Physician recommendations for diet and physical activity: which patients get advised to change?

National objectives and guidelines call upon physicians to help reduce the population burden of chronic diseases by advising patients to eat less fat and get more physical activity. However, studies show physicians are most likely to provide behavioral recommendations to patients who are already sick. Understanding factors that influence physicians' advising decisions can help broaden the reach of these activities.

Subjects were 915 adult patients and 27 physicians from four community-based family medicine clinics in southeastern Missouri. To participate, patients completed a self-administered behavioral and health questionnaire while waiting to see their doctor.

Having a high body mass index was the strongest predictor of receiving advice to increase physical activity (OR = 1.6; 95% CI 1.3, 2.0), and having a high cholesterol level was the strongest predictor of receiving advice to eat less fat (OR = 1.9; 95% CI 1.5, 2.4). Neither the actual content of patients' diets nor their levels of physical activity were associated with receiving advice.

Physicians' advising may be guided by quick but fallible heuristics that systematically exclude patients whose needs are not easily visible. This pattern misses the opportunity to reduce future needs for therapeutic counseling by taking preventive action now.