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. Author manuscript; available in PMC: 2013 Jul 1.
Published in final edited form as: Prev Med. 2012 May 16;55(1):28–33. doi: 10.1016/j.ypmed.2012.05.005

Knowledge of Energy Balance Guidelines and Associated Clinical Care Practices: The U.S. National Survey of Energy Balance Related Care among Primary Care Physicians

Nicolaas P Pronk 1,2, Susan M Krebs-Smith 3, Deborah A Galuska 4, Benmei Liu 3, Robert F Kushner 5, Richard P Troiano 3, Steven B Clauser 3, Rachel Ballard-Barbash 3, Ashley Wilder Smith 3
PMCID: PMC3377834  NIHMSID: NIHMS378893  PMID: 22609144

Abstract

Objective

To assess primary care physicians’ (PCPs) knowledge of energy balance related guidelines and the association with sociodemographic characteristics and clinical care practices.

Method

As part of the 2008 U.S. nationally representative National Survey of Energy Balance Related Care among Primary Care Physicians (EB-PCP), 1,776 PCPs from four specialties who treated adults (n=1,060) or children and adolescents (n=716) completed surveys on sociodemographic information, knowledge of energy balance guidelines, and clinical care practices.

Results

EB-PCP response rate was 64.5%. For PCPs treating children, knowledge of guidelines for healthy BMI percentile, physical activity, and fruit and vegetables intake was 36.5%, 27.0%, and 62.9%, respectively. For PCPs treating adults, knowledge of guidelines for overweight, obesity, physical activity, and fruit and vegetables intake was 81.4%, 81.3%, 70.9%, and 63.5%, respectively. Generally, younger, female physicians were more likely to exhibit correct knowledge. Knowledge of weight-related guidelines was associated with assessment of body mass index (BMI) and use of BMI-for-age growth charts.

Conclusion

Knowledge of energy balance guidelines among PCPs treating children is low, among PCPs treating adults it appeared high for overweight and obesity-related clinical guidelines and moderate for physical activity and diet, and was mostly unrelated to clinical practices among all PCPs.

Keywords: Energy balance, primary care, guidelines, physical activity, nutrition, body mass index, knowledge

Introduction

Obesity represents a significant public health concern. Possible solutions include the role of primary care physicians (PCPs) in promoting healthy diet, physical activity, and weight status among their patients. Patients regard their PCP as an important source of information related to nutrition [Tillotsen 2006], physical activity [Calfas et al, 1996], and weight [Galuska 1999]. Recent data from the National Survey of Energy Balance Related Care among Primary Care Physicians (EB-PCP), suggest that PCPs do not consistently assess, counsel, and follow-up with patients on their diet, physical activity and weight control (energy balance) practices, whether they treat children [Huang et al, 2011] or adults [Smith et al, 2011]. Knowledge deficits represent an important barrier to provision of weight-related care [Vetter et al, 2008]. The purpose of this study is to assess PCPs’ knowledge of physical activity-, diet-, and weight-related guidelines and their association with sociodemographic characteristics and energy balance-related clinical care practices.

Methods

Data Source

Between March and September, 2008, 3,145 participants in the EB-PCP, a nationally representative survey of actively practicing PCPs in the U.S. received a questionnaire and 2,027 surveys were returned. The subject sample was obtained from the American Medical Association’s Physician Masterfile [AMA, 2010]. We excluded 251 surveys due to missing data for a final of 1,776 surveys (1,060 PCPs treating adults and 716 treating children) across four specialties (Internal Medicine (n=342), Obstetrics and Gynecology (OB/GYN, n=379), Family Practice (n=666), and Pediatrics (n=389). More details on sampling methodology are described elsewhere [Smith et al, 2011; Huang et al, 2011].

