N° 24 | September 2017

Importance of doctors’ recommendation on diet and nutrition: Data on disparities among the US adult population over a decade

Decades of studies have shown the importance of proper nutrition in the health of individuals and populations. Although Americans have gradually adopted better eating habits, 90% of them still fall short of the American dietary recommendations (Healthy Eating Index – HEI). Poor eating habits are a major risk factor in four of the ten causes of preventable death: cardiovascular diseases, cancer, strokes and type-2 diabetes. One-third of premature deaths are attributed to improper dietary habits and sedentary lifestyle. Physicians are trustworthy and well respected for their expertise to guide their patients to healthy lifestyle including diet and nutrition.

Nutritional awareness remains low among the general public and people have a poor idea of their own dietary intake balance. Even though those with a diet-related disease pay more attention to the quality of their food, they are still a long way off from following the HEI recommendations. Understanding dietary information remains difficult for many people, especially those from a poor socioeconomic background and thus are at a higher risk of suffering diet-related diseases. However, raising awareness alone is not the perfect solution. There is a need for an authoritative and trustworthy guidance.

Effectiveness of dietary guidance from physicians

Patients are particularly receptive to counsel on healthy living which is provided during consultations with their doctor since they consider their doctor to be the best source of this type of information. As for the physicians, they are in a good position to help their patients adopt healthier habits in the long term. Short dietary-advice sessions are effective in changing the eating habits of patients and improving their health, especially among those who suffer or are at risk from diseases connected to poor diets.

Reduce health expenditure by at least $87 billion a year!

If the benefits to individuals are indisputable, the use of such information across the country could have an even greater impact on the population. Direct and indirect health expenditure could be reduced by at least $87 billion every year, while deaths from coronary diseases or diabetes would fall by between 20% and 30%.

In 2000, the Healthy People Objectives, under the aegis of the Center for Disease Control and Prevention (CDC), underlined the importance of dietary counseling and even considered it a national health indicator. However, such counseling by doctors has remained infrequent. Nutritional counseling during consultations has only occurred among 14% of patients.

Few studies have looked into the influence of associated factors on receiving dietary advice (socio-demographic characteristics, healthcare access, health condition, etc.), and their results have often proved contradictory. Furthermore, since the recommendations on such counseling, very few studies have examined the disparities between patients over an extended timeline and at a national level.

National Health Interview Survey results for 2000 and 2011

To mitigate this deficiency, we used the 2000 and 2011 results of the National Health Interview Surveys (a cross-sectional study based on a wide representative sample of the American population). The receipt of dietary counseling was measured by asking subjects if they had talked to a doctor or healthcare professional during the previous 12 months and had received information on nutrition at that time.  Six variables were selected to study their possible correlations with the medical advice: age, gender, ethnicity, education level, insurance coverage status and BMI.
For the years 2000 and 2011, the sample comprised 23,656 and 26,937 subjects respectively. We used a logistic regression model to examine the correlations.

Whereas only 23.7% subjects in 2000 had received nutritional counselling from their physician, the figure rose to 32.6% for 2011. During the same period, the percentage of subjects who were overweight or obese increased from 61.5% to 64%. Increase in nutritional counselling prevalence with:

  • Age
    Adults between 45 and 74 years of age were more readily counselled than younger patients (18–24 age group). For patients over 75, the prevalence of advice had a downward trend between 2000 and 2011. Conversely, 2011 showed an increase in advice given to younger patients (18–24), possibly linked to the increased obesity among young people and acknowledgement of this among doctors.
  • BMI
    Obese subjects were more often given advice on healthy eating than those at a normal weight, and the difference was even greater in 2011.
  • Education level
    The probability of receiving dietary advice increased with the level of education (better understanding, easier communication with the doctor).
  • Insurance coverage
    Patients without insurance received less counselling. This disparity was even more acute in 2011, with a probability of -60%.
  • Gender
    In 2011, male patients were significantly less likely to have received nutritional counseling than female patients in 2000.
  • Ethnicity
    Hispanics were 26% less likely to receive nutritional counselling than white people in 2000. On the other hand, they were 18% more likely in 2011. Likewise, blacks (non-Hispanics) were 42% more likely to receive such advice than whites in 2011 (this turnaround was probably connected to the Healthy People national efforts and the increase in obesity among these populations over the 11 years). It is encouraging that the prevalence of diet-related advice given by physicians mildly increased over a decade. However, there are still significant differences among the population in large part due to healthcare access and gender.

Based on: Ahmed NU, Delgado M, Saxena A. Trends and disparities in the prevalence of physicians’ counseling on diet and nutrition among the U.S. adult population,
2000-2011. Prev Med. 2016 Aug; 89: 70-5.

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