Advertisement

U.S. Health Professionals’ Views on Obesity Care, Training, and Self-Efficacy

Published:February 17, 2015DOI:https://doi.org/10.1016/j.amepre.2014.11.002

      Background

      Despite emphasis of recent guidelines on multidisciplinary teams for collaborative weight management, little is known about non-physician health professionals’ perspectives on obesity, their weight management training, and self-efficacy for obesity care.

      Purpose

      To evaluate differences in health professionals’ perspectives on (1) the causes of obesity; (2) training in weight management; and (3) self-efficacy for providing obesity care.

      Methods

      Data were obtained from a cross-sectional Internet-based survey of 500 U.S. health professionals from nutrition, nursing, behavioral/mental health, exercise, and pharmacy (collected from January 20 through February 5, 2014). Inferences were derived using logistic regression adjusting for age and education (analyzed in 2014).

      Results

      Nearly all non-physician health professionals, regardless of specialty, cited individual-level factors, such as overconsumption of food (97%), as important causes of obesity. Nutrition professionals were significantly more likely to report high-quality training in weight management (78%) than the other professionals (nursing, 53%; behavioral/mental health, 32%; exercise, 50%; pharmacy, 47%; p<0.05). Nutrition professionals were significantly more likely to report high confidence in helping obese patients achieve clinically significant weight loss (88%) than the other professionals (nursing, 61%; behavioral/mental health, 51%; exercise, 52%; pharmacy, 61%; p<0.05), and more likely to perceive success in helping patients with obesity achieve clinically significant weight loss (nutrition, 81%; nursing, behavioral/mental health, exercise, and pharmacy, all <50%; p<0.05).

      Conclusions

      Nursing, behavioral/mental health, exercise, and pharmacy professionals may need additional training in weight management and obesity care to effectively participate in collaborative weight management models.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bleich S.N.
        • Bennett W.L.
        • Gudzune K.A.
        • Cooper L.A.
        National survey of U.S. primary care physicians’ perspectives about causes of obesity and solutions to improve care.
        BMJ Open. 2012; 2
        • Block J.P.
        • DeSalvo K.B.
        • Fisher W.P.
        Are physicians equipped to address the obesity epidemic? Knowledge and attitudes of internal medicine residents.
        Prev Med. 2003; 36: 669-675https://doi.org/10.1016/S0091-7435(03)00055-0
        • Foster G.D.
        • Wadden T.A.
        • Makris A.P.
        • et al.
        Primary care physicians’ attitudes about obesity and its treatment.
        Obes Res. 2003; 11: 1168-1177https://doi.org/10.1038/oby.2003.161
        • Flegal K.M.
        • Carroll M.D.
        • Ogden C.L.
        • Curtin L.R.
        Prevalence and trends in obesity among U.S. adults, 1999-2008.
        JAMA. 2010; 303: 235-241https://doi.org/10.1001/jama.2009.2014
        • Finkelstein E.A.
        • Trogdon J.G.
        • Cohen J.W.
        • Dietz W.
        Annual medical spending attributable to obesity: payer- and service-specific estimates.
        Health Aff (Millwood). 2009; 28: w822-w831
        • Kushner R.F.
        Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners.
        Prev Med. 1995; 24: 546-552https://doi.org/10.1006/pmed.1995.1087
        • Forman-Hoffman V.
        • Little A.
        • Wahls T.
        Barriers to obesity management: a pilot study of primary care clinicians.
        BMC Fam Pract. 2006; 7: 35https://doi.org/10.1186/1471-2296-7-35
        • Vetter M.L.
        • Herring S.J.
        • Sood M.
        • Shah N.R.
        • Kalet A.L.
        What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge.
        J Am Coll Nutr. 2008; 27: 287-298https://doi.org/10.1080/07315724.2008.10719702
        • Jay M.
        • Gillespie C.
        • Ark T.
        • et al.
        Do internists, pediatricians, and psychiatrists feel competent in obesity care?: using a needs assessment to drive curriculum design.
        J Gen Intern Med. 2008; 23: 1066-1070https://doi.org/10.1007/s11606-008-0519-y
        • Schwartz M.B.
        • Chambliss H.O.
        • Brownell K.D.
        • Blair S.N.
        • Billington C.
        Weight bias among health professionals specializing in obesity.
        Obes Res. 2003; 11: 1033-1039https://doi.org/10.1038/oby.2003.142
        • Price J.H.
        • Desmond S.M.
        • Krol R.A.
        • Snyder F.F.
        • O’Connell J.K.
        Family practice physicians’ beliefs, attitudes, and practices regarding obesity.
        Am J Prev Med. 1987; 3: 339-345
        • Kristeller J.L.
        • Hoerr R.A.
        Physician attitudes toward managing obesity: differences among six specialty groups.
        Prev Med. 1997; 26: 542-549https://doi.org/10.1006/pmed.1997.0171
        • Huizinga M.M.
        • Cooper L.A.
        • Bleich S.N.
        • Clark J.M.
        • Beach M.C.
        Physician respect for patients with obesity.
        J Gen Intern Med. 2009; 24: 1236-1239https://doi.org/10.1007/s11606-009-1104-8
        • Huang J.
        • Yu H.
        • Marin E.
        • Brock S.
        • Carden D.
        • Davis T.
        Physicians’ weight loss counseling in two public hospital primary care clinics.
        Acad Med. 2004; 79: 156-161https://doi.org/10.1097/00001888-200402000-00012
        • Mold F.
        • Forbes A.
        Patients’ and professionals’ experiences and perspectives of obesity in health-care settings: a synthesis of current research.
        Health Expect. 2013; 16: 119-142https://doi.org/10.1111/j.1369-7625.2011.00699.x
        • U.S. Preventive Services Task Force
        Screening for obesity in adults: recommendations and rationale.
        Ann Intern Med. 2003; 139: 930-932https://doi.org/10.7326/0003-4819-139-11-200312020-00012
        • Bleich S.N.
        • Pickett-Blakely O.
        • Cooper L.A.
        Physician practice patterns of obesity diagnosis and weight-related counseling.
        Patient Educ Couns. 2011; 82: 123-129https://doi.org/10.1016/j.pec.2010.02.018
        • Ma J.
        • Xiao L.
        • Stafford R.S.
        Adult obesity and office-based quality of care in the United States.
        Obesity (Silver Spring). 2009; 17: 1077-1085https://doi.org/10.1038/oby.2008.653
        • Stafford R.S.
        • Farhat J.H.
        • Misra B.
        • Schoenfeld D.A.
        National patterns of physician activities related to obesity management.
        Arch Family Med. 2000; 9: 631-638https://doi.org/10.1001/archfami.9.7.631
        • Moyer V.A.
        Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2012; 157: 373-378
        • Wadden T.A.
        • Volger S.
        • Sarwer D.B.
        • et al.
        A two-year randomized trial of obesity treatment in primary care practice.
        N Engl J Med. 2011; 365: 1969-1979https://doi.org/10.1056/NEJMoa1109220
        • Jensen M.D.
        • Ryan D.H.
        • Apovian C.M.
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.
        Circulation. 2014; 129 (suppl): S102-S1038
      1. Patient Protection and Affordable Care Act. Section 3502. Establishing community heath teams to support the patient-entered medical home. United States; 2010.

