Obesity is a public health problem, being a well-documented risk factor for many chronic diseases, such as cardiovascular disease, hypertension, coronary artery disease, type 2 diabetes, and some cancers (1, 2). In the 21st century, the world is facing an obesity pandemic (3). According to the World Health Organization, over a billion people worldwide are obese: 650 million adults, 340 million adolescents, and 39 million children (2). In 2019, 53% of people living in the European Union (EU) were overweight and 17% were obese. The highest percentage of overweight adults was recorded in Malta and Croatia (65%), and the lowest in Italy (46%) and France (47%). The percentage for Poland was 58% (2, 4). Currently, 65% of the world’s population lives in countries where overweight and obesity cause more deaths than underweight (3). This has significant direct and indirect costs on health care and social resources (2).

The development of the COVID-19 pandemic in 2020 and related lockdown had a clear influence on bodyweight in Poland (3). During the COVID-19 pandemic, 29% of Polish women and 28% of men noticed an increase in body weight. In 2020, 46% of Polish women and 64% of men were overweight, and 8% of women and 12% of men were obese (5, 6). Treatment of obesity presents a challenge for healthcare professionals (7), and the typical location for dietary and physical activity counseling is the primary care facility (8).

General practitioners (GPs) are in the best position to observe changes in body weight and to determine the environmental and psychological factors responsible for eating disorders (9). They are expected to help obese patients lose weight by counseling them on ways to change their health behaviors, and are often the only healthcare professionals the patient can see (1). To do this, it is important for the GP to build good relationships based on trust and cooperation with the patients, as they will feel more comfortable and may be more receptive to their recommendations, compared to a specialist (10).

Poland lacks a coordinated system for obesity treatment, and treatment is typically the responsibility of GPs and specialist physicians. If the doctor is unable or unwilling to treat obesity, the patient should be referred to another doctor who will (11). Most physicians initiate weight loss discussions once a patient is in the obese BMI category, rather than at a normal BMI or who are overweight (12). Doctors believe that many patients with obesity are ready to lose weight, and that weight advice provided by doctors can be successful (13).

Numerous studies show that the involvement of GPs in obesity treatment is positively perceived by patients and results in weight loss (1, 14). Advice from a GP increases patient self-efficacy, and supports their motivation and their efforts to lose weight (1, 15, 16). Such advice is highly valued by patients, and GP counseling has potential to reduce the incidence of preventable chronic diseases (17, 18).

General practitioners are expected to provide lifestyle counseling and preventive services to patients with chronic conditions. In addition, the personal lifestyle of the physicians themselves has an impact on patient care. However, few studies have examined whether such personal factors, such as body weight, influence the weight management practices of GPs toward patients in primary care (12, 19). There are also gaps in the literature on the measurements of body weight, height, and waist circumference performed by general practitioners.

Studies most often take into account such lifestyle habits as physical activity, diet, smoking, alcohol consumption, and hours of sleep (20, 21). However, they do not take into account the number of patients under care, completed university, and years of service, which may have a significant impact on the counseling provided.

Therefore, there is a need to better understand the roles played by the personal characteristics of the GP, such as weight, the number of patients under care, age, the university where they graduated and years of service, in their approach to obesity management in patients.

The aim of this study was to assess the frequency of dietary and physical activity counseling provided by GPs stratified by body mass index (BMI). Predictors of counseling among GPs were also determined.

It also examines the frequency at which GPs calculate BMI and measure body weight, and waist circumference in adult patients to assess the severity of obesity, and determines the course of action taken with patients diagnosed with overweight or obesity, i.e., whether advice is given or the fact is noted in the records.

This study was the first during the COVID-19 pandemic to assess the extent to which GPs monitor and assess the health behaviors of overweight and obese patients and provide appropriate advice in this respect. It also examined the prevalence of overweight and obesity among the GPs themselves, and assessed various predictors that may influence the attitudes of the GPs toward dietary and physical activity counseling among their patients.

General practitioners should strive to implement activities related to a healthy lifestyle among their patients. Our survey results show that 90% of GPs believe they have a duty to advise patients on a healthy lifestyle. As many as 75% of them believe that they have sufficient knowledge to do so.

In our study, 30.4% of physicians were overweight and 11.8% were obese, and a significantly low percentage of physicians aged 40–54 (33.3%) and aged 55 and over (19.4%) had a normal BMI. Other results were obtained in the study of Alnasiri et al. (19) where 50% of the study participants were overweight while 16.1% were obese, and a significantly low percentage of physicians aged 40–54 (23.1%) and under 40 (39.3%) had a normal BMI.

