patient.”
Ambulatory Management of Childhood Obesity
Kolagotla, L., & Adams, W. G. (2004) · Obesity Research · doi:10.1038/oby.2004.35 · Cited by 118 · see citing works
Iacoviello, L., Bonanni, A., Costanzo, S., Curtis, A. D., Castelnuovo, A. F. D., Olivieri, M., Zito, F., Donati, M. B., & de Gaetano, G. (2007) · Italian Journal of Public Health · doi:10.2427/5886 · Cited by 112 · see citing works
Vadiveloo, M., Lichtenstein, A. H., Anderson, C., Aspry, K., Foraker, R., Griggs, S., Hayman, L. L., Johnston, E., Stone, N. J., Thorndike, A. N., et al. (2020) · Circulation: Cardiovascular Quality and Outcomes · doi:10.1161/hcq.0000000000000094 · Cited by 112 · see citing works
American College of Preventive Medicine Practice Policy statement
Nawaz, H., & Katz, D. L. (2001) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(01)00317-8 · Cited by 111 · see citing works
Adolescent Patients—Healthy or Hurting?
Frankenfield, D. L., Keyl, P. M., GIELEN, A. C., Wissow, L. S., Werthamer‐Larsson, L., & Baker, S. P. (2000) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.154.2.162 · Cited by 108 · see citing works
“7 (44) [27-80] Practice with on-site mental health service, No.”
BackgroundRandomized Trial of a “Talking Computer” to Improve Adults' Eating Habits
Delichatsios, H. K., Friedman, R. H., Glanz, K., Tennstedt, S., Smigelski, C., Pinto, B. M., Kelley, H., & Gillman, M. W. (2001) · American Journal of Health Promotion · doi:10.4278/0890-1171-15.4.215 · Cited by 107 · see citing works
Managing obesity in primary care practice: a narrative review
Carvajal, R., Wadden, T. A., Tsai, A. G., Peck, K., & Moran, C. H. (2013) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.12004 · Cited by 105 · see citing works
Yager, Z., & Dea, J. A. O. (2005) · Eating Disorders · doi:10.1080/10640260590932878 · Cited by 105 · see citing works
“In addition, 90% of doctors did not feel that their knowledge of nutrition was adequate enough for them to feel confident in providing nutritional counseling ( Kushner, 1995 ).”
BackgroundTechnology-Assisted Weight Loss Interventions in Primary Care: A Systematic Review
Levine, D. M., Savarimuthu, S., Squires, A., Nicholson, J., & Jay, M. (2015) · Journal of General Internal Medicine · doi:10.1007/s11606-014-2987-6 · Cited by 105 · see citing works
Galuska, D. A., Fulton, J. E., Powell, K. E., Burgeson, C. R., Pratt, M., Elster, A. B., & Griesemer, B. A. (2002) · PEDIATRICS · doi:10.1542/peds.109.5.e83 · Cited by 104 · see citing works
Laws, R., Kemp, L., Harris, M., Davies, G. P., Williams, A., & Eames-Brown, R. (2009) · Implementation Science · doi:10.1186/1748-5908-4-66 · Cited by 101 · see citing works
“These studies have consistently identified the importance of clinician beliefs, including perceptions about role congruence [23-26], self-efficacy [18,27-29], beliefs about effectiveness of interventions [24,25,30-33] and patient motivation [23,34], concern regarding client acceptance [23-25], as well as personal life…”
The Deficit of Nutrition Education of Physicians
Aggarwal, M., Devries, S. R., Freeman, A. M., Ostfeld, R. J., Gaggin, H. K., Taub, P. R., Rzeszut, A. K., Allen, K., & Conti, R. C. (2017) · The American Journal of Medicine · doi:10.1016/j.amjmed.2017.11.036 · Cited by 103 · see citing works
Weight Loss Through Living Well
McTigue, K. M., Conroy, M. B., Bigi, L., Murphy, C. M., & McNeil, M. (2009) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721709332815 · Cited by 103 · see citing works
Physicians' Beliefs about Discussing Obesity: Results from Focus Groups
Alexander, S. C., Østbye, T., Pollak, K. I., Gradison, M., Bastian, L. A., & Brouwer, R. J. N. (2007) · American Journal of Health Promotion · doi:10.4278/0890-1171-21.6.498 · Cited by 100 · see citing works
Chung, C.-F., Wang, Q., Schroeder, J., Cole, A., Zia, J., Fogarty, J., & Munson, S. A. (2019) · Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies · doi:10.1145/3314394 · Cited by 93 · see citing works
Impact of a preventive medicine and nutrition curriculum for medical students
Conroy, M. B., Delichatsios, H. K., Hafler, J. P., & Rigotti, N. A. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.03.009 · Cited by 98 · see citing works
Attitudes to cardiovascular health promotion among GPs and practice nurses
Steptoe, A. (1999) · Family Practice · doi:10.1093/fampra/16.2.158 · Cited by 97 · see citing works
Treatment of Obesity in Patients With Diabetes
Bramante, C. T., Lee, C. J., & Gudzune, K. A. (2017) · Diabetes Spectrum · doi:10.2337/ds17-0030 · Cited by 94 · see citing works
“Previous studies have shown that a lack of time and training limits clinicians’ desire to engage patients in weight management discussions (7,8).”
