How physicians view the causes of obesity may impact the advice they give their patients. The findings are from a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health who compared the relationship between primary care physicians’ beliefs about the causes of obesity with the frequency of nutritional counseling. They found that physicians who believed over consumption of food to be a major contributor to obesity were significantly more likely to counsel their patients to modify nutritional habits. The results are featured in the February 2013 issue of Preventive Medicine.

“Our study found that primary care physicians, who believed that overeating was a very important cause of obesity had significantly greater odds of counseling their obese patients to reduce portion sizes, avoid high-calorie ingredients when cooking and reduce sugar-sweetened beverage intake. Similarly, primary care physicians who associate sugar-sweetened beverage consumption as a primary cause of obesity were significantly more likely to advise their patients to cut back on sugary beverages such as soda and juices,” said Sara Bleich, PhD, lead author of the study and an associate professor with the Bloomberg School’s Department of Health Policy and Management. “Improved primary care physician education related to the causes of obesity may be a feasible strategy for increasing the frequency of nutritional counseling - particularly concrete dietary tips that primary care physicians can easily share with their patients.”

Bleich, along with colleagues from the Bloomberg School of Public Health and the Johns Hopkins School of Medicine, analyzed a national cross-sectional Internet-based survey of 500 U.S. primary care physicians collected between February and March of 2011.

Researchers assessed physician beliefs about the causes of obesity with the question, “How important is each of the following possible causes of obesity for your patients?” Possible causes included overconsumption of food, restaurant or fast food eating, consumption of sugar-sweetened beverages, genetics or family history and metabolic defect. For each cause, primary care physicians indicated whether it was very important, somewhat important, not very important, or not at all important. Nutritional counseling habits were assessed using the question, “How frequently do you provide each of the following types of nutritional counseling to your obese patients?” Nutritional recommendations included reading nutritional labels to determine calorie or nutrition content, avoiding high-calorie ingredients when cooking, avoiding high calorie menu items when eating outside the home, reducing consumption of sugar-sweetened beverages and reducing portion size. For each nutritional recommendation, primary care physicians indicated whether they provided it very frequently, somewhat frequently, not very frequently or not at all frequently.

“Eighty-six percent of primary care physicians indicated that overconsumption of food is a very important cause of obesity, followed by 62 percent of physicians reporting that restaurant or fast food eating is a very important cause and 60 percent attributing consuming sugar sweetened beverages as a very important cause,” noted Bleich. Few physicians reported genetics, family history or metabolic defect as an important cause of obesity.

“Do physician beliefs about causes of obesity translate into actionable issues on which physicians counsel their patients?” was written by Sara N. Bleich, Kimberly A. Gudzune, Wendy L. Bennett and Lisa A. Cooper.

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Natalie Wood-Wright
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Johns Hopkins University Bloomberg School of Public Health