Impact of nutritional counseling by family physicians in primary healthcare on chronic disease prevention: A systematic review of randomized controlled studies

Abstract

Background: Chronic diseases, heavily influenced by diet, present a global health burden. Family physicians, as primary care providers, are uniquely positioned to deliver nutritional counseling for prevention, yet its effectiveness and implementation challenges warrant systematic evaluation. This systematic review assesses the impact of family physician-delivered nutritional counseling in primary care on chronic disease prevention, examining effects on clinical outcomes, dietary behaviors, self-management, and implementation barriers.

Methods: Nine randomized controlled trials (published between 2014 and 2025) were included after searching multiple databases. Studies involved adults at risk for chronic diseases (e.g., hypertension, diabetes, obesity) receiving structured family physician counseling versus usual care. Outcomes included dietary behaviors, clinical/biochemical risk factors (weight, BMI, blood pressure, lipids, HbA1c), self-management, and barriers.

Results: Nutritional counseling by family physicians yielded modest but statistically significant improvements in key clinical outcomes: weight/BMI reductions (mean: −2.5 to −2.9 kg), HbA1c (−0.15% to −0.29%), LDL-cholesterol (−0.46 mmol/L), and blood pressure in high-risk populations (−4.6 to −5.6 mmHg diastolic). Effects on systolic BP and triglycerides were inconsistent. More robust, sustained improvements were seen in dietary behaviors (increased fruit/vegetable intake) and self-management skills (health-directed behavior, self-monitoring). Web-based counseling matched traditional effectiveness at a lower cost. Key barriers included limited consultation time, insufficient FP nutrition training, lack of tools, and patient-level challenges (food access, cost). Variability in effectiveness was linked to intervention design, intensity, and context.

Conclusion: Family physician-delivered nutritional counseling contributes to chronic disease prevention through modest clinical improvements and stronger gains in patient self-management and dietary behaviors. However, barriers, such as time, training, resource constraints, limit real-world implementation and impact. Scalable solutions include integrating technology (web platforms), team-based care, enhanced FP nutrition education, and addressing social determinants of health