Cited by 607Dietetics, Nutrition, and EducationPatient-Provider Communication in HealthcareObesity and Health Practices

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Barriers to Providing Nutrition Counseling by Physicians: A Survey of Primary Care Practitioners

Kushner, R.F.·1995·Preventive Medicine

DOI 10.1006/pmed.1995.1087

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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.

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How Much do Gastroenterology Fellows Know About Nutrition?
Raman, M., Violato, C., & Coderre, S. (2009) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e318172d647 · Cited by 64
“Despite the need for physician (particularly gastroenterologists)-driven nutrition care, physicians seldom identify or discuss nutritional issues during routine clinic visits.(5,6) Medical students identify nutritional training as incomplete or absent from their training.”
Background
Health behavior counseling in primary care: provider-reported rate and confidence.
Vickers, K. S., Kircher, K. J., Smith, M. D., Petersen, L. R., & Rasmussen, N. H. (2007) · PubMed · Cited by 62
Nutrition from the kitchen: culinary medicine impacts students’ counseling confidence
Magallanes, E., Sen, A., Siler, M. D., & Albin, J. L. (2021) · BMC Medical Education · doi:10.1186/s12909-021-02512-2 · Cited by 65
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Marra, M. V., Lilly, C. L., Nelson, K. R., Woofter, D. R., & Malone, J. (2019) · Nutrients · doi:10.3390/nu11020229 · Cited by 61
“However, delivery in primary care is limited by competing demands on the primary care practitioner (PCPs) time, lack of behavioral counseling skills and lack of resources to deliver on-site intensive comprehensive programs [8,9].”
Background
Ethical, legal and social issues in nutrigenomics: The challenges of regulating service delivery and building health professional capacity
Castle, D. G. A., & Ries, N. M. (2007) · Mutation research. Fundamental and molecular mechanisms of mutagenesis · doi:10.1016/j.mrfmmm.2007.03.017 · Cited by 61
“They include lack of time, lack of patient compliance, inadequate teaching materials, lack of nutritional knowledge and insufficient reimbursement [ 31 ].”
Background
Perceived preparedness to provide preventive counseling
Park, E. R., Wolfe, T., Gokhale, M., Winickoff, J. P., & Rigotti, N. A. (2005) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.0024.x · Cited by 60
Medical students’ perceptions of nutrition education in Canadian universities
Gramlich, L. M., Olstad, D. L., Nasser, R., Goonewardene, L. A., Raman, M., Innis, S. M., Wicklum, S., Duerksen, D. R., Rashid, M., Heyland, D. K., et al. (2010) · Applied Physiology Nutrition and Metabolism · doi:10.1139/h10-016 · Cited by 60
“In the United States, there have been several attempts to address the underrepresentation of nutrition in medical school curricula, and medical nutrition education has had some profile, particularly recently, with the Nutrition Academic Award program that was funded by the National Heart, Lung and Blood Institute betw…”
Background
Effects of a general practice-based intervention on diet, body mass index and blood lipids in patients at cardiovascular risk.
Woollard, J., Burke, V., Beilin, L., Verheijden, M. W., & Bulsara, M. K. (2003) · Journal of Cardiovascular Risk · doi:10.1097/00043798-200302000-00007 · Cited by 60
Sex disparities in the management of coronary heart disease in general practices in Australia
Lee, C., Mnatzaganian, G., Woodward, M., Chow, C. K., Sitas, F., Robinson, S., & Huxley, R. (2019) · Heart · doi:10.1136/heartjnl-2019-315134 · Cited by 60
Practical Strategies for Engaging Individuals With Obesity in Primary Care
Kahan, S. I. (2018) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2018.01.006 · Cited by 60
Dietitian–general practitioner interface: a pilot study on what influences the provision of effective nutrition management
Nicholas, L., Pond, D., & Roberts, D. C. (2003) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/77.4.1039s · Cited by 58
A Protocol to Deliver Intensive Behavioral Therapy (IBT) for Obesity in Primary Care Settings: The MODEL‐IBT Program
Wadden, T. A., Tsai, A. G., & Tronieri, J. S. (2019) · Obesity · doi:10.1002/oby.22594 · Cited by 57
“CMS’s stipulation that IBT be provided by physicians, NPs, and other PCPs was surprising, given the limited training that these professionals receive in delivering behavioral weight loss counseling, as well as their lack of time to provide such care in their already busy schedules (15).”
