Exercise, diet, and weight loss advice in the family medicine outpatient setting

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 was to discover the extent to which the 5A's heuristic is used to discuss exercise, diet, and weight loss during adult primary care visits and to test if individuals with a greater body mass index (BMI) or a chronic disease are more likely to receive more-comprehensive advice.

We performed a cross-sectional direct observation study of 300 family medicine outpatient visits. Using the 5A's heuristic, the content of each discussion of exercise, diet, and weight loss was documented by an observer.

Discussion of exercise, diet, or weight loss occurred in 56% of observed visits, and physicians initiated the majority of 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 those with 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 combination of advice and assistance, compared to physician-initiated discussions.

Physicians target exercise, diet, and weight loss advice to obese patients and those with chronic conditions. However, the content of the advice rarely includes recommended components that could increase healthy behavior change. Understanding how patients initiate health behavior topics that prompt physicians to provide advice and assistance could lead to patient and physician interventions that increase productive health behavior change discussions.