Half of all U.S. physicians have not recommended a popular or commercial dietary program to their patients in the past 5 years, according to a new study published in the International Journal of Obesity.
Almost half of the physicians�44 percent (174)– were overweight or obese. More of the overweight physicians (94, 54 percent) recommended a popular diet than did healthy weight physicians (106, 48 percent).
Successful dieters maintaining a 30 pound or greater weight loss usually follow their own individualized, primarily lower fat diet, not popular, low carb or commercial diets, write Drs. John La Puma MD, Philippe Szapary MD of the University of Pennsylvania and Kevin Maki, PhD now of Provident Clinical Research. The study was supported by the NIH and CHEF Clinic …
UNCORRECTED PROOF
LETTER
Physicians recommendations for and personal use of
low-fat and low-carbohydrate diets
International Journal of Obesity (2004) 0, 000�000. doi:10.1038/sj.ijo.0802840
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.
Methods
We conducted a descriptive, cross-sectional study using an
anonymous mailed questionnaire of a large, suburban,
community, nonteaching Midwestern hospital in Fall 2001.
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?�
Results
Of the 536, 402 (75%) responses were returned; 394 (74%)
included weight and height data. Most responders were male
(75%); mean age was 4579 y (s.d.). Over 83% spent more
than 75% of their work time in direct patient care. Average
body mass index (BMI) was 25.173.32 kg/m2; 44% were
overweight, including 8% obese (BMI430 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)).
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.3 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.4
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. Even Medicare
does not consider obesity to be a disease or illness, although
it does recognize gastric bypass surgery as treatment for
diabetes or heart disease. 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
expenseFfor the plan, provider, or the patient. It costs only
attention to the patient, record-keeping, and the time it
takes to identify BMI, the patient�s state-of-readiness to
change, and to agree on personal medical goals and a plan.
Journal: IJO Disk used Despatch Date: 15/10/2004
Article : NPG_IJO_0802840 Pages: 1�3 Op:dorthy Ed: suja(a)
This work was presented at the 4th Annual University of Chicago
Conference on Alternative Medicine, Chicago, Illinois, December 13,
2002.
International Journal of Obesity (2004) 0, 000�000
& 2004 Nature Publishing Group All rights reserved 0307-0565/04 $30.00
www.nature.com/ijo
UNCORRECTED PROOFWhile 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.
NPG_IJO_0802840
Table 1 Physician reports of popular diets personally followed and recommended to patients in the past 5 yearsa
Popular diet Subgroup Personally followed Recommended for patients
All diets 97 diet attempts by physicians 334 physician recommendations to patients
Low-fat and very low-fat diets 31 (32.0%) 225 (67.4%)
Jenny Craig (high CHO, moderate PRO, low fat)b All physicians (n�402c) 9 (2.2%) 52 (13.0%)
BMIo25 kg/m2 (n�220) 1 (0.5%) 23 (10.5%)
BMIZ25 kg/m2 (n�174) 8 (4.6%) 29 (16.7%)
Ornish (very high CHO, moderate PRO, very low fat) All physicians (n�402c) 3 (0.7%) 19 (4.7%)
BMIo25 kg/m2 (n�220) 1 (0.5%) 10 (4.5%)
BMIZ25 kg/m2 (n�174) 2 (1.1%) 9 (5.2%)
Pritikin (very high CHO, moderate PRO, very low fat) All physicians (n�402c) 5 (1.2%) 6 (1.5%)
BMIo25 kg/m2 (n�220) 2 (0.9%) 2 (0.9%)