Survey Instruments and Study Variables

Two EB-PCP versions, one for PCPs treating children (ages 2–17 years) and one for PCPs treating adults (≥18 years), were used. (See: National Cancer Institute website http://www.outcomes.cancer.gov/surveys/energy/phys_pract_q_child.pdf and http://www.outcomes.cancer.gov/surveys/energy/phys_pract_q_adult.pdf). Since the EB-PCP was fielded prior to the 2008 guidelines [USDHHS, 2008], correct responses for physical activity included 30 minutes of moderate intensity physical activity on most days of the week for adults [Pate et al, 1995] and 60 minutes for children [Corbin and Pangrazi, 2004]. Fruit and vegetables intake linked to daily caloric intake [USDHHS, 2005] and daily intake of ≥5 fruits and vegetables [Pivonka et al, 2011] were both considered correct.

For PCPs treating adults, analyzed responses related to 1) overweight and obesity (BMI criteria), 2) number of servings of fruit and vegetables per day, 3) number of moderate intensity physical activity days per week (most days of the week), 4) all guidelines simultaneously correct. The same applied to PCPs treating children, except only healthy BMI percentile responses were considered.

Sociodemographic characteristics, including age, race, ethnicity, sex, and patient population treated were obtained from the EB-PCP. Specialty and census region were obtained from the AMA [AMA, 2010].

PCP energy balance-related clinical practices considered patients with an unhealthy diet, insufficient activity, or overweight status. PCPs were asked how often they: 1) provide general counseling; 2) provide specific guidance on diet, physical activity, or weight control; 3) refer to further evaluation or management; 4) systematically track/follow patients over time; and 5) assess BMI in adults or BMI, weight-for-age, stature-for-age, or BMI-for-age in children.

Data Analysis

Sample weights compensated for differential selection probabilities, including oversampling of family practice physicians, non-response, and under-coverage of the target population. For variance estimation, we generated replicate weights using the Jackknife replication method [Wolter, 1985] and used SAS-callable SUDAAN (version 10.0 [Research Triangle Institute, 2008] for analyses. Chi-square tests were conducted to test differences between PCP knowledge and characteristics.

Binary logistic regression analyses were used to examine the relationships between PCP sociodemographic variables and knowledge. Analyses were stratified by patient population (child vs. adult). To examine associations between PCPs’ knowledge and clinical practices, we used multivariate ordinal logistical regression models and computed the likelihood of each care practice as the predicted probabilities from the corresponding logistic regression model. Covariates included in the final models were PCPs’ specialty, age, sex, race/ethnicity, and region. All alpha values were set at .05.

Results

The EB-PCP response rate was 64.5%. For PCPs treating children, knowledge of guidelines for healthy BMI percentile, physical activity, fruit and vegetables, and all guidelines simultaneously was 36.5%, 27.0%, 62.9%, and 10.6%, respectively. For PCPs treating adults, knowledge of guidelines for overweight, obesity, physical activity, fruit and vegetables, and all guidelines simultaneously was 81.4%, 81.3%, 70.9%, 63.5%, and 40.6%, respectively. [Data shown in Appendix A]

Appendix A.

Sample Characteristics by Physicians Knowledge of Guidelines in the 2008 U.S. EB-PCP Study

