ReviewNutrition and physical activity guidance practices in general practice: A critical review
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.
References (73)
- et al.
Consumers’ expectations about nutrition guidance: the importance of primary care physicians
Am J Clin Nutr
(1997) - et al.
How can and do Australian doctors promote physical activity?
Prev Med
(1997) - et al.
Speaking of weight: how patients and primary care clinicians initiate weight loss counseling
Prev Med
(2004) - et al.
Evaluating primary care behavioral counseling interventions: an evidence-based approach
Am J Prev Med
(2002) - et al.
Physician recommendations for diet and physical activity: which patients get advised to change?
Prev Med
(1997) - et al.
Counseling overweight in primary care: an analysis of patient–physician encounters
Patient Educ Couns
(2010) - et al.
Physician attitudes toward obesity: differences among six specialty groups
Prev Med
(1997) - et al.
Predictors of weight control advice in primary care practices: patient health and psychosocial characteristics
Prev Med
(2005) - et al.
Direct observation of nutrition counseling in community family practice
Am J Prev Med
(2002) - et al.
Patient–physician gender concordance and weight-related counseling of obese patients
Am J Prev Med
(2011)