Physicians facing the challenge of nutrition
Dietary advice provided by general practitioners: what do patients expect?
Most general practitioners consider that dietary education is one of their roles1. However, if it is not requested by patients, the fear of appearing moralising or overly intrusive is a common barrier to discussing diet during consultations1,2. Are these concerns valid? What do patients expect in terms of dietary advice?
As part of a cross-sectional quantitative study, 800 questionnaires were distributed in the waiting rooms of urban and rural practices in the Mayenne département of France, of which 500 were recovered. The 485 questionnaires containing at least demographic data on gender and age were considered usable. The average age of the patients was 48 years; 76% of them were women. Fifty-three percent reported a disease, including 6% obesity.
More than 90% of patients would like to receive dietary advice from their doctor
The results show that more than 90% of respondents want to be weighed at least once a year by their doctor; two-thirds of patients regularly weigh themselves. More than 90% of patients would like to receive dietary advice; the main motivation found was excess weight and then a will to help family or friends. The majority prefer oral advice (72%) and less than one in five patients would like a detailed daily meal plan. Few request advice at every consultation (8.6%) but most do in the event of a diet-related disease (80%). Patients tend to request more advice as they age and if they have a diet-related health problem.
Time devoted to diet: too short for 50% of patients
Half of the respondents think the time devoted to diet is too short and the other half consider it is sufficient, with significant differences between age groups: unlike older patients, those under the age of 45 are more likely to think the time devoted to diet is too short. Fifty-six percent of patients said they would be willing to have a diet-specific consultation and three-quarters think it is beneficial for their doctor to discuss diet with them, believing it could change their habits. General practitioners are the main source of dietary information for only 20% of patients but this increases sharply in the event of a disease. The respondents look for information mainly on the internet and then in the written press and on TV.
One in two men is interested in receiving advice about the frequency of consuming fruit and vegetables
Thirty-three percent of patients are interested in such advice while more than 55% said they are already aware of this guideline. Unlike older patients, those under the age of 45 have better knowledge of the French National Nutrition and Health Programme (PNNS) guideline “at least five fruit and vegetables per day” and are less likely to request advice. Men are most likely to request advice regarding the frequency of consuming fruit (45%) and vegetables (43%) (respectively 30% for women).
Patients who say their doctor is their main source of information are significantly more likely to request information regarding the frequency of consuming fruit and vegetables. Slightly more than 45% would like advice about snacking.
The barriers mentioned by doctors are not obstacles for patients
Although doctors consider that the overly intimate nature of diet is a barrier to dietary advice1,2, only a minority of patients are afraid of being judged when talking about their diet (10%). Diet is viewed as being too personal for doctors to discuss if they have not requested it by 6.8% of patients. This fear of discussing diet is more common for patients under the age of 45, women, and people describing themselves as too fat to receive dietary advice.
Another obstacle mentioned by doctors was a lack of effectiveness2,3, and yet the majority of patients think it is beneficial for their doctor to discuss their diet with them, and three-quarters think it could help them change their eating habits.
Lastly, another barrier mentioned by doctors was a lack of time during consultations2,3,4,5; one solution would be to propose a consultation devoted to diet only: the majority of patients said they would be willing to come to such a consultation. In spite of everything, another study showed that the majority of patients take advantage of another consultation to ask their diet-related questions6; therefore, doctors should initiate this dedicated consultation.
“May food be your best medicine”
Patients are therefore attentive to the impact of diet on their health. They request advice in the event of a diet-related disease but have little awareness of primary prevention. They are not afraid of being judged by their general practitioner when talking about their diet and think it is beneficial for their doctor to discuss it with them. This confirms that general practitioners are providers of dietary advice and should motivate them to address the issue of diet, even when patients do not request it.
According to: Labbé L. Conseils nutritionnels par le médecin généraliste : attente des patients (Dietary advice from general practitioners: patient
expectations). Dissertation for the State diploma of Doctor in Medicine. 2015-2016.
- Gruaz D, Fontaine D. Médecins généralistes et éducation nutritionnelle en rhônealpes. observatoire régional de la santé rhône-alpes. 2004. [en ligne] http://www.orsrhone-alpes.org/pdf/nutrition_2004.pdf.
- Lehr-Drylewicz A-M, Renoux C, Savan L, Lebeau J-P. La prise en charge du surpoids en médecine générale : mission impossible ? exercer. 2010 ; n°94 : 130-135
- Brotons C, Ciurana R, Piñeiro R, Kloppe P, Godycki-Cwirko M, Sammut MR. Dietary advice in clinical practice : the views of general practitioners in europe. the american journal of clinical nutrition. 2003; 77(4 suppl) : 1048s-1051s.
- Fantino B. et al, Pratiques préventives en médecine générale en région rhônealpes. santé publique. 2004/3 ; vol. 16 : 551-562.
- Guerin R, Lasserre E, Moreau A, Guioux A, Le Goaziou M-F, Faville M, Letrilliart L. Surpoids de l’adulte jeune : le poids des mots, le choc des représentations. exercer. 2008 ; n°84 : 135-141.
- Valin-Le Madec M. Recommandations alimentaires en médecine générale. thèse de médecine. université nantes ; 2004, 87p.