Preventive Medicine 53 (2011) 209–210
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Preventive Medicine j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / y p m e d
Letter to the Editor Patient–physician discussion of physical activity and environmental barriers
Keywords: Environmental barriers Obesity Physical activity Physician practices Walking
Although obese individuals may benefit from moderate physical activity (PA) such as walking, many do not engage in adequate PA (Rejeski et al., 2011). Currently, less than half of all American adults are estimated to obtain the recommended PA level of a minimum of 30 minutes of PA daily for at least five days per week (CDC, 2009). This may partly result from the major influence the physical environment such as sidewalks, recreational facilities, lighting, and safety concerns has on individuals' decision to engage or continue in PA (Santariano et al., in press; Lee, 2007; Lee and Moudon, 2006; Lee and Buchner, 2008). Regardless, healthcare providers have a role in promoting PA among their patients. Physicians generally recommend increasing PA to their patients, albeit less so to their obese patients (Phelan et al., 2009). Time constraints, lack of resources to effect behavioral changes, limited training in appropriate behavioral change counseling, and perceived lack of interest from patients have been cited by physicians as some of the reasons for their limited level of counseling (Ory et al., 2007). As part of a study to assess the influence of the built environment on PA, we explored family physicians' perceptions about environmental influences in promoting PA in their obese patients. Working in collaboration with a primary care practice-based research network in
central Texas, we conducted a cross-sectional on-line survey of family physicians. The majority recognized the benefit of PA for health, even among their obese patients. The physicians generally had a positive interaction with their obese patients about PA (Fig. 1). They also felt having more time with the patient, knowing specific strategies to overcome environmental barriers, knowing safe places in patients' neighborhoods, and knowing what environmental factors influence PA may help them discuss environmental issues with their obese patients. We conclude that physicians have an important role in helping their obese patients overcome barriers to PA. It is clear that most physicians have some knowledge about the environment and PA, but fewer do not routinely interact with their obese patients about environmental concerns. We recommend the development of targeted information and useful tools to assist physicians to help their obese patients. A simple downloadable web-based resource guide – e.g., pointing patients to places in their community where they could engage in various types of PA safely and conveniently – for family physicians that could be given to patients is one example. Conflict of interest None declared by any of the authors.
References CDC, 2009. Prevalence and trends data. Report No.: 2011. Lee, C., 2007. Environment and active living: the roles of health risk and economic factors. Am. J. Health Promot. 21, 293–304. Lee, C., Moudon, A.V., 2006. The 3Ds + R: quantifying land use and urban form correlates of walking. Trans. Res. D Trans. Environ. 11, 204–215. Lee, I.M., Buchner, D.M., 2008. The importance of walking to public health. Med. Sci. Sports Exerc. 40, S512–S518. Ory, M.G., et al., 2007. Lifestyle discussions during doctor–older patient interactions: the role of time in the medical encounter. MedGenMed 9, 48. Phelan, S., et al., 2009. What do physicians recommend to their overweight and obese patients? J. Am. Board Fam. Med. 22, 115–122.
Often
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Have you asked if your obese patient is engaged in any PA?
Have you asked if your obese patient is walking for recreation, exercise, to get to and from places, or for any other reason? Have you advised your obese patient on meeting the PA recommendation of ≥30 minutes of PA on ≥5 days a week? Have you asked your obese patient if there were any environmental barriers to being more physically active? Have you asked your obese patient if there were any environmental barriers to walking more? Have you heard your obese patient bring up the environment (e.g., no shade, poor lighting) as a barrier to being more physically active? Have you heard your obese patient bring up the environment (e.g., no shade, poor lighting) as a barrier to walking more? Have you given concrete examples on how your obese patient can deal with such environmental barriers?
Note: PA = Physical Activity Fig. 1. Physician interactions with obese patients about physical activity and walking. 0091-7435/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2011.07.010
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Letter to the Editor
Rejeski, W.J., et al., 2011. Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health [Epub ahead of print] Arch. Intern. Med. Jan 24. Santariano, W., Ory, M., Lee, C. Planned and built environments: interactions with aging. In: Public Health in an Aging Society. Baltimore: The Johns Hopkins Press; In Press.
Samuel N. Forjuoh Department of Family and Community Medicine, Scott and White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA Corresponding author. Fax: +1 254 771 8493. E-mail address:
[email protected].
Chanam Lee Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX. USA Suojin Wang Department of Statistics, College of Science, Texas A&M University, College Station, TX, USA Yan Hong Marcia G. Ory Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
