Behavioral Counseling Interventions to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults: U.S. Preventive Services Task Force Recommendation Statement

Abstract

Abstract | Summary of Recommendation and Evidence | Rationale | Clinical Considerations |Other Considerations | Discussion | Update of Previous USPSTF Recommendation |Recommendations of Other Groups | Appendices | References

Description: Update of the 2003 and 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statements on behavioral counseling to promote a healthful diet and physical activity in adults without preexisting cardiovascular disease or its risk factors.

Methods: The USPSTF reviewed new evidence on whether counseling interventions relevant to primary care for physical activity or a healthful diet modify self-reported behaviors; intermediate physiologic outcomes (for example, reduced lipid levels, blood pressure, weight, and body mass index and increased glucose tolerance); and cardiovascular morbidity and mortality in adults without known cardiovascular disease, hypertension, hyperlipidemia, or diabetes.

Population: General adult population without a known diagnosis of hypertension, diabetes, hyperlipidemia, or cardiovascular disease (CVD).

Recommendation: Although the correlation among healthful diet, physical activity, and the incidence of CVD is strong, existing evidence indicates that the health benefit of initiating behavioral counseling in the primary care setting to promote a healthful diet and physical activity is small. Clinicians may choose to selectively counsel patients rather than incorporate counseling into the care of all adults in the general population.Considerations: Issues to consider include other risk factors for CVD, a patient's readiness for change, social support and community resources that support behavioral change, and other health care and preventive service priorities.Potential Harms: Harms may include the lost opportunity to provide other services that have a greater health effect.

Grade: This is a grade C recommendation.

http://annals.org/article.aspx?articleid=1200998

COMMENT: This recommendation was published in June.  It seems a bit wishy-washy to me.  It does not seem realistic to do more than a make a cursory diet/exercise statement during a visit in a busy clinical practice.  i have always practiced in an environment where dietary consultaions were available and i referred patients who were over weight to this servce especially when there was diabetes or other cardiovascular risk factors present.  I am curious as to what your practice is.   

Sabian, there are two issues here.  The first is the appropriate role that physicians and the health care system should play in specific instances where changes in diet can significantly reduce morbidity.  Sprue would be an obvious instance where dietary counseling should be part of the care package.  I would argue that diabetes and hyperlipidemia would also fall in that category.  Second, and a much larger issue, is the question of the appropriate role of health professionals and the health care system in dealing with the malnutrition (over nutrition) that underlies the obesity epidemic and the cluster of diseases it engenderers.  I entirely agree with you that this issue is beyond the ability of the health care system to solve.  It is a public health problem, not a health care system problem.  So our role has to be similar to the early public health advocates-being Cassandra warning of the dangers that current eating habits engender.  We will, I hope, be more successful that the original Cassandra.  There is certainly precedent from Lister’s pioneering efforts to promulgate the germ theory to the successful campaign to make smoking socially unacceptable, at least in the United States.  My guess is that we physicians will have to be in this game for the long haul.  It took a quarter century to get American kids to realize that smoking was not “cool”.  And smoking, unlike eating, is a behavior that you can extinguish!  But all you have to do is look at the statistics on childhood obesity to realize that this is a fight that we cannot afford to loose.  Sorry for the diatribe, but in my professional career I have gone from never seeing a kid with type 2 diabetes to seeing one every single day.