BackgroundCurrent approaches to obesity management in UK Primary Care: the Counterweight Programme
The Counterweight Project Team (2004) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.2004.00528.x · Cited by 92 · see citing works
“This may reflect previous findings of widespread uncertainty amongst GPs about the effectiveness of different obesity interventions ( Kushner, 1995; Hiddink et al., 1995).”
BackgroundResultObesity Counseling and Guidelines in Primary CareA Qualitative Study
Leverence, R. R., Williams, R. L., Sussman, A., & Crabtree, B. F. (2007) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2006.12.008 · Cited by 91 · see citing works
Smith, S., Seeholzer, E. L., Gullett, H., Jackson, B., Antognoli, E., Krejci, S. A., & Flocke, S. A. (2015) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-14-00710.1 · Cited by 92 · see citing works
“Studies examining barriers to weight management counseling in primary care practice also report inadequate training as a common barrier.(24,26,28) We also assessed attitudes and professional norms toward ONPA counseling to explore the importance residents place on ONPA counseling and their perceptions regarding expect…”
BackgroundHark, L. A., & Deen, D. (2017) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2017.04.019 · Cited by 89 · see citing works
“Practicing physicians also feel their nutrition training was inadequate and that they lack the skills to provide effective diet and lifestyle counseling to their patients.(46,47) A review of nutrition content in medical schools shows that, on average, only 4 to 6 hours are devoted to nutrition content during the entir…”
BackgroundMonlezun, D. J., Kasprowicz, E., Tosh, K. W., Nix, J., Urday, P., Tice, D., Sarris, L., & Harlan, T. S. (2015) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2015.05.007 · Cited by 89 · see citing works
“to the standard of care is proper to later clinical trial phases, but it is noteworthy that the GCCM treatment effect superiority may be an underestimate in diet-based supplemental management for diabetes, considering the majority of primary care physicians fail to provide any substantive nutrition counseling to their…”
BackgroundNutrition in general practice: role and workforce preparation expectations of medical educators
Ball, L., Hughes, R., & LEVERITT, M. D. (2010) · Australian Journal of Primary Health · doi:10.1071/py10014 · Cited by 88 · see citing works
“Thebarriers to effective nutrition care identifiedbyGPMEs in this study (limited time and nutrition care competencies among GPs – a proxy for inadequate preparation), reflects the existing literature (Wells et al. 1984; Kelly and Joffres 1990; Levine et al. 1993; Kushner 1995;Helman 1997).”
ResultLim, S. S., Liang, X., Hill, B., Teede, H. J., Moran, L., & O'Reilly, S. L. (2019) · Obesity Reviews · doi:10.1111/obr.12846 · Cited by 86 · see citing works
“The lack of effectiveness in the real‐world setting could be due to a number of barriers to lifestyle management previously identified by health practitioners which include lack of time for lifestyle counselling, lack of reimbursement for obesity management, and perceived poor patient motivation to lose weight.(72,73)…”
BackgroundFactors Influencing Nutrition Education for Patients with Low Literacy Skills
Macario, E., Emmons, K. M., Sorensen, G., Hunt, M. K., & Rudd, R. E. (1998) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(98)00125-4 · Cited by 85 · see citing works
Harkin, N., Johnston, E., Mathews, T., Guo, Y., Schwartzbard, A., Berger, J., & Gianos, E. (2019) · American Journal of Lifestyle Medicine · doi:10.1177/1559827618809934 · Cited by 83 · see citing works
Rueda‐Clausen, C. F., Benterud, E., Bond, T. R., Olszowka, R., Vallis, M. T., & Sharma, A. M. (2013) · Clinical Obesity · doi:10.1111/cob.12038 · Cited by 83 · see citing works
“Previously reported reasons for avoiding conversations about weight include poor training and/or competency of the HCPs for obesity management (8), lack of time and economical disincentives (9), and a negative attitude towards obesity and obesity management (10).”
