Table 1.

Summary table.

NUMBER/author/year	Location/design/sample	Objective	Theoretical framework	When was health advice given	What health advice was given	Findings	Strengths/weaknesses
1. Alexander et al. (2011)	USA Mixed method 461 patients 40 physicians	To see if physician weight loss advice results in a change to patient dietary intake, physical activity and weight.	Not explicit. Social cognitive theory/motivational interviewing	In 63% of encounters of either overweight or obese, BMI 25>. Did not specify BMI category (Overweight or obese)	Nutrition: 9 subcategories. Physical activity: 6 subcategories. Specific Weight loss advice: 3 categories.	Combined advice in 34% Physical activity only in 13% Nutrition only in 8% Weight loss only in 3% Patients who received combined advice lost more weight than patients who received no advice but not statistically significant p = 0.08.	Strengths: Not self- selected and motivated. Large ethnically diverse sample. Weaknesses: Self- report for Not generalizable to young, low income.
2. Barte et al. (2012)	Netherlands Process evaluation. 11 General practices.	To investigate lifestyle interactions by nurse practitioners compared with general practitioners	Groningen Overweight and Lifestyle (GOAL) Intervention.	BMI 25>	Based on national and international guidelines.	>80% satisfaction that healthy eating and physical activity was useful by the NP.	Weakness: Self report, relies on patient recall. The intervention was not implemented as designed.
3. Brauer et al. (2012)	Canada Qualitative2184 surveys sent to 3 Ontario family health networks.	To assess patient perceptions of preventive lifestyle counselling in Primary care practice. (Shortly after dieticians joined the family health network and 1 year later).	Not explicit.	Not discussed.	Verbal advice and pamphlets were the most common. Verbal advice 61% initially and 78% 1 year later. Use of pamphlets 34% and 18% 1 year later. Content of advice not reported.	Overall rate of diet counselling 37%, exercise counselling 24%. Low rates of preventive counselling	Weakness: Self -report could lead to bias.
4. Clune et al., 2010	USA Qualitative,793 men and women over 60	To examine the prevalence and predictors of health care professionals recommendations to lose weight.	Not explicit.	In those ‘overweight with risks’ 19.8% In those ‘obese with risks’ 52%	Not reported	70% of participants met the weight loss criteria but only 36% received advice to lose weight in the past year.	Weakness: Self-report may have led to recall bias
5. Dutton et al. (2014)	USA Cross-sectional survey with 143 respondents	To examine patient characteristics, physician characteristics and characteristics of the physician/patient relationship associated with weight loss counselling and recommendations provided by physicians.	Not explicit.	Higher BMI was associated with more frequent weight loss counselling, p < 0.001.	Not reported.	A greater number of medical conditions was related to more frequent weight loss counselling, p < 0.05. Female doctors were more likely to give weight loss advice. p < 0.03.	Weaknesses: Self-report may have led to recall bias. Homogeneous- difficult to compare race and sex. Modest sample size.
6. Eley and Eley (2009)	Rural QLD, Australia Qualitative survey 40 GP practices selected 27 responded.	To determine whether rural GP's use physical activity as a weight loss strategy and if so, how?	Pope et al. (2000) 5 stage framework	Not reported.	16 GP practices reported referring to gyms or fitness classes 6 GP practices reported referring to QLD health exercise physiologists and physio. 8 GP surgeries reported using life scripts while 3 stated having never heard of them, 3 noted occasionally using them and 3 considered them a ‘gimmick’ ‘not suitable’ and ‘ineffective’	16 GP practices cited motivation and commitment, lack of local facilities and lack of footpaths as barriers to physical activity (relating to rural areas)	Weaknesses: Pilot study. Small sample size. Did not state when they give advice. Did not state what their advice was.
7. Flocke et al. (2014)	USA Mixed method observational study of 811 patient visits to 28 primary care clinicians	To examine the effectiveness of teachable moments to increase patients' recall of advice, motivation to modify behaviour, and behaviour change.	Health behaviour change.	BMI 25 and over with the presence of a chronic condition. BMI 30 and over with under consumption of fruit and veg	Not stated.	86% had at least one opportunity for discussion. 45% had a health behaviour discussion. Missed opportunities 61%	Weaknesses: No positive association between TM and BMI change at 6 weeks- too short Audio recorder-bias
8. Halbert et al. (2017)	USA Qualitative observational study, cross sectional study. 282 participants	To examine the receipt of provider advice to lose weight among primary care patients who were overweight and obese.	Not explicit.	59% of participants advised to lose weight. 41% had not received advice. 40% overweight participants had been advised to lose or maintain weight.	Not stated	Women were more likely than men to be advised to lose weight. Obese were more likely to report being asked to lose weight than overweight.	Self –reported may have led to patient recall bias. Cross sectional design led to inability to determine causality of receipt of provider advice. Health advice given was not reported.