Guideline Knowledge
Total Healthy Weight – Children Physical Activity Servings of Fruit and Vegetables Know All Guidelines
5th – 85th Percentile 60 min/day (Child) 5 Servings or Depends on Calories
Correct Chi-square Correct Chi-square Correct Chi- square Yes Chi-square
n % p-value % p-value % p-value % p-value
Physicians Treating Child/Adolescent Patients 716 36.5 27.0 62.9 10.6
Primary Specialty Family/Practice 327 23.0 <.0001 23.0 0.00
15		 59.5 0.02
44		 6.4 <.00
01
Pediatrics 389 59.3 - 33.6 - 68.5 - 17.8 -
Age < 40 192 39.8 0.6633 23.3 0.46
59		 63.3 0.11
33		 10.1 0.88
46
40–49 222 34.7 - 28.9 - 68.5 - 11.8 -
50–59 203 36.9 - 29.3 - 59.3 - 9.5 -
60–75 99 33.9 - 24.2 - 56.4 - 11.4 -
Gender Male 385 29.7 <.0001 23.7 0.02
82		 59.9 0.05
96		 9.4 0.18
46
Female 331 45.6 - 31.3 - 66.8 - 12.3 -
Race White/NH 528 33.1 0.0265 28.0 0.20
18		 63.5 0.96
67		 10.3 0.84
55
Black/NH 30 42.0 - 15.2 - 63.9 - 10.1 -
Asian/NH 119 50.7 - 23.4 - 60.8 - 12.4 -
Hispanic 24 42.4 - 37.4 - 59.7 - 14.1 -
Other 15 29.5 - 22.6 - 58.3 - 5.3 -
Region Northeast 147 42.2 0.3954 33.2 0.24
76		 71.5 0.01
55		 15.6 0.19
26
Midwest 175 36.0 - 29.1 - 59.7 - 8.9 -
South 231 34.8 - 23.5 - 55.9 - 8.8 -
West 163 34.8 - 24.5 - 69.0 - 11. 0 -
Guideline Knowledge
Total Weight Guidelines Physical Activity Servings of Fruit and Vegetables Know All Guidelines
Overweight Obese 30 min/day (Adult) 5 Servings or Depends on Calories
Correct Chi-square Correct Chi-square Correct Chi-square Correct Chi-square Yes Chi-square
n % p-value % p-value % p-value % p-value % p-value
Physicians Treating Adults 1060 81.4 81.3 70.9 63.5 40.6
Primary Specialty Internal Medicine 342 80.4 0.02
99		 79.8 0.02
92		 68.0 0.19
79		 63.2 0.07
63		 40.4 0.14
77
OB/GYN 379 76.5 - 77.1 - 69.2 - 57.9 - 35.9 -
Family Practice 339 84.4 - 84.4 - 73.9 - 66.4 - 43.0 -
Age < 40 213 87.9 0.00
02		 87.2 0.00
02		 74.7 0.09
05		 75.0 0.00
01		 51.7 <.00
01
40–49 314 86.2 - 85.9 - 73.5 - 64.4 - 43.9 -
50–59 338 78.1 - 78.1 - 68.3 - 61.6 - 36.9 -
60–75 195 70.9 - 71.9 - 66.3 - 51.7 - 28.3 -
Gender Male 663 78.7 0.00
23		 79.3 0.01
93		 66.6 <.00
01		 60.1 0.00
18		 35.5 <.00
01
Female 397 86.1 - 84.8 - 78.3 - 69.5 - 49.7 -
Race White/NH 776 82.3 0.37
49		 81.6 0.99
07		 72.0 0.03
48		 65.4 0.01
61		 41.7 0.22
14
Black/NH 63 85.8 - 80.6 - 61.6 - 58.2 - 40.4 -
Asian/NH 159 76.9 - 79.9 - 69.6 - 64.6 - 39.2 -
Hispanic 42 78.2 - 81.2 - 82.0 - 44.0 - 35.3 -
Other 20 74.7 - 82.3 - 43.0 - 35.3 - 21.1 -
Region Northeast 216 80.9 0.62
99		 76.8 0.32
25		 69.0 0.88
15		 62.7 0.55
72		 39.6 0.58
06
Midwest 255 82.2 - 83.7 - 70.4 - 65.5 - 40.3 -
South 365 79.7 - 82.3 - 71.4 - 61.4 - 39.1 -
West 224 83.7 - 81.3 - 72.4 - 65.4 - 44.5 -
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Note: U.S. = United States; EB-PCP = National Survey of Energy Balance Related Care among Primary Care Physicians; OB/GYN = Obstetrics/Gynecology; NH = Non-Hispanic.

Table 1 shows, among PCPs treating children, compared to other family practice physicians, pediatricians were more likely to report correct knowledge about healthy BMI percentile, fruit and vegetables intake, physical activity, and simultaneously meeting all guidelines. Female PCPs were more likely than male PCPs to report correct knowledge for healthy BMI percentile guidelines and physical activity guidelines.

Table 1.