BackgroundSurvey of Nutrition Knowledge of Canadian Physicians
Temple, N. J. (1999) · Journal of the American College of Nutrition · doi:10.1080/07315724.1999.10718823 · Cited by 83 · see citing works
“A recent survey of American physicians revealed that many more physicians would give dietary counselling to their patients except for the problem of various barriers [8].”
BackgroundPerceived barriers to bariatric surgery among morbidly obese patients
Afonso, B. B., Rosenthal, R. J., Li, K. M., Zapatier, J., & Szomstein, S. (2009) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2009.07.006 · Cited by 82 · see citing works
Dewhurst, A., Peters, S., Devereux‐Fitzgerald, A., & Hart, J. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.12.017 · Cited by 81 · see citing works
“Barriers to giving weight management advice reported by physicians include insufficient confidence, knowledge and skills [30] and lack of time [30,31,32].”
BackgroundManaging obesity in primary care practice: an overview with perspective from the POWER-UP study
Wadden, T. A., Volger, S., Tsai, A. G., Sarwer, D. B., Berkowitz, R. I., Diewald, L. K., Carvajal, R., Moran, C. H., & Vetter, M. L. (2013) · International Journal of Obesity · doi:10.1038/ijo.2013.90 · Cited by 76 · see citing works
What Words Should We Use When Discussing Excess Weight?
Dutton, G. R., Tan, F., Perri, M. G., Stine, C., Dancer-Brown, M., Goble, M., & Vessem, N. V. (2010) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2010.05.100024 · Cited by 77 · see citing works
Current challenges of behavior change talk for medical professionals and trainees
Chisholm, A., Hart, J., Lam, V., & Peters, S. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.12.001 · Cited by 77 · see citing works
“This study sought to identify factors underlying whether medical professionals discuss health-related behavior change with patients because although being well positioned to impart relevant knowledge and advice [9], they often struggle to facilitate these changes with patients [13,26].”
BackgroundDavis, J. W., Busch, J., Hammatt, Z. H., Novotny, R., Harrigan, R., Grandinetti, A., & Easa, D. (2004) · PubMed · Cited by 74 · see citing works
Bariatric Surgery Patients’ Views of Their Physicians’ Weight‐Related Attitudes and Practices
Anderson, D. A., & Wadden, T. A. (2004) · Obesity Research · doi:10.1038/oby.2004.198 · Cited by 76 · see citing works
Laws, R., Kirby, S. E., Davies, G. P., Williams, A., Jayasinghe, U. W., Amoroso, C. L., & Harris, M. (2008) · BMC Health Services Research · doi:10.1186/1472-6963-8-44 · Cited by 75 · see citing works
“To date, studies have been largely descriptive [11,12,14,15,17-20,22] or cross sectional, and have generally investigated the management of individual behavioural risk factors [9,10,13,16,21].”
BackgroundResultWeight loss counseling by health care providers.
Nawaz, H., Adams, M. L., & Katz, D. L. (1999) · American Journal of Public Health · doi:10.2105/ajph.89.5.764 · Cited by 72 · see citing works
A Primary Care Intervention for Weight Loss: Results of a Randomized Controlled Pilot Study
Tsai, A. G., Wadden, T. A., Rogers, M. A., Day, S. C., Moore, R. H., & Islam, B. J. (2010) · Obesity · doi:10.1038/oby.2009.457 · Cited by 72 · see citing works
Weight Loss Success in Metabolic Syndrome by Telephone Interventions: Results from the SHINE Study
Weinstock, R. S., Trief, P. M., Cibula, D. A., Morin, P. C., & Delahanty, L. M. (2013) · Journal of General Internal Medicine · doi:10.1007/s11606-013-2529-7 · Cited by 71 · see citing works
How Can and Do Australian Doctors Promote Physical Activity?
Bull, F., Schipper, E. C. C., Jamrozik, K. D., & BLANKSBY, B. A. (1997) · Preventive Medicine · doi:10.1006/pmed.1997.0226 · Cited by 72 · see citing works
Mihalynuk, T. V., Scott, C. S., & Coombs, J. B. (2003) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/77.5.1330 · Cited by 71 · see citing works
White, L. L., Gazewood, J. D., & Mounsey, A. (2007) · Medical Teacher · doi:10.1080/01421590601032443 · Cited by 71 · see citing works
“Two studies by Yeager et al. (1996) and Kushner (1995) found that physicians who were asked why they did not counsel their patients to change their diet identified several barriers, including lack of time, reimbursement, and training and low confidence in their ability to be successful.”