Background
Goals in Nutrition Science 2020-2025
Bassaganya-Riera, J., Berry, E. M., Blaak, E. E., Burlingame, B., le Coutre, J., van Eden, W., El‐Sohemy, A., German, J. B., Knorr, D., Lacroix, C., et al. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2020.606378 · Cited by 70
“Among Human Nutrition domains, Clinical Nutrition can be defined as the medical discipline focusing on assessing, preventing, diagnosing, and treating malnutrition (over- and undernutrition, selective deficits of nutrients) related to acute and chronic diseases at all ages (202, 205).”
BackgroundInfluential
General practitioner advice on physical activity: Analyses in a cohort of older primary health care patients (getABI)
Hinrichs, T., Moschny, A., Klaaßen‐Mielke, R., Trampisch, U. S., Thiem, U., & Platen, P. (2011) · BMC Family Practice · doi:10.1186/1471-2296-12-26 · Cited by 57
“The literature shows that the above-mentioned barriers are not unique to physical activity counselling, but also apply to counselling for other complex behaviours like nutrition [47-49], where counselling rates are similarly low [50,51].”
Background
Nutrition Education in Internal Medicine Residency Programs and Predictors of Residents’ Dietary Counseling Practices
Khandelwal, S., Zemore, S. E., & Hemmerling, A. (2018) · Journal of Medical Education and Curricular Development · doi:10.1177/2382120518763360 · Cited by 56
Physician adherence to preventive cardiology guidelines for women
Cabana, M. D., & Kim, C. (2003) · Women s Health Issues · doi:10.1016/s1049-3867(03)00034-3 · Cited by 57
“[23] Kushner RF.”
Weight History in Clinical Practice: The State of the Science and Future Directions
Kushner, R. F., Batsis, J. A., Butsch, W. S., Davis, N., Golden, A., Halperin, F., Kidambi, S., Machineni, S., Novick, M., Port, A., et al. (2020) · Obesity · doi:10.1002/oby.22642 · Cited by 55
“These practice-based barriers are similar to those cited for delivery of nutrition counseling by primary care providers (50,51).”
MethodSelf-citation
Prescribing 10,000 Steps Like Aspirin
Kim, Y., Heo, E., Lee, H., Ji, S., Choi, J., Kim, J., Lee, J., & Yoo, S. (2017) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3025453.3025570 · Cited by 55
“As mentioned above, situational constraints, such as lack of time [35, 49] and information overload [27, 54], have been pointed out as some of the most challenging and endemic obstacles.”
Background
Physicians' attitudes and preventive care delivery: insights from the DOPC study
Litaker, D. G., Flocke, S. A., Frolkis, J. P., & Stange, K. C. (2004) · Preventive Medicine · doi:10.1016/j.ypmed.2004.07.015 · Cited by 53
What do physicians recommend to their overweight and obese patients?
Phelan, S., Nallari, M., Darroch, F. E., & Wing, R. R. (2009) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2009.02.080081 · Cited by 54
Patient Perceptions About Prediabetes and Preferences for Diabetes Prevention
O’Brien, M. J., Moran, M. R., Tang, J. W., Vargas, M. C., Talen, M. R., Zimmermann, L. J., Ackermann, R. T., & Kandula, N. R. (2016) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721716666678 · Cited by 61
“Studies on weight loss counseling in primary care have found that lack of time is the most important barrier.(48) In this context, primary care providers cannot deliver ILIs for diabetes prevention during regular office visits, and there is currently no evidence supporting this practice.”
