249719 Receipt of exercise and nutrition counseling and barriers to behavior change among overweight and obese adults in a low-income, community-based sample

Tuesday, November 1, 2011

Karen Wang, MD , Department of Medicine, Yale University School of Medicine, New Haven, CT
Justin Fox, MD , Department of Medicine, Yale University School of Medicine, New Haven, CT
Mayur M. Desai, PhD, MPH , Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
Amy Carroll-Scott, PhD, MPH , School of Public Health, Community Alliance for Research and Engagement, Yale University, New Haven, CT
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.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
1) To increase health care providersí awareness of barriers overweight and obese patients have with physical activity and nutrition counseling 2) To discuss the use of local data for better tailored obesity prevention and treatment interventions

Keywords: Prevention, Obesity

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am a primary care physician and a post-doctoral fellow in health services research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.