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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.
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“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]
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Items 201–300 of 607
General Practitioners involvement in enteral tube feeding at home: a qualitative study
Madigan, S. M., Fleming, P. J., McCann, S., et al. (2007) · BMC Family Practice · doi:10.1186/1471-2296-8-29 · Cited by 31
“The issues identified here mirror the findings of other work where physicians have cited a lack of training, lack of time, lack of support staff with nutrition training and reimbursement concerns as barriers to their effective involvement in providing nutrition related information to patients [15-17].”
Molenaar, E. A., van Ameijden, E. J., Vergouwe, Y., Grobbee, D. E., & Numans, M. E. (2009) · Family Practice · doi:10.1093/fampra/cmp104 · Cited by 31
Primary Care Providers Need a Variety of Nutrition and Wellness Patient Education Materials
KENNER, M. M., TAYLOR, M. L., DUNN, P. C., GRUCHOW, H. W., & KOLASA, K. (1999) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(99)00113-3 · Cited by 31
“Respondents to this survey differ from those in similar, published surveys in which 71% to 96% of respondents were from urban/suburban areas (8,9).”
Km, K. (1999) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1600810 · Cited by 31
Schuster, R. J., Tasosa, J., & Terwoord, N. A. (2008) · The Journal of nutrition, health and aging · doi:10.1007/bf03028627 · Cited by 30
“Only 50 percent of US physicians feel confident in their ability to counsel patients regarding diet (30).”
Bhuyan, S. S., Chandak, A. N., Smith, P., Carlton, E. L., Duncan, K., & Gentry, D. (2015) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2015.07.005 · Cited by 30
Nutritional knowledge of primary health care physicians in Jeddah, Saudi Arabia
Alzahrani, A. M., & Al-Raddadi, R. M. (2009) · Saudi Medical Journal · doi:10.15537/1658-3175.4637 · Cited by 30
Dutton, G. R., Herman, K. G., Tan, F., Goble, M., Dancer-Brown, M., Vessem, N. V., & Ard, J. D. (2013) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2012.12.004 · Cited by 29
“However, there are numerous barriers interfering with the provision of weight loss counseling in primary care, including lack of time, lack of reimbursement, and physicians feeling ill-equipped to address these issues [5—9].”
BackgroundEvidence of a gap in understanding obesity among physicians
Tsai, A. G., Histon, T., Kyle, T. K., Rubenstein, N., & Donahoo, W. T. (2017) · Obesity Science & Practice · doi:10.1002/osp4.146 · Cited by 31
Integrated Model of Care for Polycystic Ovary Syndrome
Tay, C. T., Moran, L., Wijeyaratne, C. N., Redman, L. M., Norman, R. J., Teede, H. J., & Joham, A. E. (2018) · Seminars in Reproductive Medicine · doi:10.1055/s-0038-1667310 · Cited by 29
Arasu, A., Moran, L., Robinson, T., Boyle, J. A., & Lim, S. S. (2019) · Nutrients · doi:10.3390/nu11051024 · Cited by 29
“Hence, lack of time remains one of the primary barriers to lifestyle management by GPs [18,19,21,25,30,32,39,43,52,53].”
BackgroundPhysicians certified by the American Board of Obesity Medicine provide evidence‐based care
Gudzune, K. A., Wickham, E. P., Schmidt, S. L., & Stanford, F. C. (2020) · Clinical Obesity · doi:10.1111/cob.12407 · Cited by 29
“Guideline-recommended treatments have been associated with clinically significant weight loss in clinical trials(19); however, other studies of physicians document pessimism regarding obesity treatment efficacy and lower rates of physician referral to obesity treatment programs.(10,31,32) Our findings may provide othe…”
ResultWood, N. I., Gleit, R. D., & Levine, D. L. (2021) · BMC Medical Education · doi:10.1186/s12909-021-02702-y · Cited by 30
Crowley, J., Ball, L., Han, D. Y., Arroll, B., LEVERITT, M. D., & Wall, C. R. (2015) · Journal of Biomedical Education · doi:10.1155/2015/259653 · Cited by 30
“As a result, GPs perceive that they are inadequately prepared to provide nutrition care to patients and report low self-efficacy in this area [17–20].”