The likelihood of initiating discussions about weight loss depended on the physician’s BMI: while physicians with a normal body weight were more likely to discuss body weight than those who were overweight or obese, the differences were not statistically significant, except for advice given to healthy patients by overweight doctors. In our study, 79.6% of overweight GPs advised healthy patients on diet and physical activity (p < 0.01).

Previous studies have shown that physicians with either a normal BMI or overweight/obese advised their patients to exercise regularly and make some dietary changes to control obesity (19). In the study by Alnasiri et al. (19), 95% of overweight GPs advised patients to exercise and change their diet.

About 80% of GPs in our study advised their patients on diet or physical activity; however, only one in five indicated that they “always” provide advice on diet and physical activity. Similar results were obtained by Alnasiri et al. (19), where over 90% of the surveyed physicians indicated advising their patients on exercise and diet for weight loss, and by Al-Shammari et al. (30), where 70.8% of physicians advised their patients on eating habits, and 76.9% on physical activity. Also, two-thirds of physicians in the United States reported frequently holding consultations (18). Another study found that less than 50% of surveyed physicians always give specific advice on diet, physical activity or weight management (31).

General practitioners more often gave advice on physical activity than on diet or weight control (31). About 70% of GPs in a German study (32) said that they routinely give at least half of their patient’s brief consultations on dietary modifications, and more than 90% in an Australian study reported proactively talking to their patients about nutrition (33).

More than 90% of the GPs in our study felt that diet and exercise advice would be more effective if the GPs themselves followed health recommendations. More precisely, 11% did not assess diet, physical activity or BMI when examining patients. Such patients do not receive appropriate advice regarding healthy lifestyle.

Physicians who exercise regularly and follow a healthy diet have been shown to be more likely to address BMI reduction through diet and exercise (34, 35). This is confirmed by our present findings. GPs with a normal BMI were more likely to provide advice on nutrition and physical activity when they engaged in physical activity themselves. GPs are also aware of the important role played by primary health care in health education and highlight the need for its greater participation in promoting a healthy lifestyle (36). A similar positive attitude by physicians toward overweight and obesity counseling was also noted in the present study. GPs have been found to generally demonstrate a positive attitude toward the role of nutrition in the prevention and treatment of diseases (37, 38). Most GPs in Canada, the United States and Australia agreed it would improve patient outcomes in chronic disease (39–42). More than 90% of Lebanese GPs agreed that nutritional counseling effectively influenced patient behavior (43). Dumic et al. (44) showed that one-third of the surveyed Croatian physicians expressed a positive attitude toward nutrition and nutritional care, and the majority declared that they would provide nutritional care in their daily practice. Studies conducted in Germany and the United States confirm pretty positive attitudes regarding the role of physicians in health promotion, disease prevention, and obesity counseling (32, 45, 46). However, other studies conducted in Croatia (44, 47), Saudi Arabia (48), Australia and New Zealand (49) suggest that GPs show little interest in nutritional care, which may be a consequence of insufficient nutritional knowledge and lack of appropriate education and training (48).

Interventions focusing on the assessment and promotion of physical activity are also conducted by GPs in many countries (50–52); indeed, 80% of Americans and 77% of Canadians see a GP at least once a year, and during these visits physical activity is recommended (53, 54). Several studies have documented negative attitudes by physicians regarding counseling (1, 12, 55, 56); in particular, they have reported doubts as to whether it will influence patient behavior (12, 55) and a feeling that obesity is the responsibility of the patient (12, 55).

Despite the opportunities and benefits that dietary and physical activity counseling interventions can bring, they are provided relatively infrequently (57–61). Nutritional counseling is still underexploited. GPs highlight a number of barriers that hinder the practice of nutritional counseling (62) and physical activity counseling, such as inadequate weight counseling training, lack of time, and a need to prioritize comorbidities (12, 13). Similarly, almost two-thirds of GPs in our study indicated lack of time as the main barrier to counseling, despite having appropriate training to provide counseling (75.8%), as well as the large number of patients during a routine working week.

Other studies also indicate that little time is spent on diet and physical activity counseling by physicians in primary health care (63), with some reporting only 8% of time spent with the primary care physician being used to discuss overweight and obesity (63, 64). Similarly, some previous studies indicate the main reasons for poor lifestyle interventions to be insufficient time and lack of reimbursement (65). Inadequate time was noted by 61% GPs as the major barrier to counseling regarding physical activity (35).

Dietary and physical activity advice is integral to all weight loss consultations and should ideally be imparted by a dietician or a nutritionist (66). However, in Poland, dietitians are often unavailable in primary health care and the duty of lifestyle counseling rests with the GP. New legal provisions in force from October 1, 2022, intended to provide patients with dietary consultations and educational advice as part of coordinated care, require the GP to cooperate with specialist doctors and a dietitian (67, 68).

