Skip to main content

Different settings, different approaches: a qualitative comparison of Portuguese dietitians’ beliefs, attitudes and practices about obesity in public and private settings

  • Filipa V Teixeira (a1), José Luis Pais-Ribeiro (a2) and Ângela Maia (a1)

With obesity being a major public health epidemic, dietitians are charged with the difficult task to assist clients in modifying their behaviours. Since there are inconsistent data about dietitians’ beliefs, attitudes and practices concerning obesity and little is known concerning differences in public and private practice, we conducted the present study to address those gaps.


Semi-structured interviews analysed according to thematic analysis procedures.


Public primary-care and private settings.


Seventeen Portuguese registered dietitians working in public primary-care (n 10) and private settings (n 7).


Regardless of work context, ‘persistence of efforts’ emerged as the main characteristic of dietitians’ action. Besides holding negative attitudes towards obese patients, their practices are not negatively influenced. They perceive themselves as active agents in promoting lifestyle changes, offering as many management strategies as possible to empower patients, feeling positive about the accomplishment of a successful weight loss, believing in their own efficacy and competency in helping patients. However, differences in reimbursement, work environment, perceived barriers, patient characteristics and availability of resources seem to contribute to differences in persistence according to the setting in which dietitians are working, evidenced by an increase of efforts and engagement in private practice and a decrease in public primary-care practice.


Portuguese dietitians present a positive mindset and actions about obesity treatment outcomes; however, education in behaviour change strategies should be improved. The public health system requires reorganization to enhance effective obesity management delivery. Motivation driving dietitians’ work in private settings should be addressed.