Background
Perceived barriers of, and benefits to, healthy eating reported by a Spanish national sample
López-Azpiazu, I., Martínez‐González, M. Á., Kearney, J. M., et al. (1999) · Public Health Nutrition · doi:10.1017/s1368980099000269 · Cited by 54
Comprehensive integration of nutrition into medical training
Krebs, N. F., & Primak, L. E. (2006) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/83.4.945s · Cited by 53
Promoting change in meat consumption among the elderly: Factual and prefactual framing of health and well-being
Bertolotti, M., Chirchiglia, G., & Catellani, P. (2016) · Appetite · doi:10.1016/j.appet.2016.02.150 · Cited by 60
“…counselling delivered by primary care professionals to older patients (Ryan & Butler, 1996; Sparks & Nussbaum, 2008) include, among other practical aspects such as lack of time and resources, a lack of specific training in nutritionrelated matters and in counselling techniques (Kushner, 1995).”
Background
Adult obesity management in primary care, 2008–2013
Fitzpatrick, S. L., & Stevens, V. J. (2017) · Preventive Medicine · doi:10.1016/j.ypmed.2017.02.020 · Cited by 53
Trends and disparities in the prevalence of physicians' counseling on diet and nutrition among the U.S. adult population, 2000–2011
Ahmed, N. U., Delgado, M. E., & Saxena, A. (2016) · Preventive Medicine · doi:10.1016/j.ypmed.2016.05.014 · Cited by 54
Kansas Primary Care Weighs In: A Pilot Randomized Trial of a Chronic Care Model Program for Obesity in 3 Rural Kansas Primary Care Practices
Ely, A. C., Banitt, A., Befort, C. A., Hou, Q., Rhode, P. C., Grund, C., Greiner, A. K., Jeffries, S. K., & Ellerbeck, E. F. (2008) · The Journal of Rural Health · doi:10.1111/j.1748-0361.2008.00148.x · Cited by 50
Prevalence of Unhealthy Lifestyle Patterns Among Overweight and Obese Adults
Kushner, R. F., & Choi, S. (2009) · Obesity · doi:10.1038/oby.2009.376 · Cited by 52
Self-citation
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Christian, J. G., Byers, T., Christian, K. K., Goldstein, M. G., Bock, B. C., Prioreschi, B., & Bessesen, D. H. (2010) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2010.10.006 · Cited by 49
Is continuing medical education sufficient? Assessing the clinical nutrition knowledge of medical doctors
Grammatikopoulou, M. G., Katsouda, A., Lekka, K., Tsantekidis, K., Bouras, E., Kasapidou, E., Poulia, K., & Chourdakis, M. (2018) · Nutrition · doi:10.1016/j.nut.2018.05.013 · Cited by 53
Management of Obesity: A Challenge for Medical Training and Practice
Thande, N. K., Hurstak, E., Sciacca, R. E., & Giardina, E. V. (2008) · Obesity · doi:10.1038/oby.2008.478 · Cited by 49
Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician
Willaing, I., Ladelund, S., Jørgensen, T., Simonsen, T., & Nielsen, L. M. (2004) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000152244.58950.5f · Cited by 55
Lifestyle Modification to Improve Blood Pressure Control in Individuals With Diabetes
Egede, L. E. (2003) · Diabetes Care · doi:10.2337/diacare.26.3.602 · Cited by 49
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Huber, J. M., Shapiro, J. S., Wieland, M. L., Croghan, I. T., Douglas, K. S. V., Schroeder, D. R., Hathaway, J. C., & Ebbert, J. O. (2015) · Trials · doi:10.1186/s13063-015-0880-1 · Cited by 50
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Background
Healthcare provider counselling for weight management behaviours among adults with overweight or obesity: a cross-sectional analysis of National Health and Nutrition Examination Survey, 2011–2018
Greaney, M. L., Cohen, S. A., Xu, F., Ward‐Ritacco, C. L., & Riebe, D. A. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-039295 · Cited by 47
Which patients receive advice on diet and exercise? Do certain characteristics affect whether they receive such advice?