9. Harris et al. (2012)	Australia Qualitative survey. 698 participants	To explore whether education and referral by GP's to patients with smoking, nutrition, alcohol, physical activity and weight (SNAPW) behavioural risk factors is tailored to patients risk and readiness to change.	(Prochaska and Di Clemente, 1986) Stages of behaviour change.	Those given dietary advice had mean BMI of 30.01, those not, mean BMI 27.76 Those given physical activity advice mean BMI 30.23,those not mean BMI 27.52	Those with higher BMI recorded were more likely to receive a referral for dietary or physical activity than those with lower BMI score.	High prevalence of behavioural risk factors in diet and physical activity. Diet 72.6% physical activity 57.6%. Mean BMI 28.4. Low frequency of education and referral of patients with SNAPW in general practice.	Self –reported, potential recall bias. Practices were volunteers that expressed an interest which may have influenced the likelihood of them addressing it.
10. Kable et al. (2015)	Australia Qualitative cross sectional survey. 79 participants,	To report perceptions, practices and knowledge of nurses about providing healthy lifestyle advice for patients who may be overweight or obese and compare responses from demographic regions.	Not explicit.	28% measure height and weight 18% measure waist 65% were aware that overweight was defined as BMI 25 and over	Quality of weight loss advice was not attainable. 72% had no or low level knowledge 44% recommended increasing physical activity.	74% of nurses provided dietary advice. 81% of nurses provided physical activity advice. Most nurses reported not receiving education Only half of the participants were confident to raise issue	Weaknesses: Participation was voluntary which may suggest an interest. Low response rate noted, which may have produced a non- response rate bias. Nurses were not all in primary care
11. Korhonen et al. (2014)	Finland Longitudinal cohort study. 2752 at risk subjects.	To identify overweight and obese with increased cardiovascular risk in the community and provide with lifestyle counselling that is possible to implement in real life.	Not explicit.	BMI 25 and over Waist circumference 80 cm and over in females or 94 cm and over in males.	Aim to reduce weight by 5% by reducing saturated fat and increasing physical activity to at least 30 mins per day or 4 h per week.	By targeted screening it is possible to find overweight and obese people at increased cardiovascular risk, to induce clinically meaningful, long –term, weight loss or stabilisation in primary care.	Weaknesses: There was no comparison group. 3 year follow up was 42%
12. Noordman et al. (2012)	Netherlands Systematic review RCT, 18 yrs>, lifestyle communication, PCT	To review literature on relative effectiveness of face to face communication related behaviour change techniques provided in primary care by either physicians or nurse to intervene on patients' lifestyle behaviour.	Reference to Prochaska and Di Clemente's trans theoretical model of behavioural change and Bandura's social cognitive theory.	No difference shown between GP's and nurses' however, few studies include both so caution must be exercised.	Behavioural counselling, motivational interviewing, education and advice are most frequently evaluated as effective face to face communication related BCT's	One primary care professional does not seem better equipped that another to provide face to face related BCT's.	Strengths: High quality strategic review Included studies with rigorous design Weaknesses: Publication bias. Non- English excluded.
13. Pollak et al. (2011)	USA Qualitative40 primary care physicians, 461 encounter	To analyse time spent on the topic of weight and whether motivational interviewing was used.	Epstein et al. (2005) patient centred communication. Motivational interviewing.	Nutritional advice was given on 78% Physical activity advice was given on 82% BMI/weight was taken on 72%	Not stated.	Mean time of 3.3 min was spent addressing the topic. Obese patients spent longer talking about weight than overweight.	Weaknesses: Study may not be generalizable to young people with lower incomes.
14. Robertson et al. (2011)	Australia QLD Qualitative1261 participants	To ascertain the extent to which general practitioners in Queensland recommend physical activity to their patients, the types of patients they target, types of activity they suggest and how patients respond to the recommendations.	Not explicit. Health promotion.	GP's recommended 81% 24.7% was in the last year. 40% of overweight participants were advised to exercise more. 17% had heart problems. 15% had diabetes, asthma or osteoporosis	75% were advised to walk 13% swimming/aqua aerobics/hydrotherapy/low impact exercise 13% to use gym/weights or aerobics.	Obese were most likely to be recommended to do more exercise 34%, followed by overweight 15%, acceptable weight 7%, and underweight 4%.	Weaknesses: Self -report may lead to recall and social desirability bias. No description of BMI given.
