Receipt of exercise and nutrition counseling and barriers to behavior change among overweight and obese adults in a low-income, community-based sample

Background: Despite US Preventive Services Task Force guidelines to provide exercise and nutrition counseling to overweight and obese patients, national studies have demonstrated low rates of preventive counseling for these patients and that rates of obesity continue to increase. Because of the diverse assets and needs of the communities in which individuals live and work, local data are needed to better develop and target interventions to address obesity. We sought to determine 1) prevalence and correlates of receipt of exercise and nutrition counseling and 2) barriers to exercise and healthy diet among overweight and obese individuals in our community.

Methods: Using data from a 2009 community-based health survey in New Haven, CT, we included respondents who reported seeing a physician in the previous 12 months and being told they were overweight or obese (N=325). Logistic regression was used to examine associations between sociodemographic characteristics, health care utilization, and number of comorbidities (0, 1-2, ≥3) and receipt of exercise and nutrition counseling. We further explored potential barriers to exercise and healthy diet in this sample.

Results: The majority of the sample was female (75%), African-American (68%), and insured (88%). Although a number of demographic characteristics were associated with receipt of nutrition or exercise counseling, once these were controlled for, only the number of comorbidities remained a significant predictor. Those with 3 or more comorbidities were almost 3 times more likely to receive nutrition counseling and almost 4 times more likely to receive exercise counseling, when compared to those with zero comorbidities. Interestingly, there was no significant association between nutrition counseling and reporting avoiding unhealthy foods, and receiving exercise counseling and reporting regular exercise. Those with more comorbidities were also more likely to report both health reasons as a barrier to exercise and poor access to healthy foods.

Conclusions: Among overweight and obese individuals, increasing numbers of comorbidities was associated with greater likelihood of exercise and nutrition counseling, but also greater barriers to exercise and healthy diet. Physicians should provide nutrition and physical activity counseling to overweight and obese patients who have not yet developed comorbidities, in order to address weight management and prevent future comorbidity. Physicians who provide this counseling should tailor it to patients' needs, including barriers to diet and exercise-related behavior change.