Exercise, Diet, and Weight Loss Advice in the FamilyMedicine Outpatient Setting

摘要

BACKGROUND: The 5A's heuristic (Ask, Assess willingness to change, Advise, Assist, and Arrange followup)has been proposed as a general approach to brief health behavior advice. This study's purpose wasto discover the extent to which the 5A's heuristic is used to discuss exercise, diet, and weight loss duringadult primary care visits and to test if individuals with a greater body mass index (BMI) or a chronicdisease are more likely to receive more-comprehensive advice. METHODS: We performed a cross-sectionaldirect observation study of 300 family medicine outpatient visits. Using the 5A's heuristic, the content ofeach discussion of exercise, diet, and weight loss was documented by an observer. RESULTS: Discussionof exercise, diet, or weight loss occurred in 56% of observed visits, and physicians initiated the majorityof the discussions. Advice infrequently included offer of assistance (range 14%-17%) or plans for follow-up (range 3%-10%). Physicians were more likely to provide advice to obese patients and to thosewith one chronic condition. Twenty percent to 47% of patient-initiated discussions led to no advice.However, trend also suggests that patient-initiated discussions were more likely to lead to a combinationof advice and assistance, compared to physician-initiated discussions. CONCLUSIONS: Physicians targetexercise, diet, and weight loss advice to obese patients and those with chronic conditions. However, thecontent of the advice rarely includes recommended components that could increase healthy behaviorchange. Understanding how patients initiate health behavior topics that prompt physicians to provideadvice and assistance could lead to patient and physician interventions that increase productive healthbehavior change discussions.