Odds Ratios: Knowledge of Guidelines and Sociodemographic Variables among Physicians Treating Children and Adults in the 2008 U.S. EB-PCP Study

Physicians treating Children Total BMI Percentile: 5–85th Percentile Diet: 5 Servings or Depends on calories Physical Activity: 60 min Know all guidelines
n O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI)
Primary specialty
 Family Practice 327 Reference Reference Reference Reference
 Pediatrician 389 4.88 (3.37 – 7.06) 1.48 (1.06 – 2.09) 1.70 (1.23 – 2.34) 3.19 (1.93 – 5.25)
Age
 < 40 192 Reference Reference Reference Reference
 40–49 222 0.80 (0.54 – 1.19) 1.26 (0.83 – 1.91) 1.34 (0.79 – 2.28) 1.19 (0.62 – 2.27)
 50–59 203 0.88 (0.59 – 1.33) 0.85 (0.54 – 1.31) 1.37 (0.89 – 2.11) 0.93 (0.48 – 1.80)
 60–75 99 0.77 (0.48 – 1.24) 0.75 (0.45 – 1.26) 1.05 (0.59 – 1.87) 1.14 (0.56 – 2.30)
Gender
 Male 385 Reference Reference Reference Reference
 Female 331 1.98 (1.45 – 2.70) 1.35 (0.99 – 1.84) 1.47 (1.05 – 2.07) 1.35 (0.86 – 2.11)
Race/Ethnicity
 White/NH 528 Reference Reference Reference Reference
 Black/NH 30 1.46 (0.70 – 3.04) 1.01 (0.46 – 2.24) 0.46 (0.20 – 1.08) 0.98 (0.33 – 2.91)
 Asian/NH 119 2.07 (1.32 – 3.26) 0.89 (0.57 – 1.39) 0.79 (0.49 – 1.27) 1.23 (0.67 – 2.27)
 Hispanic 24 1.49 (0.59 – 3.76) 0.85 (0.37 – 1.95) 1.54 (0.65 – 3.64) 1.43 (0.36 – 5.71)
 Other 15 0.84 (0.35 – 2.07) 0.80 (0.23 – 2.80) 0.75 (0.26 – 2.20) 0.49 (0.26 – 0.92)
Region
 Northeast 147 Reference Reference Reference Reference
 Midwest 175 0.77 (0.52 – 1.14) 0.59 (0.35 – 1.01) 0.83 (0.51 – 1.35) 0.53 (0.29 – 0.95)
 South 231 0.73 (0.48 – 1.11) 0.51 (0.30 – 0.84) 0.62 (0.36 – 1.05) 0.52 (0.27 – 1.01)
 West 163 0.73 (0.47 – 1.13) 0.89 (0.49 – 1.60) 0.65 (0.40 – 1.07) 0.66 (0.35 – 1.25)
Physicians treating Adults Total BMI: Overweight BMI: Obese Diet: 5 Servings or depends on calories Physical Activity: 30 min Know all guidelines
n O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI)
Primary Specialty
 Internal Medicine 342 Reference Reference Reference Reference Reference