15. Schauer et al. (2014)	USA Qualitative 30 P.C. physicians, nurses, assistants from 4 multi clinic health centres	To use qualitative methods to explore how clinicians approach weight counselling, including who, how, what, and what referrals.	Not explicit.	Addressed with all, rapport first, chronic consults, unwritten protocol when to address it, when doing vitals	Specific diets, walking common, increase activity Some develop their own or use existing brochures or handouts. Some told to google weight loss apps.	Overwhelming majority have no external resources or behavioural treatments, e.g. dietician, classes, programmes.	Weaknesses: Self -report may lead to recall bias. Not generalizable to the whole population.
16. Shay et al. (2009)	USA Comprehensive review of articles	To provide a practical approach to managing overweight and obese adult patients based on data from research and recommendations from established guidelines.	Not explicit.	It should be addressed when BMI is calculated and a diagnosis of overweight or obese is given.	Advice should be: Calorie intake and goal weight, educate, follow up, weight maintenance.	Nurse practitioners can easily integrate simple, safe, and effective weight management strategies into their practice.
17. Shuval et al. (2014)	USA Pilot Cross sectional study. 157 patients,	To examine the reliability and validity of brief sedentary assessment tool for primary care.	5 A's framework	During routine visits. Most participants were overweight with a mean BMI of 27.	No specific advice noted. 10% reported sedentary behaviour counselling in the last year. 53% received physical activity counselling 45% advised to modify physical activity time. None received a written plan	Sedentary behaviour counselling practices are infrequent in primary care clinics.	Weaknesses: No specific advice noted, Self – report, limited sample size, one primary care clinic.
18. Stephens et al. (2008)	USA Qualitative. Survey of 283 participants pre intervention, 386 in post intervention.	To investigate the effects of a simple visual prompts poster on occurrence of patient/physician weight loss conversation.	5 A's framework	When patients brought weight up or when GP brought weight up. Not very clear.	Not stated.	42% reported interest in weight loss but did not discuss it with the physician. Visual prompt poster did not increase proportion of patients reporting they wanted to lose weight.	Weaknesses: No demographics taken. Poster was not pretested. Not documented who initiated the discussion.
19. Sonntag et al. (2010)	Germany Cross sectional study with 12 GP practices.	To analyse GP encounters with overweight and obese patients. To test whether patients with a BMI 30 or over had longer consultations relating to lifestyle, nutrition and physical activity than those with a BMI under 30.	Not explicit. Behavioural change theory.	Not clear. During biennial checks of over 35 year olds.	Not stated.	78% of dialogues were between 0 and 6.76 min. 70% of dialogues had physical activity brought up. Female GPs had longer consults and more consults relating to weight/nutrition than male GP's	Weaknesses: BMI - self reported may have been influenced by social desirability bias. GP's volunteered- may suggest they were more motivated
20. ter Bogt et al. (2011)	Netherlands. Quantitative. Randomized controlled trial. 11 general practitioners, 457 participants,	To compare structured lifestyle counselling by nurse practitioners with usual care from GP. To see if results at 1 year were sustained at 3 years.	Not explicit.	BMI 25 or over with a co morbidity.	Not stated.	Preventing weight gain by Nurse practitioners did not lead to better results than GP's.	Strengths: Large population, equal male and female participants, low dropout rate. Weaknesses: Hawthorne effect, participants had to be informed of the study
21. van Dillen et al. (2014)	Netherlands Qualitative. Observational study. 19 practice nurses	To examine the content of Dutch practice nurses' advices about weight, nutrition and physical activity to overweight and obese patients.	Not explicit.	PN initiated/PT initiated. Weight 118/39 Nutrition 161/78 Physical activity 135/66	To lose weight. Reduce fat, salt, sugar, alcohol, increase fruit. 1 in 10 included possibility of dietician Be more active- walking, cycling.	Majority of advice based on guidelines, type II diabetes in particular. Advice based on GP standards for a specific illness. BMI was calculated in 9% Often not tailored	Weaknesses: No ethics approval Recording may have resulted in bias.
22. Waring et al. (2009)	USA Quantitative	To examine overweight and obesity management in primary care in relation to Body Mass Index, documentation of weight status, and comorbidities	Not explicit: Behavioural change theory	The higher the BMI the more likely to have weight status and intervention documented	Behavioural interventions. To lose weight, Physical activity, diet, referral to nutritional counselling	Documentation of OW/obesity was associated with higher odds of advice to lose weight among OW compared with mild/moderate/severe obesity. Advice was prevalent in >50% of patients with a documented mod/severe obesity.	Weaknesses: Not generalizable- mostly white non-Hispanic Unclear who initiated the conversations.
23. Yoong et al. (2014)	Australia Qualitative. Cross sectional study. 1111 patients	To determine extent that Australian GP's recognise overweight and obese patients.	Not explicit.	Not discussed.	Not discussed.	Males without hypertension or type II diabetes had higher odds of not being identified. GP reported prevalence of overweight and obesity was lower than the patient report- 38% v. 53% 12% of obese were categorised as none overweight