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Mertens HL, Kaifie A. [Nutrition counseling in medical practices-a cross-sectional study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:721-729. [PMID: 38639815 PMCID: PMC11166768 DOI: 10.1007/s00103-024-03870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION The purpose of this study was to assess the status of nutrition care and counseling in German medical practices, including physicians' nutrition interest and knowledge, existing obstacles, and possible ways of improving nutrition care. METHODS After development and a two-stage pretest, questionnaires with 32 items were distributed to all resident doctors of general medicine, internal medicine, gynecology and obstetrics, orthopedics, and occupational medicine in Aachen (n = 360) in early spring 2022. RESULTS The response rate was 29.2% and n = 105 participants were included in the analysis. During their consultation hours, 85.7% of the doctors conducted nutrition counseling (NC). While doctors estimated that 39.5% of their patients need NC, they counseled only 28.1%. General practitioners spent an average of 13 min on NC; all other specialties spent 9.5 min. Most participants felt well informed about healthy nutrition (95.2%). Nutrition was of high personal interest to 57.7% of the participants, and 47.6% considered it important for their work as a doctor. Barriers preventing better NC included the lack of nutrition education during medical studies (89.5%) and specialist training (79.6%), and the lack of time (75.2%). Most participants were willing to conduct more NC if they were paid better and had more time for NC during their working hours. DISCUSSION Doctors consider NC a relevant part of their work, despite many barriers. To make better use of NC as a measure for treating and preventing common diseases, improvements like better nutrition education for doctors, better funding, and more time for NC are required.
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Affiliation(s)
- Hannah Luisa Mertens
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - Andrea Kaifie
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Kommunal verankerte Versorgungsstrukturen zur Förderung der Ernährungsgesundheit in den ersten 1000 Tagen – eine Analyse des aktuellen Status quo. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2022. [PMCID: PMC9707151 DOI: 10.1007/s11553-022-00998-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Ziel
Die Ernährung in den ersten 1000 Tagen stellt einen relevanten Einflussfaktor für eine gesunde (Gewichts)entwicklung von Kindern dar. Verhältnispräventive, kommunalbasierte Ansätze scheinen am Erfolg versprechendsten in der Bekämpfung von (kindlichem) Übergewicht bzw. nicht übertragbaren Erkrankungen zu sein. Ziel dieser Arbeit war es, Strategien zum Gelingen der Ernährungsgesundheit in den ersten 1000 Tagen herauszuarbeiten.
Methodik
Auf Basis einer internetbasierten Recherche möglicher kommunalbasierter Praxisprojekte wurden standardisierte, leitfadengestützte Interviews mit Expertinnen und Experten aus Wissenschaft und Praxis durchgeführt. Der Fokus lag auf der allgemeinen Einschätzung der Versorgungslage bzw. einem möglichen Handlungs- und Versorgungsbedarf sowie konkreten Handlungsempfehlungen unter besonderer Berücksichtigung von Schwangeren bzw. jungen Familien in belasteten Lebenslagen. 14 von 40 im Schneeballverfahren ausgewählten Personen nahmen teil.
Ergebnisse
Alle Teilnehmenden schätzen die aktuelle primärpräventive Versorgung als nicht ausreichend ein. Als kritisch wurden von ihnen v. a. die fehlenden strukturellen und politischen Rahmenbedingen, insbesondere die häufig bestehenden zeitlich begrenzten Programme, gesehen. Dadurch seien Maßnahmen zur Förderung der Ernährungsgesundheit oder vergleichbare Interventionen nicht erfolgreich zu etablieren. Gefordert wurde daher eine deutlichere Unterstützung durch politische und andere relevante Stakeholder, z. B. Krankenversicherungen und Vernetzung mit bzw. Einbettung dieses Themenfeldes in den öffentlichen Gesundheitsdienst.
Schlussfolgerung
Unsere Ergebnisse bestätigen aus Sicht von Expertinnen und Experten, dass die Förderung der Ernährungsgesundheit in den ersten 1000 Tagen sinnvoll und wichtig ist. Allerdings ist ein deutlicher Optimierungsbedarf hinsichtlich der Versorgungsstrukturen und der konkreten nachhaltigen Umsetzung von primärpräventiven Angeboten sowie niederschwelligen Zugängen für belastete Schwangere und Familien erkennbar.