 OB/GYN 379 0.79 (0.56 – 1.13) 0.85 (0.59 – 1.23) 0.80 (0.60 – 1.08) 1.06 (0.77 – 1.44) 0.83 (0.62 – 1.10)
 Family Practice 339 1.31 (0.88 – 1.97) 1.37 (0.91 – 2.04) 1.15 (0.82 – 1.61) 1.33 (0.95 – 1.87) 1.11 (0.81 – 1.53)
Age
 < 40 213 Reference Reference Reference Reference Reference
 40–49 314 0.87 (0.52 – 1.45) 0.90 (0.53 – 1.52) 0.60 (0.40 – 0.91) 0.94 (0.61 – 1.47) 0.73 (0.51 – 1.05)
 50–59 338 0.49 (0.30 – 0.82) 0.52 (0.33 – 0.83) 0.53 (0.36 – 0.79) 0.73 (0.48 – 1.11) 0.55 (0.39 – 0.77)
 60–75 195 0.34 (0.19 – 0.58) 0.37 (0.22 – 0.65) 0.36 (0.23 – 0.55) 0.67 (0.44 – 1.01) 0.37 (0.24 – 0.56)
Gender
 Male 663 Reference Reference Reference Reference Reference
 Female 397 1.67 (1.19 – 2.35) 1.45 (1.05 – 2.00) 1.51 (1.16 – 1.96) 1.80 (1.37 – 2.37) 1.80 (1.39 – 2.32)
Race/Ethnicity
 White/NH 776 Reference Reference Reference Reference Reference
 Black/NH 63 1.30 (0.57 – 2.99) 0.93 (0.42 – 2.06) 0.74 (0.41 – 1.34) 0.62 (0.33 – 1.17) 0.95 (0.52 – 1.73)
 Asian/NH 159 0.72 (0.46 – 1.11) 0.89 (0.57 – 1.39) 0.97 (0.67 – 1.40) 0.89 (0.63 – 1.26) 0.90 (0.63 – 1.30)
 Hispanic 42 0.77 (0.38 – 1.58) 0.97 (0.46 – 2.05) 0.42 (0.22 – 0.78) 1.77 (0.80 – 3.94) 0.76 (0.39 – 1.49)
 Other 20 0.63 (0.17 – 2.35) 1.05 (0.27 – 4.15) 0.29 (0.11 – 0.76) 0.29 (0.11 – 0.81) 0.37 (0.12 – 1.19)
Region
 Northeast 216 Reference Reference Reference Reference Reference
 Midwest 255 1.09 (0.66 – 1.81) 1.55 (0.97 – 2.49) 1.13 (0.78 – 1.63) 1.07 (0.69 – 1.66) 1.03 (0.70 – 1.51)
 South 365 0.93 (0.59 – 1.46) 1.40 (0.91 – 2.17) 0.95 (0.66 – 1.36) 1.12 (0.76 – 1.64) 0.98 (0.68 – 1.39)
 West 224 1.21 (0.74 – 1.98) 1.32 (0.80 – 2.17) 1.13 (0.76 – 1.67) 1.17 (0.79 – 1.75) 1.22 (0.83 – 1.80)
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Note: Bold associations are significant (p<.05); U.S. = United States; EB-PCP = National Survey of Energy Balance Related Care among Primary Care Physicians; OB/GYN = Obstetrics/Gynecology; NH = Non-Hispanic; O.R. = Odds Ratio; CI = Confidence Interval