BackgroundClinician reflections on promotion of healthy behaviors in primary care practice
Flocke, S. A., Crabtree, B. F., & Stange, K. C. (2007) · Health Policy · doi:10.1016/j.healthpol.2007.04.003 · Cited by 30
“Prior studies have used surveys and focus groups to elicit beliefs and explanations about providing preventive services and health behavior counseling[24-28] and predominately have focused on identifying barriers rather than encouraging identification of potential solutions.”
BackgroundDietary Counseling for High Blood Cholesterol in Families at Risk of Coronary Disease
Moy, T. F., Yanek, L. R., Raqueño, J. V., Bezirdjian, P. J., Blumenthal, R. S., Wilder, L. B., & Becker, D. M. (2001) · Preventive Cardiology · doi:10.1111/j.1520-037x.2001.00543.x · Cited by 29
The Impact of Primary Care Resident Physician Training on Patient Weight Loss at 12 Months
Jay, M. R., Gillespie, C. C., Schlair, S. L., et al. (2012) · Obesity · doi:10.1038/oby.2012.137 · Cited by 29
Crowley, J., O’Connell, S. L., Kavka, A., Ball, L., & Nowson, C. A. (2016) · Public Health · doi:10.1016/j.puhe.2016.08.013 · Cited by 29
Elhady, G. W., Ibrahim, S. K., Abbas, E. S., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1064837 · Cited by 28
“Unfortunately, the insufficient resource component of the health system is a commonly encountered barrier in many countries (8, 31, 32) because healthcare funds are skewed mainly toward treatment, with little funds directed toward nutrition education programs or malnutrition prevention in general (33, 34).”
BackgroundResultLifestyle Medicine in Medical Education: Maximizing Impact
Frates, B., Ortega, H., Freeman, K. J., Co, J. P. T., & Bernstein, M. (2024) · Mayo Clinic Proceedings Innovations Quality & Outcomes · doi:10.1016/j.mayocpiqo.2024.07.003 · Cited by 36
Nutrition Knowledge, Attitudes, and Confidence of Australian General Practice Registrars
Nowson, C. A., & O’Connell, S. L. (2015) · Journal of Biomedical Education · doi:10.1155/2015/219198 · Cited by 28
“There appear to be real challenges to engaging GP registrars’ interest in delivering nutrition/lifestyle support to their patients [21, 22].”
BackgroundYoong, S. L., Carey, M. L., Sanson‐Fisher, R., D’Este, C. A., Mackenzie, L., & Boyes, A. (2013) · Journal of General Internal Medicine · doi:10.1007/s11606-013-2637-4 · Cited by 28
Donini, L. M., Leonardi, F., Rondanelli, M., et al. (2017) · Frontiers in Nutrition · doi:10.3389/fnut.2017.00002 · Cited by 28
Mogre, V., Aryee, P. A., Stevens, F. C. J., & Scherpbier, A. J. J. A. (2017) · Medical Science Educator · doi:10.1007/s40670-017-0413-5 · Cited by 28
Shaikh, U., Nettiksimmons, J., & Romano, P. S. (2010) · The Journal of Rural Health · doi:10.1111/j.1748-0361.2010.00335.x · Cited by 28
The time burden of overweight and obesity in primary care
Tsai, A. G., Abbo, E. D., & Ogden, L. G. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-191 · Cited by 28
“Barriers to the provision of obesity treatment include the increasing complexity of primary care visits [4-6] as well as limitations in time, resources, training, and reimbursement [7-10].”
BackgroundHow to deliver high-quality obesity counseling in primary care using the 5As framework
Schlair, S., Moore, S., McMacken, M. M., & Jay, M. R. (2012) · Journal of clinical outcomes management · Cited by 28
Suboptimal identification of obesity by family physicians.
Melamed, O. C., Nakar, S., & Vinker, S. (2009) · PubMed · Cited by 28
Verheijden, M. W., der Veen, J. E. V., Bakx, J. C., Akkermans, R. P., van den Hoogen, H. J. M., van Staveren, W. A., & van Weel, C. (2004) · Journal of Nutrition Education and Behavior · doi:10.1016/s1499-4046(06)60385-0 · Cited by 28
Dutton, G. R., Phillips, J. M., Kukkamalla, M., Cherrington, A., & Safford, M. M. (2015) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721715575356 · Cited by 28
Ahmed, N. U., Delgado, M. E., & Saxena, A. (2017) · Preventive Medicine · doi:10.1016/j.ypmed.2017.01.015 · Cited by 27
Louzada, M. L. D. C., Tramontt, C. R., de Jesus, J. G. L., Rauber, F., Hochberg, J. R. B., Santos, T. S. S., & Jaime, P. C. (2022) · Family Medicine and Community Health · doi:10.1136/fmch-2021-001276 · Cited by 28
Hughes, R., Maher, J. H., Baillie, E., et al. (2011) · Australian Journal of Primary Health · doi:10.1071/py10012 · Cited by 27
“The limited literature suggests that medical practitioners, nurses and other PHC professionals are inadequately prepared to provide up-to-date and practically applicable nutrition information and advice (Uprichard 1979; Kushner 1995; Mulliner and Spidy 1995; Summerbell 1996; Ayoob et al. 2002; Ball et al. 2010), sugge…”
BackgroundBarriers to Home and Community-Based Service Referrals: The Physician's Role
Reder, S., Hedrick, S. C., Guihan, M., et al. (2009) · Gerontology & Geriatrics Education · doi:10.1080/02701960802690241 · Cited by 27
“There is some evidence that physician knowledge is an important component of referral behavior and that training may be helpful (Deng et al., 2006; Gerard et al., 2000; Kushner, 1995).”
BackgroundSecular Trends in the Diagnosis and Treatment of Obesity Among US Adults in the Primary Care Setting
Yates, E. A., Macpherson, A., & Kuk, J. L. (2011) · Obesity · doi:10.1038/oby.2011.271 · Cited by 27
“However, numerous barriers to weight-related counseling have been cited frequently by physicians, including lack of time (11,29), lack of reimbursement (13,29), and poor confidence, knowledge, and experience in weight-related counseling (11,13,14); these factors may, in part, explain the stagnant rates of provider-car…”
BackgroundEnhancing the role of nutrition professionals in weight management: A cross-sectional survey
Bleich, S. N., Bandara, S. N., Bennett, W. L., Cooper, L. A., & Gudzune, K. A. (2014) · Obesity · doi:10.1002/oby.20945 · Cited by 33
Recognition, diagnosis and management of obesity after myocardial infarction
López-Jiménez, F. A., Malinski, M. K., Gutt, M., Sierra‐Johnson, J., Aude, Y. W., Rimawi, A., Mego, P. A., Thomas, R. J., Allison, T. G., Kirby, B., et al. (2004) · International Journal of Obesity · doi:10.1038/sj.ijo.0802831 · Cited by 27
Amoore, B. Y., Gaa, P. K., Amalba, A., & Mogre, V. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1063316 · Cited by 27
“However, doctors frequently are unable to effectively provide nutrition care due to lack of nutrition counseling training, inadequate knowledge and low confidence and skills to give nutrition care (8, 9).”
BackgroundThe role of the general practitioner and the dietitian in patient nutrition management.
Nicholas, L., Roberts, D., & Pond, D. (2003) · PubMed · Cited by 26
Improving the Population's Health: The Affordable Care Act and the Importance of Integration
Hardcastle, L. E., Record, K. L., Jacobson, P., & Gostin, L. O. (2011) · The Journal of Law Medicine & Ethics · doi:10.1111/j.1748-720x.2011.00602.x · Cited by 27
Evaluating Approaches for Communication About Genomic Influences on Body Weight
Persky, S., & Street, R. L. (2015) · Annals of Behavioral Medicine · doi:10.1007/s12160-015-9701-8 · Cited by 27
“There are limited evidence-based treatment options to support long-lasting weight loss [7–9] and a great deal of uncertainty on the part of physicians about how to communicate about weight with patients [10, 11].”
BackgroundFeasibility of an interdisciplinary program for obesity management in Canada.
Wharton, S., VanderLelie, S., Sharma, A. M., Sharma, S., & Kuk, J. L. (2012) · PubMed Central · Cited by 27
Wolff, L. S., Massett, H. A., Weber, D., Mockenhaupt, R. E., Hassmiller, S. B., & Maibach, E. W. (2010) · Health Promotion International · doi:10.1093/heapro/daq030 · Cited by 26
“…setting, ranging from physician barriers of lack of time, reimbursement and counseling skills to no firm recommendation from the US Preventive Service Task Force for counseling unselected patients (Kushner, 1995; Walsh et al., 1999; Abramson et al., 2000; U.S. Preventive Services Task Force, 2006).”
BackgroundSurvey of nutrition knowledge of physicians in Kuwait
Allafi, A. R., Alajmi, F. A., & Al-Haifi, A. R. (2012) · Public Health Nutrition · doi:10.1017/s1368980012003606 · Cited by 26
“inadequate counselling skills – prevented physicians from giving proper dietary counselling((12)).”
BackgroundBleich, S. N., Gudzune, K. A., Bennett, W. L., & Cooper, L. A. (2013) · Preventive Medicine · doi:10.1016/j.ypmed.2013.01.012 · Cited by 26
“, 1987), and pessimism regarding weight loss (Kushner, 1995; Laws et al., 2009).”
Wagenschutz, H., Ross, P. T., Purkiss, J. A., Yang, J., Middlemas, S., & Lypson, M. L. (2010) · Patient Education and Counseling · doi:10.1016/j.pec.2010.07.047 · Cited by 25
Crowley, J., Ball, L., LEVERITT, M. D., Arroll, B., Han, D. Y., & Wall, C. R. (2014) · Journal of Primary Health Care · doi:10.1071/hc14101 · Cited by 25
Dietitians' Perspectives on Teaching Nutrition to Medical Students
Burch, E., Crowley, J., Laur, C. V., et al. (2017) · Journal of the American College of Nutrition · doi:10.1080/07315724.2017.1318316 · Cited by 25
Sciamanna, C., Marcus, B. H., Goldstein, M. G., Lawrence, K., Swartz, S., Bock, B. C., Graham, A. L., & Ahern, D. K. (2004) · Journal of Innovation in Health Informatics · doi:10.14236/jhi.v12i1.107 · Cited by 25
“Images” of nutrition in medical education and primary care
Kolasa, K. M. (2001) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/73.6.1006 · Cited by 25
HIV and Medical Nutrition Therapy
YOUNG, J. S. (1997) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(97)00755-4 · Cited by 25
Benefits of commercial weight-loss programs on blood pressure and lipids: a systematic review
Mehta, A. K., Doshi, R. S., Chaudhry, Z. W., Jacobs, D. K., Vakil, R. M., Lee, C. J., Bleich, S. N., Clark, J. M., & Gudzune, K. A. (2016) · Preventive Medicine · doi:10.1016/j.ypmed.2016.06.028 · Cited by 26
“Preventive Services Task Force has recommended that clinicians provide intensive counseling and behavioral interventions (LeFevre, 2014); however, barriers exist to implementing this practice due to limited time and counseling skill (Kushner, 1995).”
BackgroundNutritional status of undergraduate healthcare students at the University of the Free State
van den Berg, L., Abera, B., Nel, M., & Walsh, C. M. (2013) · South African Family Practice · doi:10.1080/20786204.2013.10874394 · Cited by 24
Ruzicka, M., Hiremath, S. S., Steiner, S., Helis, E., Szczotka, A., Baker, P., & Fodor, G. J. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000182 · Cited by 24
Exploring the provision of diabetes nutrition education by practice nurses in primary care settings
Gianfrancesco, C., & Johnson, M. (2019) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12720 · Cited by 30
Nutrition in medical education in Latin America: Results of a cross‐sectional survey
Cárdenas, D., Díaz, G., Sierra, J. C., et al. (2021) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.2107 · Cited by 24
Process evaluation of a clinical preventive nutrition intervention
Hunt, M. K., Lobb, R., Delichatsios, H. K., et al. (2001) · Preventive Medicine · doi:10.1016/s0091-7435(01)80003-7 · Cited by 24
McClinchy, J., Dickinson, A. M., Barron, D., & Thomas, H. (2011) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.2011.01200.x · Cited by 22
Primary care and youth mental health in Ireland: qualitative study in deprived urban areas
Leahy, D., Schaffalitzky, E., Armstrong, C., Bury, G., Cussen-Murphy, P., Davis, R., Dooley, B. A., Gavin, B. E., Keane, R., Keenan, E., et al. (2013) · BMC Family Practice · doi:10.1186/1471-2296-14-194 · Cited by 27
“Lack of time and training are often mentioned by healthcare professionals in primary care as major barriers to a comprehensive psychosocial diagnosis [14 – 16].”
McClinchy, J., Williams, J., Gordon, L., et al. (2015) · Healthcare · doi:10.3390/healthcare3010064 · Cited by 23
Gaboreau, Y., Imbert, P., Jacquet, J.-P., et al. (2013) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2013.161 · Cited by 23
Curbach, J., Apfelbacher, C., Knoll, A., Herrmann, S., Szagun, B., & Loss, J. (2018) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2018.02.001 · Cited by 24
Survey Correlations: Proficiency and Adequacy of Nutrition Training of Medical Students
Mihalynuk, T. V., Coombs, J. B., Rosenfeld, M. E., et al. (2008) · Journal of the American College of Nutrition · doi:10.1080/07315724.2008.10719675 · Cited by 23
Identification of nutrition communication styles and strategies: A qualitative study among Dutch GPs
van Dillen, S. M. E., Hiddink, G. J., Koelen, M. A., de Graaf, C., & van Woerkum, C. M. J. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2005.09.001 · Cited by 23
Safe Bariatric Patient Handling Toolkit
Baptiste, A. S. (2007) · Bariatric Nursing and Surgical Patient Care · doi:10.1089/bar.2006.9996 · Cited by 22
McTigue, K. M., Bhargava, T. D., Bryce, C. L., Conroy, M. B., Fischer, G. S., Hess, R., Simkin‐Silverman, L. R., & Zickmund, S. L. (2010) · Patient Education and Counseling · doi:10.1016/j.pec.2010.05.009 · Cited by 22
“009 clinician training, inhibit their translation into clinical practice [8,12–15].”
MethodWinzenberg, T. M., Reid, P., & Shaw, K. A.-M. (2009) · British Journal of General Practice · doi:10.3399/bjgp09x472818 · Cited by 22
Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study
van Dillen, S. M. E., Noordman, J., van Dulmen, S., & Hiddink, G. J. (2014) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2014.129 · Cited by 22
Falvo, A. M., Philp, F. H., & Eid, G. M. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2018.05.002 · Cited by 22
Bass, P. F., Stetson, B. A., Rising, W., Wesley, G. C., & Ritchie, C. S. (2004) · Medical Education Online · doi:10.3402/meo.v9i.4359 · Cited by 22
“tients look to physicians for credible health information and research supports the effectiveness of simple counseling behaviors, few physicians actually provide physical activity (PAC) or nutritional counseling (NC) services to patients.(5-9)”
BackgroundAyala, C., Tong, X., Neeley, E., Lane, R. I., Robb, K. J., & Loustalot, F. V. (2017) · Journal of Clinical Hypertension · doi:10.1111/jch.12983 · Cited by 24
Diehl, K., Gansefort, D., Herr, R. M., Görig, T., Böck, C., Mayer, M., & Schneider, S. O. (2015) · Journal of Public Health Research · doi:10.4081/jphr.2015.534 · Cited by 21
Nurses’ knowledge and attitudes regarding malnutrition in children and its management in Ghana
Mogre, V., Yakubu, A., Fuseini, M., et al. (2017) · Curationis · doi:10.4102/curationis.v40i1.1618 · Cited by 21
“However, doctors may lack the confidence to provide this care because it has been recognised widely that doctors’ knowledge and skills in nutrition are not adequate (Kushner 1995; Mihalynuk et al. 2008).”
BackgroundMogre, V., Stevens, F. C. J., Aryee, P. A., Matorwmasen-Akkermans, F. L., Abubakari, B. B., & Scherpbier, A. J. J. A. (2018) · Medical Science Educator · doi:10.1007/s40670-018-0591-9 · Cited by 20
Counseling overweight patients: analysis of preventive encounters in primary care
Sonntag, U., Henkel, J., Renneberg, B., Bockelbrink, A., Braun, V., & Heintze, C. (2010) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzq060 · Cited by 21
Kading, C. L. (2019) · PubMed · doi:10.17615/2pq9-xq40 · Cited by 21
Mogre, V., Stevens, F. C. J., Aryee, P. A., & Scherpbier, A. J. J. A. (2017) · Health Professions Education · doi:10.1016/j.hpe.2017.02.003 · Cited by 19
“28,46,47 Unsurprisingly, and in consonance with previous studies, 30,31,38,41,48 most of the students regarded nutrition education to be highly relevant to their future practice.”
ResultBansa, M., Brown, D., DeFrino, D. T., Mahoney, N., Saulsberry, A., Marko-Holguin, M., Fogel, J., Gladstone, T. R. G., & Voorhees, B. W. V. (2017) · Journal of the National Medical Association · doi:10.1016/j.jnma.2017.02.006 · Cited by 21
Dailey, R., Schwartz, K., Binienda, J., Moorman, J. D., & Neale, A. V. (2006) · PubMed Central · Cited by 19
Communication Between Family Physicians and Registered Dietitians in the Outpatient Setting
Kuppersmith, N. C., & Wheeler, S. (2002) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(02)90378-0 · Cited by 20
Crowley, J., Ball, L., Wall, C. R., & LEVERITT, M. D. (2012) · Australian Journal of Primary Health · doi:10.1071/py11116 · Cited by 19
“GPs may not feel equipped to provide nutrition care because of the lack of recognition of nutrition as an important subject in medical school (Hiddink et al. 1995; Kushner 1995).”
BackgroundAlameddine, M. S., Saleh, S. S., & Natafgi, N. (2015) · Human Resources for Health · doi:10.1186/s12960-015-0031-5 · Cited by 19
“dataset included data from 943 questionnaires with a corresponding response rate of 44 %, comparable to other studies conducted in similar settings [27–29].”
ResultAddressing Obesity in the Hospitalized Patient: A Needs Assessment
Howe, E. E., Wright, S. M., Landis, R., & Kisuule, F. (2010) · Southern Medical Journal · doi:10.1097/smj.0b013e3181dfd715 · Cited by 19
“Postulated explanations include: lack of provider training and education, perceived inability to change their patients’ behaviors,(11,23) lack of known effective treatments,(18,19,24) negative attitudes toward obese patients,(19,25) belief that patients are not interested in or ready for an intervention,(18,19,22) and…”
BackgroundVillette, C., Vasseur, P., Lapidus, N., Debin, M., Hanslik, T., Blanchon, T., Steichen, O., & Rossignol, L. (2022) · Nutrients · doi:10.3390/nu14153101 · Cited by 18
“Limited time and gaps in knowledge have been identified as barriers [22,24].”
BackgroundThang, C. K., Guerrero, A. D., Garell, C. L., et al. (2023) · Nutrients · doi:10.3390/nu15194240 · Cited by 18
Ball, L., Ball, D., LEVERITT, M. D., Ray, S., Collins, C. E., Patterson, E., Ambrosini, G. L., Lee, P. J., & Chaboyer, W. P. (2016) · Australian Journal of Primary Health · doi:10.1071/py16038 · Cited by 21
Effect of an obesity best practice alert on physician documentation and referral practices
Fitzpatrick, S. L., Dickins, K. A., Avery, E., Ventrelle, J., Shultz, A., Kishen, E., & Rothschild, S. K. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-017-0514-0 · Cited by 23
Nair, D., & Hart, A. Y. (2018) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2018.04.170467 · Cited by 18
“Previous studies surveying physicians about their perceived barriers to nutrition counseling have cited lack of time during appointments, inadequate reimbursement, lack of patient compliance, and physicians’ low selfefficacy or lack of knowledge.(21,22) Our findings were consistent with these studies.”
ResultIdentifying Opportunities for Advancing Weight Management in Primary Care
Croghan, I. T., Ebbert, J. O., Njeru, J. W., Rajjo, T. I., Lynch, B. A., DeJesus, R. S., Jensen, M. D., Fischer, K. M., Phelan, S. M., Kaufman, T. K., et al. (2019) · Journal of Primary Care & Community Health · doi:10.1177/2150132719870879 · Cited by 18
Lepre, B., Crowley, J., Mpe, D., Bhoopatkar, H., Mansfield, K. J., Wall, C. R., & Beck, E. J. (2020) · Nutrients · doi:10.3390/nu12030598 · Cited by 18
Behavioural weight management for the primary careprovider
Rutledge, T. R., Groesz, L. M., Linke, S., Woods, G. N., & Herbst, K. L. (2011) · Obesity Reviews · doi:10.1111/j.1467-789x.2010.00818.x · Cited by 19
“Barriers to greater PCP involvement in weight management are well-known (5,6).”
BackgroundEvaluation of a workshop to improve residents' patient-centred obesity counselling skills
Burton, A. M., Brezausek, C. M., Agne, A. A., Hankins, S. L. R., Willett, L. L., & Cherrington, A. (2016) · Postgraduate Medical Journal · doi:10.1136/postgradmedj-2015-133590 · Cited by 18
Nutrition communication styles of family doctors: results of quantitative research
van Dillen, S. M. E., Hiddink, G. J., Koelen, M. A., & van Woerkum, C. M. J. (2005) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1602174 · Cited by 17
“87 Nutrition training (Kushner, 1995) 1 — — Perception of nutrition and physical activity (Anis et al, 2004) 1 — — Task perception of nutrition issues (Hiddink et al, 1997) 6 0.”
BackgroundParent-Led Activity and Nutrition (PLAN) for healthy living: Design and methods
Dalton, W. T., Schetzina, K. E., Holt, N., Fulton-Robinson, H., Ho, A.-L., Tudiver, F. G., McBee, M. T., & Wu, T. (2011) · Contemporary Clinical Trials · doi:10.1016/j.cct.2011.07.004 · Cited by 17
“However, primary care providers report barriers to treatment including lack of confidence and knowledge [19,20], time, materials, and reimbursement [21], and training in behavioral techniques [19].”
Frank, A. (2005) · Humana Press eBooks · doi:10.1385/1-59259-865-x:375 · Cited by 17
“Furthermore, they may be concerned that, if they raise the issue, they are then obligated to assist the patient in its management and they often feel that there is little that they can offer to help the patient succeed ( 48 ,51).”
BackgroundInfluentialThe Role of Optimal Healing Environments in the Management of Childhood Obesity
Freedman, M. R., & Stern, J. S. (2004) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2004.10.s-231 · Cited by 17
“81,83,84 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.”
Use of the internet in the treatment of obesity and prevention of type 2 diabetes in primary care
McTigue, K. M., & Conroy, M. B. (2012) · Proceedings of The Nutrition Society · doi:10.1017/s0029665112002777 · Cited by 19
The effectiveness of nutrition counselling by Australian General Practitioners
Nicholas, L., Pond, D., & Roberts, D. (2005) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1602187 · Cited by 17
“However, there is variation in the number of GPs who self-report that they provide nutrition counselling: 9–66% of US physicians (Kottke et al, 1984; Dever et al, 1992; Levine et al, 1993; Kushner, 1995) and 28– 48% of Dutch GPs (Hiddink et al, 1995).”
BackgroundMakoul, G., Dhurandhar, A., Goel, M. S., Scholtens, D., & Rubin, A. S. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00467.x · Cited by 16
Chhour, I., Blackshaw, L., Moran, L., Boyle, J. A., Robinson, T., & Lim, S. S. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.12.013 · Cited by 16
Metadata
- 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 › 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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