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USPSTF: Behavioral Counseling for CVD Prevention

JAMA; 2017 Jul 11; US Preventive Services Task Force

Primary care professionals should individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes to behavioral counseling to promote a healthful diet and physical activity. This according to an updated recommendation statement from the US Preventive Services Task Force (USPSTF) on behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease (CVD) prevention in adults without obesity and without CV risk factors. The statement updates the group’s 2012 recommendation. The USPSTF reviewed the evidence on whether primary-care relevant counseling interventions to promote a healthful diet, physical activity, or both improve health outcomes. The C-level recommendation includes the following:

  • The USPSTF recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes to behavioral counseling to promote a healthful diet and physical activity.
  • Existing evidence indicates a positive but small benefit of behavioral counseling for the prevention of cardiovascular disease (CVD) in this population.
  • Persons who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling.

Citation:

US Preventive Services Task Force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors. US Preventive Services Task Force recommendation statement. JAMA. 2017;318(2):167-174. doi:10.1001/jama.2017.7171.

Commentary:

Among adults aged 20 to 49 years, only approximately 50% meet the current physical activity recommendations of 150 minutes or more of moderate physical activity a week or 75 minutes of vigorous physical activity weekly. Less than 40% of adults older than 50 years meet those levels.1 In both groups, less than 2% meet dietary recommendations. An abundance of observational data shows that increased levels of physical activity and healthy diets lead to a decrease in the development of hypertension, dyslipidemia, diabetes, cardiovascular illness, cancer, and even age-adjusted mortality. This USPSTF statement acknowledges that while a healthy lifestyle leads to better outcomes, there is limited evidence regarding how effective behavioral counseling is in convincing patients to initiate the behavioral changes needed to adapt a healthy lifestyle. The statement concludes that patients who express interest in making a change are among those most likely to sustain the efforts necessary to make lifestyle changes. These are the people on whom we should focus in order to see worthwhile results. It is also worth noting, as discussed in a recent essay published in Circulation, how our own attitudes and actions may influence the way that we communicate with our patients and how that in turn may influence their decisions about lifestyle modification.2—Neil Skolnik, MD

  1. Mozaffarian D, Benjamin EJ, Go AS; Writing Group Members; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: A report from the American Heart Association. Circulation. 2016;133(4):e38-e360. doi:10.1161/CIR.0000000000000350.
  2. Skolnik N. The best we can be. Circulation. 2017;136:247–248. doi:10.1161/CIRCULATIONAHA.117.029042.