Sinclair, J., Lawson, B. J., & Burge, F. (2008) · PubMed Central · Cited by 47
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Rosal, M. C., Ockene, J. K., Luckmann, R., Zapka, J. G., Goins, K. V., Saperia, G. M., Mason, T. H., & Donnelly, G. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.04.020 · Cited by 47
An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals
Kennelly, S., Kennedy, N. P., Rughoobur, G. F., Slattery, C. G., & Sugrue, S. (2010) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.2010.01111.x · Cited by 46
“These two factors have been identified in other studies investigating low professionals (Kushner, 1995; Hiddink et al., 1999; Moore & Adamson, 2002).”
Background
Nutrition and the health care agenda: a primary care perspective
Moore, H. J., Adamson, A., Gill, T., & Waine, C. (2000) · Family Practice · doi:10.1093/fampra/17.2.197 · Cited by 44
LIFELAX – diet and LIFEstyle versus LAXatives in the management of chronic constipation in older people: randomised controlled trial
Speed, C., Heaven, B., Adamson, A., Bond, J. B., Corbett, S. S., Lake, A. A., May, C. R., Vanoli, A., McMeekin, P. J., Moynihan, P. J., et al. (2010) · Health Technology Assessment · doi:10.3310/hta14520 · Cited by 44
Behavioral Counseling for Cardiovascular Disease Prevention in Primary Care Settings
Böck, C., Diehl, K., Schneider, S. O., Diehm, C., & Litaker, D. G. (2012) · Medical Care Research and Review · doi:10.1177/1077558712441084 · Cited by 44
“In a large survey from the United States, 31% [28%, 34%] of physicians reported that a majority of their patients received nutrition counseling by a provider in their practice (Kushner, 1995).”
BackgroundMethodInfluential
Body weight, eating practices and nutritional knowledge amongst university nursing students, Eastern Cape, South Africa
den Berg, V. L. V., Okeyo, A. P., Dannhauser, A., & Nel, M. (2012) · African Journal of Primary Health Care & Family Medicine · doi:10.4102/phcfm.v4i1.323 · Cited by 44
Primary care providers’ communication with patients during weight counseling: A focus group study
Gudzune, K. A., Clark, J. M., Appel, L. J., & Bennett, W. L. (2012) · Patient Education and Counseling · doi:10.1016/j.pec.2012.06.033 · Cited by 50
“Despite these benefits, providers have identified multiple barriers to providing the recommended weight counseling including inadequate training in weight management and lack of time during primary care visits [4-6].”
Background
Exploring Self-Efficacy in Australian General Practitioners Managing Patient Obesity: A Qualitative Survey Study
Ashman, F., Sturgiss, E., & Haesler, E. (2016) · International Journal of Family Medicine · doi:10.1155/2016/8212837 · Cited by 43
Collective Efficacy and Obesity-Related Health Behaviors in a Community Sample of African Americans
Halbert, C. H., Bellamy, S. L., Briggs, V., Bowman, M. A., Delmoor, E., Kumanyika, S., Rogers, R., Purnell, J., Weathers, B., & Johnson, J. C. (2013) · Journal of Community Health · doi:10.1007/s10900-013-9748-z · Cited by 48
“Similarly, incorporation of weight loss programs into primary care may be challenging [7, 8].”
Medical school fails to improve Mediterranean diet adherence among medical students
Fiore, M., Ledda, C., Rapisarda, V., Sentina, E., Mauceri, C., D’Agati, P., Conti, G. O., Serra‐Majem, L., & Ferrante, M. (2015) · European Journal of Public Health · doi:10.1093/eurpub/ckv127 · Cited by 43
Satisfaction with primary care provider involvement is associated with greater weight loss: Results from the practice-based POWER trial
Bennett, W. L., Wang, N., Gudzune, K. A., Dalcin, A., Bleich, S. N., Appel, L. J., & Clark, J. M. (2015) · Patient Education and Counseling · doi:10.1016/j.pec.2015.05.006 · Cited by 44
Teaching Nutrition Skills to Primary Care Practitioners
Eaton, C. B., McBride, P. E., Gans, K. A., & Underbakke, G. L. (2003) · Journal of Nutrition · doi:10.1093/jn/133.2.563s · Cited by 43
U.S. Health Professionals’ Views on Obesity Care, Training, and Self-Efficacy
Bleich, S. N., Bandara, S. N., Bennett, W. L., Cooper, L. A., & Gudzune, K. A. (2015) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.11.002 · Cited by 47
How to make exercise counseling more effective: lessons from rural America.