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Bayer S, Drabsch T, Schauberger G, Hauner H, Holzapfel C. Responsibility of Individuals and Stakeholders for Obesity and a Healthy Diet: Results From a German Survey. Front Psychiatry 2020; 11:616. [PMID: 32719623 PMCID: PMC7350775 DOI: 10.3389/fpsyt.2020.00616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/12/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Overweight and obesity are thought to be mainly caused by an energy-rich diet and a sedentary lifestyle. The opinions of those with and without obesity about an individual´s and stakeholder´s responsibility for overweight and obesity as well as a healthy diet is rather unclear. Therefore, a survey was conducted to assess the thoughts of persons with and without obesity about the responsibilities for a high body weight and healthy diet. METHODS This telephone-based survey was conducted in Germany. Landline and mobile phone users older than 17 years were quota sampled to represent the German population (n=1,003). Additionally, 354 adults with a body mass index (BMI) ≥ 30 kg/m2 were included in the survey population. Questions on weight management, eating and drinking and anthropometry were asked. Furthermore, the opinions of participants on the responsibility of individuals and stakeholders for obesity and a healthy diet were collected. Data was statistically weighted by age, gender, education, domicile, and BMI. RESULTS Data of 1,357 persons (51.1% female, age: 50.5 ± 18.5 years, 15.9% with BMI ≥ 30 kg/m2) were analyzed. Participants responded that the general causes of a high body weight were low physical activity (82.7%) and excessive caloric intake (80.5%) followed by a lack of will power (72.1%). Almost 90% of the survey population reported that each individual is responsible for his/her own healthy diet. More than 85% of the survey population agreed that a healthy diet in kindergarten and nutrition education at schools should be the preferred approaches when politics take care of a person´s healthy diet. Sub-analyses revealed that BMI, sex, age, and education are potential confounders. CONCLUSION This German survey showed that the majority of participants indicated that the responsibility for a healthy diet lies with the individual and high body weight is caused by self-controlled attitudes. These results suggest that the survey population underestimates societal and environmental factors that contribute to the development of obesity, which could lead to attitudes that facilitate weight-related stigmatization. Furthermore, survey participants indicated that they would support policy-driven measures that promote a healthy diet.
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Affiliation(s)
- Sandra Bayer
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Theresa Drabsch
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Gunther Schauberger
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
- ZIEL - Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Christina Holzapfel
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
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Timpel P, Harst L, Reifegerste D, Weihrauch-Blüher S, Schwarz PEH. What should governments be doing to prevent diabetes throughout the life course? Diabetologia 2019; 62:1842-1853. [PMID: 31451873 DOI: 10.1007/s00125-019-4941-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022]
Abstract
Health systems and governments are increasingly required to implement measures that target at-risk populations to prevent noncommunicable diseases. In this review we lay out what governments should be doing to prevent diabetes throughout the life course. The following four target groups were used to structure the specific recommendations: (1) pregnant women and young families, (2) children and adolescents, (3) working age population, and (4) the elderly. The evidence to date supports the effectiveness of some known government policy measures, such as sugar taxes and regulatory measures in the (pre-)school setting for children and adolescents. Many of these appear to be more effective if they are part of a bundle of strategies and if they are supplemented by communication strategies. Although there is a current focus on strategies that target the individual, governments can make use of evidence-based population-level prevention strategies. More research and continuous evaluation of the overall and subgroup-specific effectiveness of policy strategies using high-quality longitudinal studies are needed.
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Affiliation(s)
- Patrick Timpel
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Lorenz Harst
- Research Association Public Health Saxony/Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Doreen Reifegerste
- Department of Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Susann Weihrauch-Blüher
- Department of Pediatrics I, Pediatric Endocrinology and Diabetology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany
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Weihrauch-Blüher S, Kromeyer-Hauschild K, Graf C, Widhalm K, Korsten-Reck U, Jödicke B, Markert J, Müller MJ, Moss A, Wabitsch M, Wiegand S. Current Guidelines for Obesity Prevention in Childhood and Adolescence. Obes Facts 2018; 11:263-276. [PMID: 29969778 PMCID: PMC6103347 DOI: 10.1159/000486512] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Current guidelines for prevention of obesity in childhood and adolescence are discussed. METHODS A literature search was performed in Medline via PubMed, and appropriate studies were analyzed. RESULTS Programs to prevent childhood obesity have so far remained mainly school-based and effects have been limited. Analyses by age group show that prevention programs have the best results in younger children (<12 years). Evidence-based recommendations for pre-school- and early school-aged children indicate the need for interventions that address parents and teachers alike. During adolescence, school-based interventions proved most effective when adolescents were addressed directly. To date, obesity prevention programs have mainly focused on behavior-oriented prevention. Recommendations for community- or environment-based prevention have been suggested by the German Alliance of Noncommunicable Diseases and include a minimum of 1 h of physical activity at school, promotion of healthy food choices by taxing unhealthy foods, mandatory standards for meals at kindergartens and schools as well as a ban on unhealthy food advertisement aimed at children. CONCLUSION Behavior-oriented prevention programs showed only limited long-term effects. Certain groups at risk for the development of obesity are not reached effectively by current programs. Although universally valid conclusions cannot be drawn given the heterogeneity of available studies, clearly combining behavior-based programs with community-based prevention to counteract an 'obesogenic environment' is crucial for sustainable success of future obesity prevention programs.
