Abstract
Background/Objectives: The ongoing obesity epidemic remains a significant public health challenge in the U.S. Nearly one-third of adults are overweight, and nearly half of the population (42.4%) are obese. These conditions, driven by poor and unsustainable diets, are major risk factors for several chronic diseases, including heart disease, which continues to be the leading cause of death in the country. This review aims to examine existing research on health care professionals’ attitudes and perceptions of plant-based nutrition and explore how this knowledge can be utilized to promote the adoption of plant-based diets (PBDs) among Americans as an alternative to the standard American diet. Methods: PubMed and Web of Science databases were searched in April, 2024. Out of the 151 articles identified, 27 were deemed eligible and included in the narrative review. Results: Nine key themes were identified as major influences on the attitudes and behaviors of health professionals regarding PBDs. These themes were mapped with the domains of the Theoretical Domains Framework (TDF) to stratify key enablers and barriers to implementation of PBDs in routine care for patients. Conclusions: Key barriers to incorporating plant-based nutrition into routine care include time constraints, limited educational resources, insufficient skills, lack of multidisciplinary collaboration, and inadequate professional training. Access to evidence-based research summaries, clear guidelines, ongoing professional development, and other relevant educational resources were identified as facilitators of successfully integrating PBDs into everyday practice.
Generated Summary
This narrative review explores existing research on attitudes and perceptions of health professionals towards plant-based nutrition. The study examines barriers and enablers influencing the incorporation of plant-based diets (PBDs) in routine patient care. The methodology included a search of PubMed and Web of Science databases in April 2024. A total of 27 articles were included in the narrative review. The study analyzed the influence of the Theoretical Domains Framework (TDF) and its domains on the attitudes and behaviors of health professionals towards implementing PBDs in routine patient care. The study aimed to understand how existing research on healthcare professionals’ perceptions of PBDs can be utilized to promote the adoption of plant-based diets as an alternative to the standard American diet.
Key Findings & Statistics
- Nearly one-third of U.S. adults are overweight, and nearly half (42.4%) are obese.
- The obesity rate has increased from 3.4% to 35% in the last one hundred years.
- 90% of the country’s $4.1 trillion annual health expenditure is spent on chronic and mental health conditions.
- Obesity alone costs the American healthcare system $173 billion annually.
- Less than 10% of Americans follow a PBD.
- In a study, 55% of patients were more willing to implement a PBD for three weeks if a nutritionist or dietitian recommended it.
- The majority (62.9%) of the articles were published between 2020 and 2024.
- Twenty-three of the twenty-seven articles used questionnaires for data collection.
- Articles came from 12 countries, with most (15/27) articles coming from the USA (9/27) and Australia (6/27).
- Nine studies were conducted with only dietitians or nutritionists [56–64], eight included dietitians/nutritionists and various health professionals, and ten studies were conducted with health professionals not including dietitians or nutritionists.
- Approximately 33% of respondents were willing to recommend PBDs, while the majority (51%) responded with maybe.
- Only 28% were willing to adopt PBDs, and 25% were willing to try it for 6 months or more.
- Approximately 72% of health care providers reported knowledge of PBDs for the management of type 2, while the majority of patients (89%) had not heard of using PBDs to treat/manage type 2 diabetes.
- Less than 25% of the physicians in the study followed the facets of MD.
- Over 80% of nutrition professionals agreed that following a PBD promoted good nutrition, and over 70% disagreed that it was hard to meet protein requirements while following a PBD.
- Over 80% of dietitians considered the food guide’s recommendation to choose plant-based protein foods as evidence-based.
- Most had a positive view of the new guidelines, and 58.7% were more likely to encourage their clients to select plant-based protein options.
Other Important Findings
- Nine key themes were identified as major influences on the attitudes and behaviors of health professionals regarding PBDs.
- Key barriers to incorporating plant-based nutrition into routine care include time constraints, limited educational resources, insufficient skills, lack of multidisciplinary collaboration, and inadequate professional training.
- Access to evidence-based research summaries, clear guidelines, ongoing professional development, and other relevant educational resources were identified as facilitators of successfully integrating PBDs into everyday practice.
- The most salient TDF domains determined to be strongly linked to these themes were environmental context and resources (n = 5), skills (n = 4), social/professional role and identity (n = 3), beliefs about consequences (n = 3), and knowledge (n = 2).
- Health professionals with a history of following PBDs were found to be more knowledgeable about PBDs than their counterparts who had never tried any version of PBDs.
- High knowledge scores in some studies were found to be positively correlated with positive attitudes towards PBDs [74].
- Ten of the twenty-seven studies reviewed reported that participants indicated that their university and professional education and training had not equipped them with the education and skills related to plant-based nutrition and therefore felt less confident about discussing and implementing it in their practice [60,62,68–70,73].
- Several studies reported education and training as enablers for health professionals to discuss and recommend plant-based nutrition with their patients [37,56,64,65,70,71].
- Some health professionals indicated that having robust evidence-based guidelines/summaries of research findings regarding plant-based nutrition would increase their self-efficacy and enable them to discuss and recommend it to their clients [37,58,60,65,70].
- In connection with evidence-based guidelines, a few studies also highlighted the need for collaborations across various health/scientific disciplines involved in providing health care services relating to diet and nutrition to patients.
- Health professionals were more inclined to provide regular counseling on plant-based nutrition if they personally adhered to it most of the time or always, in contrast to only occasionally or less frequently [60,77].
- Several participants indicated that access to opportunities for practical-based professional development, such as scientific conferences, continuous training programs, and plant-based nutrition-related education resources [60] and tools for both health professionals and their clients, would enhance their ability to deliver improved clinical care to their patients.
- Study participants also reported that they were limited by time constraints regarding keeping up with the literature and had limited clinician time to discuss and counsel patients on plant-based nutrition [59,60,65,68,75,76,78].
- Study participants expressed fear around potassium control in patients with chronic kidney disease, especially in instances of comorbid conditions such as diabetes and CVD.
- Several health professionals expressed a lack of belief in patients’ capabilities to change behavior and improve diet adherence.
- Subgroup analysis by professional category (physicians/clinicians versus dietitians/nutritionists) highlighted unique barriers and enablers that both groups face in relation to recommending PBDs.
Limitations Noted in the Document
- The predominance of observational studies in the analysis limits the generalizability of the findings.
- Future studies should aim to incorporate a greater number of studies, including longitudinal studies, to enhance the robustness and applicability of results.
Conclusion
The review underscores the critical need to address barriers and leverage enablers for promoting PBDs within healthcare settings. Key themes, including knowledge, education, and training, evidence-based guidelines, multidisciplinary collaboration, and personal experience, significantly influence health professionals’ attitudes and behaviors. The dominance of the environmental context and resources domain indicates that systemic support is crucial. Specific challenges include time constraints, limited skills, and a lack of patient confidence in adopting PBDs. Conversely, access to educational resources and professional development, along with personal experience, can facilitate the integration of PBDs into clinical practice. The findings highlight that tailored strategies are needed for physicians/clinicians and dietitians/nutritionists, emphasizing the importance of evidence-based guidance and institutional support respectively. The integration of PBDs in clinical practice is vital. Providing health professionals with continuous opportunities, targeted training programs, workshops, and resources will empower them to confidently recommend plant-based nutrition. Policymakers and institutions should prioritize the development of guidelines, educational materials, and practical support, to ensure patient care is informed by the latest scientific research.