Among PCPs treating adults (Table 1), compared to PCPs under 40 years old, older PCPs (≥50 years), were less likely to report correct knowledge about weight-related guidelines, fruit and vegetables intake, and all guidelines simultaneously. Compared to males, female PCPs reported higher levels of knowledge in relation to all guidelines.

Table 2 (multivariate analyses), indicates that among PCPs treating children with knowledge of healthy BMI percentile guidelines, fruit and vegetables intake, and all guidelines simultaneously, likelihood to assess BMI was higher. Knowledge of physical activity guidelines increased the likelihood to refer patients for further evaluation and management and to systematically track patients over time.

Table 2.

Knowledge of Guidelines and Related Clinical Practices among Physicians Treating Children and Adults in the 2008 U.S. EB-PCP Study

Total Provide general counseling Provide guidance on diet Provide guidance on physical activity Provide guidance on weight control Refer patients for further evaluation/management Systematically Track/follow patients over time Assess BMI Weight- for-age Stature- for-age BMI-for-age
n (%) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95% CI) O.R. (95 % CI)
Physicians Treating Children
BMI Percentile: 5–85th Percentile 30 6 (36.5) 1.15 (0.86 – 1.55) 1.32 (0.97 – 1.81) 1.06 (0.79 – 1.42) 1.12 (0.82 – 1.53) 1.28 (0.96 – 1.70) 0.97 (0.69 – 1.37) 2.20 (1.46 – 3.31) 1.24 (0.73 – 2.10) 1.06 (0.64 – 1.75) 2.54 (1.82 – 3.55)
Diet: 5 Servings or Depends on calories 46 4 (62.9) 1.18 (0.85 – 1.63) 1.22 (0.86 – 1.72) 1.07 (0.74 – 1.54) 0.80 (0.57 – 1.12) 1.29 (0.95 – 1.76) 1.01 (0.73 – 1.41) 1.50 (1.03 – 2.19) 1.28 (0.76 – 2.14) 1.04 (0.65 – 1.65) 1.31 (0.93 – 1.84)
Physical Activity: 60 min 20 6 (27.0) 1.24 (0.88 – 1.75) 1.05 (0.76 – 1.44) 1.24 (0.87 – 1.77) 1.26 (0.93 – 1.72) 1.41 (1.01 – 1.97) 1.57 (1.12 – 2.18) 1.11 (0.76 – 1.63) 0.99 (0.56 – 1.76) 1.22 (0.69 – 2.15) 1.13 (0.80 – 1.58)
Know all guidelines 90 (10.6) 1.13 (0.74 – 1.72) 0.85 (0.55 – 1.34) 0.98 (0.62 – 1.54) 0.87 (0.58 – 1.29) 1.50 (0.94 – 2.42) 1.37 (0.89 – 2.09) 1.80 (1.04 – 3.13) 1.43 (0.56 – 3.67) 1.32 (0.58 – 2.99) 1.83 (1.16 – 2.90)
Physicians Treating Adults
BMI: Overweight 849 (81.4) 1.77 (1.28 – 2.45) 1.46 (1.04 – 2.06) 1.27 (0.86 – 1.86) 1.06 (0.78 – 1.44) 1.04 (0.71 – 1.52) 1.32 (0.98 – 1.76) 2.66 (1.91 – 3.70) NA NA NA
BMI: Obese 849 (81.3) 1.34 (0.95 – 1.90) 0.96 (0.66 – 1.39) 1.00 (0.67 – 1.48) 0.99 (0.69 – 1.42) 0.77 (0.55 – 1.10) 1.20 (0.86 – 1.67) 2.52 (1.77 – 3.60) NA NA NA
Diet: 5 Servings or Depends on calories 659 (63.5) 0.91 (0.69 – 1.21) 0.81 (0.61 – 1.07) 0.90 (0.68 – 1.21) 0.75 (0.57 – 0.97) 1.08 (0.87 – 1.36) 0.64 (0.50 – 0.83) 1.10 (0.86 – 1.40) NA NA NA
Physical Activity: 30 min 744 (70.9) 1.09 (0.82 – 1.44) 0.98 (0.76 – 1.26) 0.97 (0.75 – 1.26) 0.98 (0.73 – 1.31) 0.94 (0.74 – 1.20) 1.03 (0.82 – 1.31) 1.25 (0.96 – 1.62) NA NA NA
Know all guidelines 418 (40.6) 0.98 (0.74 – 1.29) 0.84 (0.63 – 1.12) 0.93 (0.71 – 1.21) 0.77 (0.60 – 0.98) 0.96 (0.77 – 1.21) 0.74 (0.58 – 0.93) 1.28 (1.02 – 1.61) NA NA NA
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Note: Bold associations are significant (p<.05); Models adjust for PCP specialty, age, sex, race, and region; U.S. = United States; EB-PCP = National Survey of Energy Balance Related Care among Primary Care Physicians; BMI = Body Mass Index; O.R. = Odds Ratio; CI = Confidence Interval

Among PCPs treating adults (Table 2), knowledge of overweight guidelines was associated with an increased likelihood to provide general counseling, guidance on diet, and assess BMI. A higher likelihood to assess BMI was associated with knowledge of obesity guidelines and all guidelines simultaneously. Knowledge of fruit and vegetables intake, as well as all guidelines simultaneously, was associated with a lower likelihood to provide guidance for weight control practices and the systematic tracking and follow-up of patients over time.

Discussion

Weight-related clinical guidelines were first published over a decade ago [NIH 1998] and obesity is widely recognized as a clinical concern. However, physical activity guidance has not focused on PCPs and diet and physical activity-related guidelines have, until recently, not been supported by strong evidence of clinical effectiveness [Lin et al, 2010].

Knowledge of weight-related guidelines did correlate with more assessment of BMI and use of BMI-for-age growth charts. Clinical use of electronic medical records makes this practice simple and efficient. Pediatric HEDIS measures that call for measurement of BMI and physical activity and nutrition counseling are important to improve clinical care for weight-related concerns [NCQA 2009].

Study Limitations and Strengths

Limitations include the self-reported nature of the data and since fielding the EB-PCP, new guidelines have emerged thereby limiting applicability of findings. Finally, obesity represents a complex problem with causal factors that go far beyond the variables reported here.