Weidinger, K. A., Lovegreen, S. L., Elliott, M., Hagood, L., Haire-Joshu, D. L., McGill, J. B., & Brownson, R. C. (2008) · PubMed · Cited by 41
Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review
Blackshaw, L. C. D., Chhour, I., Stepto, N. K., & Lim, S. S. (2019) · Medical Sciences · doi:10.3390/medsci7070076 · Cited by 40
“Some healthcare professionals report a lack of motivation to implement lifestyle management as poor patient compliance means repeated messages made during lifestyle consultations are unlikely to prompt changes [88,89,93,98].”
BackgroundInfluential
Clinical nutrition in primary care: An evaluation of resident physicians' attitudes and self-perceived proficiency
Han, S., Auer, R., Cornuz, J., & Marques-Vidal, P. M. (2016) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2016.06.005 · Cited by 40
“Similarly, in the US, a survey conducted in 1995 among primary care physicians reported that only 58% stated they had previously received clinical nutrition training, and 62% stated they lacked the knowledge necessary to counsel their patients in diet-related health care [25].”
Background
Low carbohydrate diets in family practice: what can we learn from an internet-based support group
Feinman, R. D., Vernon, M. C., & Westman, E. C. (2006) · Nutrition Journal · doi:10.1186/1475-2891-5-26 · Cited by 40
“This result should be seen in the context of what might be described as a quandary for most family practitioners – surveys generally show a strong feeling among physicians of the importance of nutritional counseling but a limited ability to provide such counseling [23-25] due to a lack of training, limitations of time…”
Background
Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations
van Dillen, S. M. E., Noordman, J., van Dulmen, S., & Hiddink, G. J. (2013) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2013.219 · Cited by 43
The Impact of Primary Care Resident Physician Training on Patient Weight Loss at 12 Months
Jay, M. R., Gillespie, C. C., Schlair, S., Savarimuthu, S. M., Sherman, S. E., Zabar, S. R., & Kalet, A. L. (2012) · Obesity · doi:10.1002/oby.20237 · Cited by 46
“However, the CMS decision will not overcome other barriers to promoting high-quality physician counseling including perceived lack of effectiveness (26), competing demands on time during the medical visit (27), lack of training (15,24,28), and lack of skills (29).”
Background
Electronic Tools to Assist with Identification and Counseling for Overweight Patients: a Randomized Controlled Trial
Tang, J. W., Kushner, R. F., Cameron, K. A., Hicks, B., Cooper, A., & Baker, D. W. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2022-8 · Cited by 39
“Barriers to weight counseling include failure to recognize that patients are overweight, time constraints, insufficient training, and limited access to weight loss tools.(12) Electronic health record (EHR) systems have the potential to overcome these barriers through computerized decision support tools to remind physi…”
BackgroundSelf-citation
Nutrition in medical education: reflections from an initiative at the University of Cambridge
Ray, S., Ball, L., Crowley, J., Laur, C. V., Rajput‐Ray, M., & Gillam, S. (2014) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s59071 · Cited by 39
Nutrition advice in general practice: the role of general practitioners and practice nurses
MITCHELL, L. J., MacDonald‐Wicks, L. K., & Capra, S. M. (2011) · Australian Journal of Primary Health · doi:10.1071/py10101 · Cited by 39
Prevalence of Self‐Reported Hypertension, Advice Received From Health Care Professionals, and Actions Taken to Reduce Blood Pressure Among US Adults—HealthStyles, 2008
Valderrama, A. L., Tong, X., Ayala, C., & Keenan, N. L. (2010) · Journal of Clinical Hypertension · doi:10.1111/j.1751-7176.2010.00323.x · Cited by 40
Behavioral Transitions and Weight Change Patterns Within the PREMIER Trial
Bartfield, J. K., Stevens, V. J., Jerome, G. J., Batch, B. C., Kennedy, B. M., Vollmer, W. M., Harsha, D. W., Appel, L. J., Desmond, R. A., & Ard, J. D. (2011) · Obesity · doi:10.1038/oby.2011.56 · Cited by 38
“Clinicians may also find themselves more comfortable and confident in their ability to counsel and motivate patients toward behavior change using these modest targets, particularly given that time constraints and futility are commonly cited as barriers to weight loss counseling in daily practice (23,24).”
