PHYSICIAN RECOMMENDATIONS FOR DIET AND PHYSICAL-ACTIVITY - WHICH PATIENTS GET ADVISED TO CHANGE

Background. National objectives and guidelines call upon physicians to help reduce the population burden of chronic diseases by advising pat ients 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 influenc e physicians' advising decisions can help broaden the reach of these a ctivities. Methods. Subjects were 915 adult patients and 27 physicians from four community-based family medicine clinics in southeastern Mis souri. To participate, patients completed a self-administered behavior al and health questionnaire while waiting to see their doctor. Results . Having a high body mass index was the strongest predictor of receivi ng advice to increase physical activity (OR = 1.6; 95% CI 1.3, 2.0), a nd having a high cholesterol level was the strongest predictor of rece iving 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 activit y were associated with receiving advice. Conclusions. Physicians' advi sing may be guided by quick but fallible heuristics that systematicall y exclude patients whose needs are not easily visible. This pattern mi sses the opportunity to reduce future needs for therapeutic counseling by taking preventive action now. (C) 1997 Academic Press.