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Affiliation(s)
- Susann Weihrauch-Blüher
- IFB AdiposityDiseases; Leipzig University Medical Center, University of Leipzig, Leipzig, Germany
- Department of Pediatrics I / Pediatric Endocrinology and Diabetology, University Hospital of Halle/Saale, Halle/Saale, Germany
| | - Kartin Kromeyer-Hauschild
- Institute of Human Genetics, Jena University Medical Center, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Christine Graf
- Institute of Movement and Neuroscience, German Sport University of Cologne, Cologne, Germany
| | - Kurt Widhalm
- Department Of Clinical Nutrition and Prevention, Children's Hospital, University Hospital of Vienna, Vienna, Austria
| | - Ulrike Korsten-Reck
- Department of Rehabilitative and Preventive Sports Medicine, University Medical Center Freiburg, Freiburg i.Br., Germany
| | - Birgit Jödicke
- Department of Pediatric Endocrinology and Diabetology and Center for Social-Pediatric Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jana Markert
- IFB AdiposityDiseases; Leipzig University Medical Center, University of Leipzig, Leipzig, Germany
- Institute of Special and Inclusive Education, University of Leipzig, Leipzig, Germany
| | - Manfred James Müller
- Institute for Human Nutrition and Food Sciences, Christian-Albrechts University, Kiel, Germany
- Department of Pediatric Endocrinology and Diabetology, Hospital for Children and Adolescents, University of Ulm, Ulm, Germany
| | - Anja Moss
- Department of Pediatric Endocrinology and Diabetology, Hospital for Children and Adolescents, University of Ulm, Ulm, Germany
| | - Martin Wabitsch
- Department of Pediatric Endocrinology and Diabetology, Hospital for Children and Adolescents, University of Ulm, Ulm, Germany
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology and Center for Social-Pediatric Care, Charité Universitätsmedizin Berlin, Berlin, Germany
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[Promoting a balanced diet and physical activity among children : Conditions for the successful implementation and maintenance of multi-level interventions and policies: Results of two qualitative case studies]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:1124-1138. [PMID: 28812123 DOI: 10.1007/s00103-017-2611-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND To date, conditions for successfully implementing and maintaining multi-level interventions and policies for the promotion of a balanced diet and physical activity are not well understood from the perspective of stakeholders. OBJECTIVE The aim of this article is to examine which factors are regarded as facilitating or impeding introduction, implementation and maintenance of multi-level interventions and policies from the standpoint of stakeholders. MATERIALS AND METHODS Semi-structured face-to-face interviews with stakeholders of one multi-level intervention (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS [IDEFICS] for the prevention of childhood obesity, n = 4) and one policy (Federal state offices coordinating networks for the provision of healthy food options in schools, n = 3) were analysed using qualitative content analysis. RESULTS In both cases, the use of existing structures facilitated introduction, implementation and maintenance. Additionally, training of staff for implementation according to standardised protocols or concepts and taking structures and work conditions of settings into account during implementation were considered essential. In both cases, conflicting interests in interdisciplinary stakeholder teams regarding intervention content and implementation were identified as a barrier. A lack of political support and insecure long-term funding only played a role in regard to the implementation and maintenance of policies. On the other hand, target groups of the multi-level intervention were not sufficiently involved in the development of intervention materials which resulted in a lack of tailoring and acceptance in the target groups. CONCLUSIONS The results provide important insights into the long-term implementation of multi-level interventions and policies in different settings.
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