Background
Impact of Patient–Doctor Race Concordance on Rates of Weight‐Related Counseling in Visits by Black and White Obese Individuals
Bleich, S. N., Simon, A. E., & Cooper, L. A. (2011) · Obesity · doi:10.1038/oby.2010.330 · Cited by 39
“It could also reflect physicians’ belief that their advice will have little effect on patient behavior (40,41), that patients are not interested or ready for treatment (40,42–44), and that obesity is the responsibility of the patient (45).”
Background
Insights from the POWER Practice-Based Weight Loss Trial: A Focus Group Study on the PCP’s Role in Weight Management
Bennett, W. L., Gudzune, K. A., Appel, L. J., & Clark, J. M. (2013) · Journal of General Internal Medicine · doi:10.1007/s11606-013-2562-6 · Cited by 39
“You Guys Really Care About Me…”: a Qualitative Exploration of a Produce Prescription Program in Safety Net Clinics
Schlosser, A. V., Smith, S., Joshi, K., Thornton, A., Trapl, E., & Bolen, S. D. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05326-7 · Cited by 42
Modifying Health Behavior to Prevent Cardiovascular Diseases: A Nationwide Survey among German Primary Care Physicians
Schneider, S. O., Diehl, K., Böck, C., Herr, R. M., Mayer, M., & Görig, T. (2014) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph110404218 · Cited by 38
“87% to 81%) [35,38].”
Motivational interviewing and shared decision making in primary care
Sonntag, U., Wiesner, J., Fahrenkrog, S., Renneberg, B., Braun, V., & Heintze, C. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.07.026 · Cited by 38
Physician informational needs in providing nutritional guidance to patients.
Mihalynuk, T. V., Knopp, R. H., Scott, C. S., & Coombs, J. B. (2004) · PubMed · Cited by 37
Obesity in the US: what is the best role for primary care?
Ard, J. D. (2015) · BMJ · doi:10.1136/bmj.g7846 · Cited by 37
State of the science: a focus on physical activity.
Hills, A. P., & Byrne, N. M. (2006) · PubMed · Cited by 37
Pediatric Hypertension: Provider Perspectives
Bello, J. K., Mohanty, N., Bauer, V., Rittner, S. S., & Rao, G. (2017) · Global Pediatric Health · doi:10.1177/2333794x17712637 · Cited by 38
“Specifically, the desire among clinicians for education about how to promote lifestyle changes, including improved nutrition, is consistent with the well-documented lack of nutrition education in medical training and poor knowledge of nutrition among physicians generally.(19,20)”
Background
Geographic Availability of Physicians Certified by the American Board of Obesity Medicine Relative to Obesity Prevalence
Gudzune, K. A., Johnson, V. R., Bramante, C. T., & Stanford, F. C. (2019) · Obesity · doi:10.1002/oby.22628 · Cited by 37
“Practicing primary care physicians have repeatedly identified insufficient training about obesity as well as low confidence and self-efficacy with respect to weight management skills (14-16).”