BMIZ25 kg/m2 (n�174) 3 (1.7%) 4 (2.3%)
Weight watchers (high CHO, moderate PRO, low fat) All physicians (n�402c) 14 (3.5%) 148 (36.8%)
BMIo25 kg/m2 (n�220) 4 (1.8%) 69 (31.4%)
BMIZ25 kg/m2 (n�174) 10 (5.7%) 79 (45.4%)
Low-carbohydrate and very low-carbohydrate diets 37 (38.1%) 67 (20.0%)
Atkins (very low CHO, high PRO, high fat) All physicians (n�402c) 29 (7.2%) 47 (11.7%)
BMIo25 kg/m2 (n�220) 9 (4.1%) 24 (10.9%)
BMIZ25 kg/m2 (n�174) 20 (11.5%) 23 (13.2%)
Sugar busters (low CHO, high PRO, high fat) All physicians (n�402c) 3 (0.7%) 4 (1.0%)
BMIo25 kg/m2 (n�220) 1 (0.5%) 1 (0.5%)
BMIZ25 kg/m2 (n�174) 2 (1.1%) 3 (1.7%)
Suzanne somers (low CHO, moderate PRO, high fat)b All physicians (n�402c) 1 (0.2%) 2 (0.5%)
BMIo25 kg/m2 (n�220) 0 (0.0%) 0 (0.0%)
BMIZ25 kg/m2 (n�174) 1 (1.1%) 2 (1.1%)
Zone (moderate CHO, high PRO, moderate fat) All physicians n�402c 4 (1.0%) 14 (3.5%)
BMIo25 kg/m2 (n�220) 1 (0.5%) 7 (3.2%)
BMIZ25 kg/m2 (n�174) 3 (1.7%) 7 (4.0%)
Other and unspecified diets 29 (29.9%) 42 (12.6%)
Andrew Weil (high CHO, moderate PRO, moderate fat,)b All physicians (n�402c) 6 (1.5%) 7 (1.7%)
BMIo25 kg/m2 (n�220) 3 (1.4%) 4 (1.8%)
BMIZ25 kg/m2 (n�174) 3 (1.7%) 3 (1.7%)
Unspecified diets All physicians (n�402c) 23 (5.7%)d 35 (8.7%)e
BMIo25 kg/m2 (n�220) 9 (4.1%) 22 (10.0%)
BMIZ25 kg/m2 (n�174) 14 (8.0%) 13 (7.5%)
No diet followed or recommended All physicians (n�402c) 318 (79.1%)f 196 (48.8%)f
BMIo25 kg/m2 (n�220) 190 (86.4%) 114 (51.8%)
BMIZ25 kg/m2 (n�174) 126 (72.4%) 80 (46.0%)
aCarbohydrates (CHO): very low (o10%), low (10�29%), moderate (30�55%), high (455%). Protein (PRO): low (o10%), moderate (10�19%), high (20�29%),
very high (430%). Fats: very low (o15% total energy), low (15�24%) , moderate (25�39%), high (439%) adapted from references.6 bDiet descriptions based on
recipe analysis, as reported in Roizen M, La Puma J (The real age diet. HarperCollins: NY; 2001. pp 101�131), except for Jenny Craig descriptions, based on
www.jennycraig.com and www.weightwatcher.com descriptions, 2001). cIncludes eight physicians for whom no BMI data were available. dIncludes six
individualized diets, three low-carbohydrate diets, three low-fat diets, three other popular diets, and eight attempts at seven miscellaneous other diet types.
eIncludes seven recommendations for liquid diets, six for low-fat diets, five for dietitian/nutritionist counseling, four for other group programs, and 13 for eight
miscellaneous other diet types. fIncludes two respondents for whom no BMI data were available.
Letter
JL Puma et al
2
International Journal of Obesity
UNCORRECTED PROOF
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.
JL Puma1, P Szapary2 and KC Maki3
1Santa Barbara Institute for Medical Nutrition and Healthy
Weight (a division of CHEF Clinict), Santa Barbara, CA, USA;
2Division of General Internal Medicine, University of
Pennsylvania School of Medicine, Philadelphia, Pa, USA; and
3Radiant Development, Chicago, IL, USA
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.
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.
3 Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev
Nutr 2001; 21: 323�341.
4 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.
5 Freedman MR, King J, Kennedy E. Popular diets: a scientific
review. Obes Res 2001; 9 (Suppl 1): 1S�40S.
Supplementary Information accompanies the paper on International Journal of Obesity website (http://www.nature.com/ijo).
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International Journal of Obesity