Knowledge of energy balance guidelines and associated clinical care practices: The U.S. National Survey of Energy Balance Related Care among Primary Care Physicians☆
Highlights
► We assess primary care physicians’ knowledge of energy balance related guidelines. ► We examine associations with physician characteristics and clinical care practices. ► Knowledge of guidelines among physicians treating children was low. ► Knowledge of obesity-related guidelines among physicians treating adults was high. ► In general, knowledge of guidelines was not related to clinical care practices..
Introduction
Obesity represents a significant public health concern. Possible solutions include the role of primary care physicians (PCPs) in promoting healthy diet, physical activity, and weight status among their patients. Patients regard their PCP as an important source of information related to nutrition (Tillotson, 2006), physical activity (Calfas et al., 1996), and weight (Galuska et al., 1999). Recent data from the National Survey of Energy Balance Related Care among Primary Care Physicians (EB-PCP) suggest that PCPs do not consistently assess, counsel, and follow-up with patients on their diet, physical activity and weight control (energy balance) practices, whether they treat children (Huang et al., 2011) or adults (Smith et al., 2011). Knowledge deficits represent an important barrier to provision of weight-related care (Vetter et al., 2008). The purpose of this study is to assess PCPs' knowledge of physical activity-, diet-, and weight-related guidelines and their association with sociodemographic characteristics and energy balance-related clinical care practices.
Section snippets
Data source
Between March and September, 2008, 3145 participants in the EB-PCP, a nationally representative survey of actively practicing PCPs in the U.S. received a questionnaire and 2027 surveys were returned. The subject sample was obtained from the American Medical Association's Physician Masterfile (AMA, 2010). We excluded 251 surveys due to missing data for a final of 1776 surveys (1060 PCPs treating adults and 716 treating children) across four specialties (Internal Medicine (n = 342), Obstetrics and
Results
The EB-PCP response rate was 64.5%. For PCPs treating children, knowledge of guidelines for healthy BMI percentile, physical activity, fruit and vegetables, and all guidelines simultaneously were 36.5%, 27.0%, 62.9%, and 10.6%, respectively. For PCPs treating adults, knowledge of guidelines for overweight, obesity, physical activity, fruit and vegetables, and all guidelines simultaneously were 81.4%, 81.3%, 70.9%, 63.5%, and 40.6%, respectively. (Data shown in Appendix A.)
Table 1 shows, among
Discussion
Weight-related clinical guidelines were first published over a decade ago (NIH, 1998), and obesity is widely recognized as a clinical concern. However, physical activity guidance has not focused on PCPs, and diet and physical activity-related guidelines have, until recently, not been supported by strong evidence of clinical effectiveness (Lin et al., 2010).
Knowledge of weight-related guidelines did correlate with more assessment of BMI and use of BMI-for-age growth charts. Clinical use of
Conclusions
Energy balance guidelines knowledge among PCPs treating children is low, whereas among PCPs treating adults it is relatively high for weight-related guidelines but moderate for physical activity and fruit and vegetables intake. Knowledge of all guidelines simultaneously is low for all PCPs. Knowledge appears largely unrelated to clinical care. Addressing gaps in knowledge is important; however, it is unlikely that knowledge improvement alone will be sufficient to generate improvements in
Conflict of interest statement
The authors of this paper declare there are no conflicts of interest.
Acknowledgments
Data collection for this survey was supported by the National Cancer Institute's contract no. N02-PC-61301. We would like to thank the following members of the Department of Health and Human Services' survey development team and outside consultants:
National Cancer Institute: Ashley Wilder Smith, Steven Clauser, Rachel Ballard-Barbash, Carrie Klabunde, Susan M. Krebs-Smith, Laurel Borowski, Emily Dowling, Gordon Willis, Richard Troiano, Audie Atienza, Tanya Agurs-Collins, Bill Davis.
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Disclaimer: The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health or the Centers for Disease Control and Prevention.