BackgroundImplementation of a Primary Care Physician Network Obesity Management Program
Bowerman, S., Bellman, M., Saltsman, P., Garvey, D., Pimstone, K., Skootsky, S. A., Wang, H., Elashoff, R. M., & Heber, D. (2001) · Obesity Research · doi:10.1038/oby.2001.137 · Cited by 71 · see citing works
“Among those who do address dietary issues with their patients, the time spent discussing weight management has been reported to be 5 minutes or less (2).”
BackgroundKeyserling, T. C., Sheridan, S., Draeger, L. B., Finkelstein, E. A., Gizlice, Z., Kruger, E., Johnston, L. F., Sloane, P. D., Samuel‐Hodge, C. D., Evenson, K. R., et al. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.1984 · Cited by 74 · see citing works
Physician—Patient Interactions Regarding Diet, Exercise, and Smoking
Nawaz, H., Adams, M. L., & Katz, D. L. (2000) · Preventive Medicine · doi:10.1006/pmed.2000.0760 · Cited by 70 · see citing works
Co‐creating value using customer training and education in a healthcare service design
Damali, U., Miller, J. L., Fredendall, L. D., Moore, D. D., & Dye, C. J. (2016) · Journal of Operations Management · doi:10.1016/j.jom.2016.10.001 · Cited by 69 · see citing works
Prevalence of nutrition and exercise counseling for patients with hypertension
Mellen, P. B., Palla, S. L., Goff, D. C., & Bonds, D. E. (2004) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2004.30355.x · Cited by 67 · see citing works
Documentation and Management of Overweight and Obesity in Primary Care
Waring, M. E., Roberts, M. B., Parker, D. R., & Eaton, C. B. (2009) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2009.05.080173 · Cited by 67 · see citing works
From the Patient’s Perspective: The Impact of Training on Resident Physician’s Obesity Counseling
Jay, M. R., Schlair, S., Caldwell, R., Kalet, A. L., Sherman, S. E., & Gillespie, C. C. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1299-8 · Cited by 65 · see citing works
EatSmart: Efficacy of a multifaceted preventive nutrition intervention in clinical practice
Delichatsios, H. K., Hunt, M. K., Lobb, R., Emmons, K. M., & Gillman, M. W. (2001) · Preventive Medicine · doi:10.1016/s0091-7435(01)80004-9 · Cited by 66 · see citing works
GPs' role in the detection of psychological problems of young people: a population-based study
Mauerhofer, A., Berchtold, A., Michaud, P., & Surı́s, J.-C. (2009) · British Journal of General Practice · doi:10.3399/bjgp09x454115 · Cited by 65 · see citing works
“Finally, lack of time and training are often mentioned by GPs as major barriers to a comprehensive psychosocial anamnesis.(34,35)”
BackgroundNutrition education in the care of patients with chronic kidney disease and end‐stage renal disease
Anderson, C. A. M., & Nguyen, H. A. (2018) · Seminars in Dialysis · doi:10.1111/sdi.12681 · Cited by 65 · see citing works
- Authors
- Kushner, R. F.
- Affiliations
- University of Chicago (US)
- Corresponding author
- Kushner, R.F.
- ORCID
- Kushner, R.F.
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 1995-11
- Volume
- 24
- Issue
- 6
- Pages
- 546-552
- ISSN
- 0091-7435 (ISSN-L)
- OpenAlex
- W2007745104
- Cited by
- 604
- References
- 0
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 17 · 2023: 19 · 2022: 18 · 2021: 21 · 2020: 15 · 2019: 29 · 2018: 25 · 2017: 27 · 2016: 34 · 2015: 33 · 2014: 27 · 2013: 28 · 2012: 29
- FWCI
- 7.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p30dk026678-20)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-26678)
- Topics
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- nutrition counseling, primary care physicians, barriers to counseling, physician attitudes, physician practice behavior, time constraints, patient noncompliance, physician confidence, physician training, reimbursement, diet and health
- MeSH terms
- Adult, Counseling, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Physicians, Family, Surveys and Questionnaires, Time Factors, United States, Treatment Refusal, Workload, Nutritional Sciences
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