The predictors of healthy lifestyle counseling identified in our study, viz. sex, age, health status, physical activity, BMI, weight loss intention, working years, and the number of patient visits during a routine working week, may be important considerations when designing appropriate strategies aimed at improving public health.

Our study also examined the frequency with which GPs calculate BMI and measure weight and waist circumference in adult patients. According to recommendations in Poland, BMI should be calculated once a year for each adult (3).

Anthropometric measurements (body weight, height, and waist circumference) should be performed during the first meeting and during routine visits in patients with excessive body weight, or when this is suspected, together with any related complications (3). Our findings indicate that annual BMI measurements and calculations are rarely performed. Typically, doctors measure and calculate BMI when clinically indicated. Only one in 10 GPs in our study calculate patient BMI at each routine visit.

Other studies have found that Hite et al. (69) report that 91% of physicians routinely calculate BMI, and only 61% routinely discuss BMI. Other studies have found that approximately half of the studied GPs, viz. 49% (31) and 60% (30), reported regularly recording BMI. Our study shows that the studied GPs undertake counseling with their patients, and do not just note this fact in the patient’s documentation. The GP systematically observes the patient’s behavior regarding diet, physical activity, and body weight (89.4% GPs). Overweight or obese patients receive pharmacological treatment to lose weight and, if necessary, are referred to another health specialist. 59% of GPs prescribe drug treatment for weight loss and 86.3% refer patients to another health specialist.

Our study found no differences in overweight and obesity counseling between private and public medical practices. While many service providers feel comfortable providing exercise and dietary advice (69), more financial resources are spent on treatment than prevention in Poland.

The study has limitations. It was cross-sectional, being conducted at a single-time point, which makes it impossible to observe changes over longer periods of time. In addition, due to the COVID-19 pandemic of the time, access to GPs was more limited due to government restrictions. Also, the questionnaire did not include a question about the purpose of the patient’s visit; however, regardless of the reason for the visit, a GP should always notice overweight and obesity and give advice on a healthy lifestyle. Furthermore, a lack of association was noted in the multivariate analyses, possibly due to the small sample size, the anonymous nature of the study prevented patients from being linked with particular GPs, and all assessments were carried out only among GPs and did not include the opinions of patients. It should also be noted that the observed patterns of physicians may reflect the situation in urban areas; however, physicians are trained in the same way and their approach to risk factor assessment, counseling, and treatment should be independent of the workplace.

The study also has certain strengths. Most importantly, it is one of the first to examine the relationship between the personal characteristics of GPs (including BMI) and their readiness, and ability to provide counseling on overweight and obesity in primary care patients. It is certainly the first to do so in Poland during the COVID-19 pandemic. Few such studies have been prepared in other countries.

Nutritional and physical activity counseling provided by GPs was assessed using self-reported questionnaire data.

The results may play an important role in the development of health programs aimed at reducing overweight and obesity in Poland and elsewhere. Tackling obesity should be linked to an overall strategy to combat chronic non-communicable diseases and health promotion efforts. Specific interventions in this regard may include: introducing early recognition and management of overweight and obesity in primary health care, providing training on obesity prevention for family doctors, and increasing reimbursement for this type of health services. Further research on the influence of a GP on the health behavior of patients in primary health care and the identification of predictors of healthy lifestyle counseling is recommended.

Our findings suggest that variation in physician BMI had an effect on their practice and counseling of obesity care. The likelihood of measuring body weight, height, and BMI by GPs were associated with a greater chance of giving advice on diet or physical activity. In addition, a high proportion of the studied physicians were found to be overweight and obese themselves.

Physicians should be properly trained so that the scope and frequency of advice provided should not be influenced by their individual characteristics, but only by their patient’s health condition. GPs are “role models” and hence should serve as good examples for patients. A doctor with a normal BMI will be more credible for a patient than a doctor who is overweight or obese, which can help make weight loss advice more effective.

The is a need for more practical guidelines, greater community involvement and more comprehensive training among primary care physicians to improve obesity treatment in Poland. The latter are particularly important as a significant percentage of doctors have little opportunity to improve their knowledge and skills in this area and doubt their effectiveness. A health policy that helps overcome barriers and create a stimulating environment for GPs to effectively implement nutrition and physical activity counseling strategies is key to improving the quality and quantity of counseling.

In addition, organizational changes are needed to reduce the number of patients admitted to reducing time constraints, and financial incentives are needed to improve counseling and patient measurement. GPs should be encouraged to advise healthy patients on how to prevent overweight and obesity, not only those already affected by the problem. Our findings reinforce the need for the development of educational strategies to support dietary and physical activity intervention among primary care physicians.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

MZ: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Validation, Writing – original draft, Writing – review & editing. DK: Supervision, Writing – review & editing.