Corresponding author
* Corresponding author: Email
Hide All
1. Sardinha, LB, Santos, D, Silva, AM et al. (2012) Prevalence of overweight, obesity, and abdominal obesity in a representative sample of Portuguese adults. PLoS One 7, e47883.
2. Pereira, J & Mateus, C (2003) Custos indirectos associados à obesidade em Portugal (Productivity costs associated with obesity in Portugal). Rev Port Saude Publica 3, 6580.
3. Campbell, K & Crawford, D (2000) Management of obesity: attitudes and practices of Australian dietitians. Int J Obes Relat Metab Disord 24, 701710.
4. Barr, SI, Yarker, K V, Levy-Milne, R et al. (2004) Canadian dietitians’ views and practices regarding obesity and weight management. J Hum Nutr Diet 17, 503512.
5. Endevelt, R & Gesser-Edelsburg, A (2014) A qualitative study of adherence to nutritional treatment: perspectives of patients and dietitians. Patient Prefer Adher 8, 147154.
6. McArthur, L (1995) Nutrition and nonnutrition majors have more favorable attitudes toward overweight people than personal overweight. J Am Diet Assoc 95, 593596.
7. Harvey, EL, Summerbell, CD, Kirk, SFL et al. (2002) Dietitians’ views of overweight and obese people and reported management practices. J Hum Nutr Diet 15, 331347.
8. McArthur, L & Ross, J (1997) Attitudes of registered dietitians toward personal overweight and overweight clients. J Am Diet Assoc 97, 6365.
9. Oberrieder, H (1995) Attitude of dietetics students and registered dietitians toward obesity. J Am Diet Assoc 95, 914916.
10. Swift, JA, Hanlon, S, Puhl, RM et al. (2012) Weight bias among UK trainee dietitians, doctors, nurses and nutritionists. J Hum Nutr Diet 26, 395402.
11. Berryman, DE, Dubale, GM, Manchester, DS et al. (2006) Dietetics students possess negative attitudes toward obesity similar to nondietetics students. J Am Diet Assoc 106, 16781682.
12. Puhl, R, Wharton, C & Heuer, C (2009) Weight bias among dietetics students: implications for treatment practices. J Am Diet Assoc 109, 438444.
13. Budd, GM, Mariotti, M, Graff, D et al. (2011) Health care professionals’ attitudes about obesity: an integrative review. Appl Nurs Res 24, 127137.
14. Chapman, GE, Sellaeg, K, Levy-milne, R et al. (2005) Canadian dietitians’ approaches to counseling adult clients seeking weight-management advice. J Am Diet Assoc 105, 12751279.
15. Almajwal, A, Williams, P & Batterham, M (2009) Current dietetic practices of obesity management in Saudi Arabia and comparison with Australian practices and best practice criteria. Nutr Diet 66, 94100.
16. Zinn, C, Schofield, G & Hopkins, WG (2013) Management of adult overweight and obesity: consultation characteristics and treatment approaches of private practice dietitians. Nutr Diet 70, 113119.
17. Lu, A & Dollahite, J (2011) Assessment of dietitians’ nutrition counselling self-efficacy and its positive relationship to reported skill usage. J Hum Nutr Diet 23, 144153.
18. Cowburn, G & Summerbell, C (1998) A survey of dietetic practice in obesity management. J Hum Nutr Diet 9, 191195.
19. Brown, LJ, Mitchell, LJ, Williams, LT et al. (2011) Private practice in rural areas: an untapped opportunity for dietitians. Aust J Rural Health 19, 191196.
20. Braun, V & Clarke, V (2006) Using thematic analysis in psychology. Qual Res Psychol 3, 77101.
21. Taylor, B & Francis, K (editors) (2013) Qualitative Research in the Health Sciences. London: Routledge.
22. Creswell, J (editor) (2007) Qualitative Inquiry & Research Design: Choosing Among Five Approaches, 2nd ed. Thousand Oaks, CA: SAGE Publications, Inc.
23. Leverence, R, Williams, R, Sussman, A et al. (2007) Obesity counseling and guidelines in primary care: a qualitative study. Am J Prev Med 32, 334339.
24. Stone, O & Werner, P (2012) Israeli dietitians’ professional stigma attached to obese patients. Qual Health Res 22, 768776.
25. Teachman, B & Brownell, KD (2001) Implicit anti-fat bias among health professionals: is anyone immune? Int J Obes Relat Metab Disord 10, 15251531.
26. Malterud, K & Ulriksen, K (2011) Obesity, stigma, and responsibility in health care: a synthesis of qualitative studies. Scand J Prim Health Care 1, 111.
27. Brownell, K & Puhl, R (2003) Weight management and obesity stigma and discrimination in weight management and obesity. Perm J 7, 2123.
28. Stewart, M (1995) Effective physician–patient communication and health outcomes: a review. CMAJ 152, 14231433.
29. MacLellan, D & Berenbaum, S (2007) Canadian dietitians’ understanding of the client-centered approach to nutrition counseling. J Am Diet Assoc 107, 14141417.
30. Neumark-Sztainer, D (1999) The weight dilemma: a range of philosophical perspectives. Int J Obes Relat Metab Disord 23, Suppl. 2, S31S37.
31. Rapoport, L & Perry, KN (2000) Do dietitians feel that they have had adequate training in behaviour change methods? J Hum Nutr Diet 13, 287298.
32. Ball, L, Hughes, R & Leveritt, M (2013) Health professionals’ views of the effectiveness of nutrition care in general practice setting. Nutr Diet 70, 3541.
33. Nicholas, LG, Pond, CD & Roberts, DCK (2003) Dietitian–general practitioner interface: a pilot study on what influences the provision of effective nutrition management. Am J Clin Nutr 77, Suppl. 4, S1039S1042.
34. Wynn, K, Trudeau, J, Taunton, K et al. (2010) Nutrition in primary care: current practices, attitudes and practices. Can Fam Physician 56, 109116.
35. Mowe, M, Bosaeus, I, Rasmussen, HH et al. (2008) Insufficient nutritional knowledge among health care workers? Clin Nutr 27, 196202.
36. Kuppersmith, N & Wheeler, S (2002) Communication between family physicians and registered dietitians in the outpatient setting. J Am Diet Assoc 102, 17561763.
37. Townshend, T & Lake, A (2017) Obesogenic environments: current evidence of the built and food environments. Perspect Public Health 137, 3844.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *