Review
Nutrition and physical activity guidance practices in general practice: A critical review

https://doi.org/10.1016/j.pec.2012.10.022Get rights and content

Abstract

Objective

The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity.

Methods

Relevant studies were identified by a computerized search of multiple electronic databases (MEDLINE, PsycINFO) for all available papers between 1 January 1995 and 1 January 2012. In addition, two independent reviewers judged all studies on ten quality criteria.

Results

In total, 41 studies were retrieved. More studies were found about the guidance of obese patients than of overweight patients. The most common weight guidance practice was discussion of weight. The range of communication strategies for nutrition showed to be more diverse than for physical activity. Twelve studies were considered as high-quality studies, 18 were having medium quality, and 11 were seen as low quality.

Conclusion

We reflected on the fact that the content of advice about nutrition and physical activity was quite general. GPs’ provision of combined lifestyle advice to overweight and obese patients seems to be rather low.

Practice implications

Observational research is needed to unravel the quality of the advice given by GPs to overweight and obese patients.

Introduction

Evidence is emerging that the prevalence of overweight and obesity is increasing worldwide at an alarming rate [1]. In the Netherlands, almost half of the population is overweight [2]. Poor diet and physical inactivity increase the risk of several health problems, including obesity.

These findings have led to the development of multiple recommendations about nutrition [3], [4], [5]. According to the Dutch Dietary Guidelines for example, consumers are recommended to eat a balanced diet, be sufficiently physically active every day, eat plenty of vegetables, fruits and whole grains products, eat (fatty) fish regularly, limit saturated fatty acids and trans fatty acids, limit intake of foods and drinks with added sugars, reduce sodium intake, and moderate alcohol intake [4].

Also several recommended guidelines about physical activity have been developed, that range from at least 30 min of moderate-intensity physical activity on five or more days of the week to 20 min of vigorous-intensity on three or more days of the week [6], [7], [8].

Recommended guidelines can be delivered by general practitioners (GPs) to their patients. GPs are ideally placed to promote healthy nutrition and physical activity. Patients perceived GPs as the most reliable source of nutrition information [9], [10] or physical activity information [11]. The percentage of overweight and obese individuals seen in general practice even exceeds the percentage found in the general population [12]. Apart from the general guidelines about nutrition and physical activity, specific guidelines for the identification and management of obesity have been developed for health professionals [13], [14], [15]. These guidelines may offer GPs recommendations to support their daily guidance practices.

However, it is not known to what extent GPs actually guide their patients on nutrition and/or physical activity to prevent or treat overweight and obesity. Understanding of their specific guidance practices used in daily practice is needed in order to develop appropriate interventions for overweight in the general practice, and to highlight these in medical education.

Therefore, the aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity.

The following research questions will be answered:

  • What is known about the main outcomes of studies conducted regarding GPs’ (nutrition and/or physical activity) guidance practices in order to prevent or treat overweight or obesity?

  • What is known about the extent to which GPs integrate both nutrition and physical activity guidance practices into prevention or treatment of overweight and obesity?

  • What are the specific nutrition and/or physical activity communication strategies of GPs in their management of overweight and obesity?

  • What can be noticed about the study quality of these studies?

Section snippets

Search strategy

Relevant studies were identified by a computerized search of multiple electronic databases (MEDLINE, PsycINFO) with EBSCOhost as resource for all available papers between 1 January 1995 and 1 January 2012. Moreover, we systematically screened the reference lists of (review)articles for other potentially relevant papers.

The search strategy was based on the combination of five different categories, which had the following keywords in the title or abstract:

  • 1.

    GP (general practitioner or family doctor

Review process

Fig. 1 outlines the method of article selection. A total of 182 studies were identified in the electronic literature search. Review of these abstracts however revealed that 173 articles did not met our criteria. Reference lists of collected (review)articles were screened for potentially relevant papers, resulting in another 32 articles. Finally, in total 41 studies about this topic were retrieved for this review and judged on its quality.

Main characteristics of the studies are summarized in

Discussion

First, we elaborated upon the content of advice about nutrition and physical activity, which was quite general. A common advice was “increase physical activity”. Although there were a lot of different approaches to obesity management, it seems like GPs only used a few. Obese patients reported a variety of interventions, but all frequencies showed to be lower than 20% [28]. In another study, almost 50% of obese patients reported that their GP had not recommended any of ten common weight loss

Conflict of interest

The authors declare that there are no conflicts of interest.

Acknowledgement

This research was supported by the Dutch Dairy Association.

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