Strengths include the nationally representative data, an almost 70% response rate, and baseline knowledge levels prior to new guideline releases provide opportunity to measure progress over time across PCP specialties.

Conclusions

Energy balance guidelines knowledge among PCPs treating children is low, whereas among PCPs treating adults it is relatively high for weight-related guidelines but moderate for physical activity and fruit and vegetables intake. Knowledge of all guidelines simultaneously is low for all PCPs. Knowledge appears largely unrelated to clinical care. Addressing gaps in knowledge is important; however, it is unlikely that knowledge improvement alone will be sufficient to generate improvements in clinical care.

Appendix.

EB-PCP Adult and Child survey questions and correct responses

Adult Patients Child Patients
BMI Question: According to current guidelines, at what BMI level are adult patients (18 years or older) considered to be … Question: According to current guidelines, in what BMI percentile range are children or adolescents 17 years) considered to have healthy weight?
Overweight

  1. ≥ 20 kg/m2

  2. ≥ 25 kg/m2

  3. ≥ 30 kg/m2

  4. ≥ 35 kg/m2

  5. Don’t Know

  1. 5th– 65th percentile

  2. 5th– 75th percentile

  3. 5th– 85th percentile

  4. 5th– 95th percentile

  5. Other (Please specify):

  6. Don’t Know
Obese:

  1. ≥ 20 kg/m2

  2. ≥ 25 kg/m2

  3. ≥ 30 kg/m2

  4. ≥ 35 kg/m2

  5. Don’t Know

Physical Activity Question: According to current guidelines, for adults, 18 and older, how much moderate physical activity is recommended (on most days of the week) for general health and prevention of chronic diseases (Check one box):

  1. 20 minutes

  2. 30 minutes

  3. 40 minutes

  4. 60 minutes

  5. 90 minutes

  6. Other (Please specify):

  7. Don’t Know

 Question: According to current guidelines, for children/adolescents, (2–17 years), how much moderate physical activity is recommended (on most days of the week) for general health and prevention of chronic diseases?( Check one box):

  1. 20 minutes

  2. 30 minutes

  3. 40 minutes

  4. 60 minutes

  5. 90 minutes

  6. Other (Please specify):

  7. Don’t Know
Diet Question: According to current guidelines, for adults, 18 and older, how many servings of fruits and vegetables should a person have in a day?

  1. 3 servings

  2. 5 servings

  3. 7 servings

  4. It depends on daily calorie intake

  5. Other (Please specify):

  6. Don’t Know

 Question: According to current guidelines, for children/adolescents, ages 2–17, how many servings of fruits and vegetables should a person have in a day?

  1. 3 servings

  2. 5 servings

  3. 7 servings

  4. It depends on daily calorie intake

  5. Other (Please specify):

  6. Don’t Know
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Acknowledgments

Data collection for this survey was supported by the National Cancer Institute’s Contract No. N02-PC-61301. We would like to thank the members of the Department of Health and Human Services’ survey development team and outside consultants:

National Cancer Institute: Ashley Wilder Smith, Steven Clauser, Rachel Ballard-Barbash, Carrie Klabunde, Susan M. Krebs-Smith, Laurel Borowski, Emily Dowling, Gordon Willis, Richard Troiano, Audie Atienza, Tanya Agurs-Collins, Bill Davis

Eunice Kennedy Shriver National Institute of Child Health and Human Development: Terry Huang, Caroline Signore

National Institute of Diabetes and Digestive and Kidney Diseases: Mary Horlick, Myrlene Staten, Susan Yanovski

National Institutes of Health Office of Behavioral and Social Sciences Research: Deborah Olster

Centers for Disease Control and Prevention: Deborah Galuska, Laura Kettel Khan, Beth Tohill

National Heart, Lung, and Blood Institute: Barbara Wells, Karen Donato

Agency for Healthcare Research and Quality: Iris Mabry-Hernandez

Outside Consultants: Nico Pronk, Robert Kushner, Erica Frank, Jim Reschovsky, Gregory Pawlson

Footnotes

Disclaimer: The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health or the Centers for Disease Control and Prevention.

Conflict of Interest Statement: The authors of this paper declare there are no conflicts of interest.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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