        • Bleich S.N.
        • Gudzune K.A.
        • Bennett W.L.
        • Cooper L.A.
        Do physician beliefs about causes of obesity translate into actionable issues on which physicians counsel their patients?.
        Prev Med. 2013; 56: 326-328https://doi.org/10.1016/j.ypmed.2013.01.012
        • Jay M.
        • Kalet A.
        • Ark T.
        • et al.
        Physicians’ attitudes about obesity and their associations with competency and specialty: a cross-sectional study.
        BMC Health Serv Res. 2009; 9: 106https://doi.org/10.1186/1472-6963-9-106
        • Zhu D.Q.
        • Norman I.J.
        • While A.E.
        Nurses’ self-efficacy and practices relating to weight management of adult patients: a path analysis.
        Int J Behav Nutr Phys Act. 2013; 10: 131
        • IOM
        Preventing Childhood Obesity: Health in the Balance.
        National Academies Press, Washington, DC2005
        • IOM
        Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.
        IOM, Washington, DC2012
        • Ogden J.
        • Bandara I.
        • Cohen H.
        • et al.
        General practitioners’ and patients’ models of obesity: whose problem is it?.
        Patient Educ Couns. 2001; 44: 227-233https://doi.org/10.1016/S0738-3991(00)00192-0
        • Epstein L.
        • Ogden J.
        A qualitative study of GPs’ views of treating obesity.
        Br J Gen Pract. 2005; 55: 750-754
        • Papas M.A.
        • Alberg A.J.
        • Ewing R.
        • Helzlsouer K.J.
        • Gary T.L.
        • Klassen A.C.
        The Built Environment and Obesity.
        Epidemiol Rev. 2007; 29: 129-143https://doi.org/10.1093/epirev/mxm009
        • Lovasi G.S.
        • Hutson M.A.
        • Guerra M.
        • Neckerman K.M.
        Built environments and obesity in disadvantaged populations.
        Epidemiol Rev. 2009; 31: 7-20https://doi.org/10.1093/epirev/mxp005
        • NCHS
        Table 1. Physician office visits, by selected physician characteristics: United States, 2010.
        NCHS, Washington, DC2011
        • Bennett W.L.
        • Gudzune K.A.
        • Appel L.J.
        • Clark J.M.
        Insights from the POWER practice-based weight loss trial: a focus group study on the PCP’s role in weight management.
        J Gen Intern Med. 2014; 29: 50-58https://doi.org/10.1007/s11606-013-2562-6
        • Appel L.J.
        • Clark J.M.
        • Yeh H.C.
        • et al.
        Comparative effectiveness of weight-loss interventions in clinical practice.
        N Engl J Med. 2011; 365: 1959-1968https://doi.org/10.1056/NEJMoa1108660
        • Romanova M.
        • Liang L.J.
        • Deng M.L.
        • Li Z.
        • Heber D.
        Effectiveness of the MOVE! Multidisciplinary weight loss program for veterans in Los Angeles.
        Prev Chronic Dis. 2013; 10: E112https://doi.org/10.5888/pcd10.120325
        • Reeves S.
        • Perrier L.
        • Goldman J.
        • Freeth D.
        • Zwarenstein M.
        Interprofessional education: effects on professional practice and healthcare outcomes (update).
        Cochrane Database Syst Rev. 2013; 3: CD002213
        • Pollak K.I.
        • Coffman C.J.
        • Alexander S.C.
        • et al.
        Can physicians accurately predict which patients will lose weight, improve nutrition and increase physical activity?.
        Family Pract. 2012; 29: 553-560https://doi.org/10.1093/fampra/cms004
        • Cheng T.L.
        • DeWitt T.G.
        • Savageau J.A.
        • O’Connor K.G.
        Determinants of counseling in primary care pediatric practice: physician attitudes about time, money, and health issues.
        Arch Pediatr Adolesc Med. 1999; 153: 629-635https://doi.org/10.1001/archpedi.153.6.629
        • Jelalian E.
        • Boergers J.
        • Alday C.S.
        • Frank R.
        Survey of physician attitudes and practices related to pediatric obesity.
        Clin Pediatr (Phila). 2003; 42: 235-245https://doi.org/10.1177/000992280304200307