1. Introduction
The prevalence of being overweight or obese has increased substantially over the past decade [
1]. In one of the few population-based studies with objective body mass index (BMI) measurement of over 11,000 adults, 67% of men and 52% of women over 24 years of age were overweight (BMI > 25) or obese (BMI > 30) in 1999–2000 [
2]. Additionally, adults are progressing from being overweight to being obese or morbidly obese at alarming rates [
3,
4,
5]. Obesity increases the risk of developing chronic diseases including type 2 diabetes, cardiovascular disease and some cancers, with the primary recommendation from the World Cancer Research Fund for adults to be as lean as possible, without becoming underweight [
6,
7]. A high prevalence of obesity increases the demands on the public health system and on health professionals whose role it is to provide weight loss interventions.
Consequently, there is a clear need for developing strategies to target individuals who are overweight or obese and to prevent further weight gain during a range of patients’ encounters within the health system. Furthermore, although guidelines for providing weight management advice exist, they are not being routinely utilised by health professionals [
8]. Within the healthcare setting, weight loss interventions are usually provided by dietitians and general practitioners [
9,
10,
11]. However, other allied health professionals such as physical therapists, occupational therapists, psychologists, nurses, exercise physiologists and occupational health nurses may also be able to provide some evidence-based healthy lifestyle advice to their clients, within their existing role, and potentially before severe co-morbidities develop in clients who may be overweight [
12,
13,
14]. What is not known is whether allied health professionals consider the provision of healthy lifestyle advice as part of their role, whether they have adequate knowledge to provide evidence-based weight management advice, and whether they are already doing this.
Previous studies regarding weight management beliefs and practices of allied health professionals have primarily focused on dietitians [
9,
15], nurses [
16] and physical therapists [
17,
18]. Surveys of nurses and physical therapists indicate that they believe the provision of weight loss advice is an important component of their client management [
17,
18,
19], and that additional training to improve skills and confidence in providing healthy lifestyle advice would be beneficial. The Counterweight programme [
16] in the UK demonstrated that after a six to eight-hour training program, general practice nurses could effectively lead practice-based weight loss interventions that included patient assessment and strategies for healthy eating, physical activity and behaviour change. These patient interventions were provided over six individual or group sessions with continued follow-up and demonstrated that after 12 months, 34% of patients had achieved a weight loss of five percent or more [
16]. These results suggest that allied health professionals, in addition to dietitians, may be able to contribute to interventions to effectively assist clients with weight management advice. We have previously reported on educational and personal factors associated with allied health practitioner’s health promotion actions and behaviours in the provision of weight management advice to clients within in the Community Healthy Adult Project (CHAP), a cross-sectional survey across a broad range of allied health professionals (dietitians, physical therapists, exercise physiologists occupational therapists, community nurses, occupational health nurses and psychologists) [
20]. To date, however, the views of allied health professionals in regard to provision of weight management interventions have only been reported for individual allied health disciplines without comparisons between disciplines. Further, no study has been identified that includes a range of allied health professionals working in the same setting and region. This enables comparisons of health professional practices and service provision within a single geographic population.
Therefore the aim of the current study was to determine from the CHAP survey in a broad range of Australian allied health professionals their knowledge, attitudes and practices in relation to the provision of healthy lifestyle to clients with overweight or obesity, specifically nutrition and physical activity advice for weight management. In addition, the factors influencing the provision of that advice will be explored.
4. Discussion
The current study demonstrates that the majority of health professionals believe it is within their scope of practice to provide dietary and physical activity advice for weight management. Within each discipline surveyed, ≥60% believed it was within their scope of practice, with the exception of occupational therapists, where this was 47%. However, in this survey few health professionals other than dietitians reported having received any education or training in provision of weight management advice. Health professionals in the current survey were more likely to provide dietary and physical activity advice if they believed it was within their scope of practice and if they had received education in client weight management either during their entry-level professional qualification or by attending continuing education. This indicates that allied health professionals, in addition to dietitians who commonly spend large proportion of their time in provision of weight management services [
9,
10,
11], may be responsive to receiving further training and continuing education in the area of weight management as a strategy to assist their clients who are overweight or obese. Further, the inclusion of weight management education within entry-level curricula may encourage more health professionals to provide advice for weight management, having an impact on rising levels of obesity.
