Although many obese patients do not engage in adequate physical activity (PA), little is known about whether physicians discuss environmental barriers in promoting PA. We conducted this study to describe physicians’ views about discussing environmental barriers in promoting PA with obese patients and determine whether counseling varies by years of practice. We conducted an online survey of family physicians practicing in 17 clinics in Central Texas. We performed descriptive analysis on barriers to PA, counseling on meeting PA recommendation, and written prescription for exercise and bivariate analysis by years of practice. Statistical significance was set at p < 0.05. Of 96 physicians invited, 57 (59.4%) completed the survey. Majority reported their obese patients brought up the environment as a barrier to walking (89.3%) or PA (91.2%). Majority (80.7%) also reported asking about environmental barriers to walking, with 84.2% giving specific examples to overcome these barriers. While 96.5% reported advising their obese patients about meeting the PA recommendation, only 26.3% reported giving them a written prescription for exercise. These did not vary significantly by years of practice. Physicians felt having more time with their patients and knowing specific strategies to overcome environmental barriers, safe places in patients’ neighborhoods, and what environmental factors influence PA may help discuss environmental issues with their obese patients. Physicians want and counsel their obese patients to be physically active, but do not generally give prescriptions for exercise irrespective of years of practice. They also want tools to enhance their abilities to better assist these patients.
Obesity is a growing health problem worldwide. It affects Americans of all ages across the entire nation [
The physical environment may have a major influence on physical activity by acting both as a barrier and as a facilitator [
Healthcare providers have a role in promoting physical activity. Physicians generally recommend increasing physical activity to patients, albeit less so to their overweight and obese patients [
Working in collaboration with the Central Texas Primary Care Research Network (CenTexNet), a primary care Practice-Based Research Network (PBRN) based in Temple, Texas, we conducted a cross-sectional on-line survey using the website of the Agency for Healthcare Research and Quality’s PBRN Resource Center. The study setting was 17 primary care clinics of a large university-affiliated, multi-specialty group practice associated with a 250,000-member health maintenance organization in Central Texas. All the clinics were affiliated with CenTexNet and were staffed by a total of 100 family physicians. The study was conducted from October of 2008 through January of 2009. Both the Scott & White Healthcare and the Texas A&M University Institutional Review Boards reviewed and approved the study protocol. No written informed consent was sought from subjects for study participation.
Study subjects were all family physicians practicing in the 17 primary care clinics, who were all members of CenTexNet. They were enrolled voluntarily and provided a link to the PBRN Resource Center website to access the survey via e-mail.
To inform the development of our survey instrument, we visited with our network physicians during one of their monthly meetings to solicit their ideas and opinions on areas of particular interest to them regarding obesity, physical activity, and the physical environment. We also discussed their awareness of environmental barriers that might affect their recommendations for increasing physical activity, as well as the survey formatting and length. Based on the visit, the survey instrument was designed to obtain data on: 1) physicians’ opinions about physical activity and neighborhood environments; 2) physicians’ interactions with their typical obese patients regarding physical activity during their last few clinic encounters; 3) their assessments of obese patients’ engagement in physical activity and walking specifically; 4) physicians’ likelihood of bringing up environmental issues and concerns related to physical activity and walking during clinic encounters with their obese patients; 5) physicians’ perceptions about environmental barriers to physical activity and walking for obese patients; 6) physicians’ perceptions about good walking environments for obese patients; and 7) physicians’ own physical activity behaviors and practices.
The final survey instrument included ordinal-scale questions such as “Strongly agree to strongly disagree” (4 items), “Often-Sometimes-Never” (3 items), and “Very important-Somewhat important-Not at all important” (3 items), “Yes-No” (2 items), and open-ended questions, along with questions on basic demographic data. No individually identifiable information such as name and age was collected. A copy of the contents of the survey can be obtained from the lead author.
Data management and analysis were performed using SPSS version 17. We first compared the respondents and non-respondents using the chi-square statistic. We then performed descriptive analysis on barriers to PA, counseling on meeting PA recommendation, and written prescription for exercise and bivariate analysis by years of practice. Statistical significance was set at p < 0.05. Given the small sample size and lack of adequate descriptive information about the physicians, we were not able to perform more multivariate analyses.
Of all the 100 physicians initially invited to participate in the study, four were deemed ineligible due to one respondent being on maternity leave, one leaving their practice, one not providing continuity care, and one being a dietician. Of the 96 eligible physicians, 57 completed the survey resulting in a 59.4% response rate. Respondents were similar to non-respondents by gender, with 70.2% of respondents being male versus 71.8% of non-respondents (p = 0.95).