Letter

International Journal of Obesity (2005) 29, 251–253. doi:10.1038/sj.ijo.0802840 Published online 9 November 2004

Physicians recommendations for and personal use of low-fat and low-carbohydrate diets

This work was presented in part at the 4th Annual University of Chicago Conference on Alternative Medicine, Chicago, Illinois, December 13, 2002.

J La Puma1, P Szapary2 and K C Maki3

  1. 1Santa Barbara Institute for Medical Nutrition and Healthy Weight (a division of CHEF Clinic™), Santa Barbara, CA, USA
  2. 2Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
  3. 3Radiant Development, Chicago, IL, USA
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Introduction:

Little is known about the prevalence of overweight and obesity in physicians. Studies find that between 30 and 58% define themselves as overweight, and 8–18% as obese.1,2 As part of a physician survey of personal weight management strategies, we investigated physicians' own personal dieting behavior and their diet recommendations to their patients.

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Methods:

We conducted a descriptive, cross-sectional study using an anonymous mailed questionnaire of a large, suburban, community, nonteaching Midwestern hospital in Fall 2001 as previously reported.3 We surveyed the entire active, current medical staff (MD or DO degree), totaling 538. We asked 'In the last 5 y, have you followed any of the following diets yourself?'; and 'In the last 5 y, have you prescribed or recommended any of the following diets for your patients?'

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Results:

Of the 536, 402 (75%) responses were returned; 394 (74%) included weight and height data. Most responders were male (75%); mean age was 45plusminus9 y (s.d.). Over 83% spent more than 75% of their work time in direct patient care. Average body mass index (BMI) was 25.1plusminus3.32 kg/m2; 44% were overweight, including 8% obese (BMI>30 kg/m2). Nonrespondents did not differ with respect to age, gender, and physician specialty.

Most respondents had not attempted to follow a diet in the past 5 y, including most overweight physicians (126 or 72%). Of the 97 actual diet attempts, 66 (67%) were by overweight physicians (Table 1). Equal percentages of respondents had followed popular low-carbohydrate and low-fat diets (9% each). Overall, 37 attempts (38%) were for low-carbohydrate diets; 31 (32%) were for low-fat diets; and 29 (30%) were for other or unspecified diets.


In contrast, most physician recommendations (225 of 334, or 67%) were for popular low-fat diets. Most physicians making recommendations (56%) recommended low fat; only 16% of physicians recommended low carbohydrate. Nearly half (196 or 49%) of all respondents reported not recommending any diet, although a greater percentage of overweight physicians (n=94 (54%)) had recommended a diet than had healthy weight physicians ((n=106 (48%) (P=NS)).

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Comment:

Review of a national registry of successful dieters maintaining a 30 pound or greater weight loss shows that most follow their own individualized, primarily low-fat diet, not popular or commercial diets.4 The diets which physician respondents recommended most to their patients, however, tend to be commercial. These are aggressively marketed, have a prominent social component and result in a mean of 6 pounds sustained weight loss at up to 2 years.5

We believe that physicians tended to follow lower carbohydrate diets because of their effectiveness, at least short term; because of their promotion; and because of their initial gustatory appeal. The data likely understate the current true difference between personal use of and patient recommendations for low-carbohydrate diets, given their recent increased fashionableness.

Managed care as an industry has been criticized for noncoverage of obesity-related treatments. Medicare now considers obesity to be a disease or illness, but it recognizes gastric bypass surgery as treatment for diabetes or heart disease, not obesity. Federal coverage for medical nutrition therapy has been increased, but obesity is not a covered diagnosis. State Medicaid programs vary widely in their coverage of medications and operations, and requirements for coverage.

Yet the prescription of a particular diet or eating plan, with careful follow-up and monitoring, is not an out-of-pocket expense—for the plan, provider, or the patient. It costs only attention to the patient, record-keeping, and the time it takes to identify BMI, and the patient's state-of-readiness to change, and to agree on personal medical goals and a plan.

While the sample size of physicians is small and may be representative only of the community identified, it does suggest that physicians seldom prescribe diets, although when they do, there is discordance between their personal use of and patient recommendation for popular diets. Physicians can and should begin to prescribe particular eating plans for their patients.

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Disclosures:

Dr La Puma has received compensation from 1999 to 2004 for consulting with medical conference sponsors to create and supervise healthful conference meals. Dr Maki has received honoraria, research stipends, and/or consulting fees related to products or research on weight management from: Roche Pharmaceuticals, Ross Products Division of Abbott Laboratories, Kao Corporation, Glanbia Foods, AMBI Corporation, and General Mills. Dr Szapary has nothing to declare.

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References

  1. Neser WB, Thomas J, Semenya K, Thomas DJ & Gillum RF. Obesity and hypertension in a longitudinal study of black physicians: the Meharry Cohort Study. J Chron Dis 1986; 39: 105−113. | Article | PubMed | ChemPort |
  2. Frank E, Wright EH, Serdula MK, Elon LK & Baldwin G. Personal and professional nutrition-related practices of US female physicians. Am J Clin Nutr 2002; 75: 326−332. | PubMed | ChemPort |
  3. La Puma J, Szapary P & Maki KC. Physicians' personal intake and prescription of weight loss products: are we practicing what we preach? Arch Intern Med 2004; 164: 806−807. | Article | PubMed |
  4. Wing RR & Hill JO. Successful weight loss maintenance. Annu Rev Nutr 2001; 21: 323−341. | Article | PubMed | ChemPort |
  5. Heshka S, Anderson JW, Atkinson RL, Greenway FL, Hill JO & Phinney SD et al. Weight loss with self-help compared with a structured commercial program: a randomized trial. JAMA 2003; 289: 1792−1798. | Article | PubMed |
  6. Freedman MR, King J & Kennedy E. Popular diets: a scientific review. Obes Res 2001; 9 Suppl 1: 1S−40S. | PubMed | ChemPort |

Supplementary Information accompanies the paper on International Journal of Obesity website (http://www.nature.com/ijo).

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