The results of this survey suggest that health professionals are potentially willing and able to provide an initial basic intervention to clients earlier in their weight gain trajectory through provision of evidence-based information on making lifestyle changes. Indeed, one pilot study has shown that dental hygienists can successfully provide a healthy weight intervention to children as part of their routine care [
26]. Provision of consistent weight management messages by a wide range of allied health professionals could potentially ease the burden on the dietetics profession and reserve their expertise for those clients requiring specialised dietetics interventions to address co-morbidities associated with existing chronic conditions. Further research is now needed to examine whether a range of allied health professionals, who are willing to contribute to the team providing weight management advice, can impact on the weight gain trajectories of their clients and potentially impact on obesity prevalence.
Few of the allied health professionals in the current survey had received any education or training related to weight management, despite the high numbers believing it was within their scope of practice to provide this advice and the high numbers already providing both dietary and physical activity advice for weight management. This is in agreement with a previous survey reporting that, although health professionals usually promote the concepts of lifestyle modification, few had adequate knowledge for providing practical advice on diet or physical activity [
27]. For those who did report receiving education in weight management in the current study, it is unclear how much of this included dietary advice versus physical activity advice, or the source and quality of this instruction. For those who were providing advice without having received weight management education, the quality of the advice given is unclear. With the high percentage of allied health professionals willing and able to provide weight management advice, it is essential that adequate education programs and evidence-based resources be developed [
27].
In the current survey, having had previous education in client weight management was associated with health professionals providing both dietary and physical activity advice to clients (
Table 4 and
Table 6). Having previous education may increase a health professional’s confidence in providing weight management advice, leading to greater participation of health professionals in the management of obesity. Indeed, one previous survey of health professionals found that self-efficacy was the best predictor for providing healthy lifestyle advice to clients [
17]. As self-efficacy can be a mediator of the provision of advice to clients, future research should consider measuring it. If self-efficacy is lacking in health professionals, future research could investigate methods to improve self-efficacy within training programs for the provision of lifestyle advice.
Interestingly, a health professional’s area of practice (e.g., community care, public hospital) and their location of practice (e.g., major city, regional) were not associated with whether or not they provided advice. These factors differed between health disciplines (
Table 2) suggesting that variability in these factors may have possibly contributed to their non-significant result in the regression modelling. This was despite a significant association between health professional discipline and the provision of advice. A health professional’s gender was not associated with the provision of dietary or physical activity advice. However, the discipline with the highest percentage of male respondents was physical therapists. Therefore it is possible that gender may have had some influence on the responses of this group or the findings specific to physical therapists, as compared to the other health professional disciplines. The impact of gender on the provision of advice is an area for future study, and would require a greater proportion of male respondents than observed in the current study. Nonetheless, the representation of gender within the disciplines in the current study reflects the gender balance within these disciplines in the clinical setting.
An important factor associated with health professionals providing both dietary and physical activity advice for weight management was their belief that it was within their scope of practice. This suggests that continuing education in weight management and the provision of evidence-based advice will be required, if health professionals’ beliefs about their role in the provision of care are to be influenced. Having departmental guidelines was associated with the provision of dietary, and to a lesser extent physical activity advice. However, few health professional disciplines in the current study, other than dietitians, reported having departmental guidelines for provision of dietary or physical activity advice. The development and implementation of guidelines that would be applicable and acceptable to a wide range of allied health professionals may facilitate provision of dietary and physical activity advice by these professionals, and this is an area for future research.
Despite the fact that the minority of allied health professionals, with the exception of dietitians, had received any education or training in the provision of healthy lifestyle or weight management advice for clients with overweight or obesity, the majority believed it was within their scope of practice and many reported already providing this type of advice to their clients. This indicates that education programs in weight management are urgently needed so that allied health professionals can provide consistent and evidence-based weight loss advice, even if brief. Future research is needed to determine the types of education formats that would be acceptable and engaging for health professionals, and whether this differs for different health professional disciplines, age groups or genders.
Limitations
This study is limited to a single geographical region in Australia, and to the health professional groups surveyed. Though the sample was considered representative of allied health professionals in these groups within Australia, including additional health professional groups or those from other countries or regions may produce different results. Furthermore, it was not possible to evaluate the quality of weight management advice provided by health professionals, as the survey relied on the health professionals’ self-report.