Background
Appraisal of the knowledge of hypertensive patients and assessment of the role of the pharmacists in the management of hypertension: results of a regional survey
Ragot, S., Sosner, P., Bouche, G., Guillemain, J., & Herpin, D. (2005) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001859 · Cited by 37
Teaching Behavior Change Concepts and Skills During the Third-Year Medicine Clerkship
Moser, E. M., & Stagnaro‐Green, A. (2009) · Academic Medicine · doi:10.1097/acm.0b013e3181a856f8 · Cited by 37
Web-Based, Computer-Tailored, Pedometer-Based Physical Activity Advice: Development, Dissemination Through General Practice, Acceptability, and Preliminary Efficacy in a Randomized Controlled Trial
Cocker, K. A. D., Spittaels, H., Cardon, G., Bourdeaudhuij, I. D., & Vandelanotte, C. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.1959 · Cited by 36
“As such, a possible promising dissemination channel of online physical activity interventions is the visit to primary health care [26], as general practitioners (GPs) have personal face-to-face contact with their patients but often lack the time or the skills to provide counseling on health behaviors themselves [27,28…”
Background
Advising overweight persons about diet and physical activity in primary health care: Lithuanian health behaviour monitoring study
Klumbienė, J., Petkevičienė, J., Vaisvalavičius, V., & Misevičienė, I. (2006) · BMC Public Health · doi:10.1186/1471-2458-6-30 · Cited by 36
Physicians’ personal beliefs about weight-related care and their associations with care delivery: The U.S. National Survey of Energy Balance Related Care among Primary Care Physicians
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Dixon, J. B., Hayden, M. J., O'Brien, P. E., & Piterman, L. (2008) · Australian Journal of Primary Health · doi:10.1071/py08031 · Cited by 36
Smoking Cessation and Counseling: Knowledge and Views of Canadian Physical Therapists
Bodner, M. E., Miller, W., Rhodes, R. E., et al. (2011) · Physical Therapy · doi:10.2522/ptj.20100245 · Cited by 36
Changing Professional Practice
Reeves, J., Forde, C., O'Brien, J., Smith, P., & Tomlinson, H. (2002) · SAGE Publications Ltd eBooks · doi:10.4135/9781446220931.n4 · Cited by 36
Utility of a Brief Self-Efficacy Scale in Clinical Training Program Evaluation
Lorenz, R. A., Gregory, R., & Davis, D. (2000) · Evaluation & the Health Professions · doi:10.1177/016327870002300204 · Cited by 35
“Accordingly, lack of self-efficacy has been regarded as a potential barrier to desirable professional practice behaviors (Bull, Schipper, Jamrozik, & Blanksby, 1997; Glanz, Tziraki, Albright, & Fernandes, 1995; Kushner, 1995; Maibach, Schieber, & Carroll, 1996; Mann & Putnam, 1989).”
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Al-Ghawi, A., & Uauy, R. D. (2009) · Public Health Nutrition · doi:10.1017/s1368980008004564 · Cited by 35
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Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in Southern Sweden
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Compliance with National Cholesterol Education Program dietary and lifestyle guidelines among older women with self-reported hypercholesterolemia
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Obesity prevention in pediatrics: A pilot pediatric resident curriculum intervention on nutrition and obesity education and counseling.
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Treatment of the Obese Patient in Primary Care: Targeting and Meeting Goals and Expectations
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“57 There have been enduring claims since the 1980s that PCPs provide inadequate nutrition care 58 to patients (18-22), with minimal clear gains over recent times.”
Background
Nutrition Education in Medical Schools: Trends and Implications for Health Educators
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Background
Primary care physicians′ knowledge and perceived barriers in the management of overweight and obesity
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“[18] Despite these facts, primary health care (PHC) is still underutilized for obesity counseling[19] and its capacity is usually diminished by a number of limitations[20] such as short consultation time, patients’ low motivation and non‐compliance, inadequate teaching materials, lack of reimbursement, low level of ph…”
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Rhodes, E., Ebbeling, C., Meyers, A., Bayerl, C., Ooi, W. L., Bettencourt, M., & Ludwig, D. S. (2007) · La Clinica pediatrica · doi:10.1177/0009922806298704 · Cited by 36
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Inadequate physician knowledge of the effects of diet on blood lipids and lipoproteins.
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Behavior Modification in Primary Care: The Pressure System Model
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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)
DOI: 10.1006/pmed.1995.1087
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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 › Nursing › Nutrition and Dietetics › Dietetics, Nutrition, and Education
Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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

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Barriers to Providing Nutrition Counseling by Physicians: A Survey of Primary Care Practitioners

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