Cardiovascular disease (CVD) is the leading cause of death in the United States. All adults, regardless of risk for cardiovascular disease, can benefit from better nutrition, improved eating behaviors, and more physical activity. The U.S. Preventive Services Task Force (USPSTF) recently updated its 2003 recommendation on dietary counseling for adults with risk factors for cardiovascular disease (CVD), and concluded with moderate certainty that intensive behavioral counseling interventions to promote a healthful diet and physical activity have a moderate net benefit in overweight or obese adults who are at increased risk for CVD.
Based on this systematic review conducted by the U.S. Preventive Services Task Force (USPTF), low-intensity behavioral counseling consisted of only mailed materials or 1 to 2 sessions with a primary care provider or other trained person. The low-intensity counseling did not have an impact on behavioral or intermediate health outcomes. Medium-intensity behavioral counseling involved 3 to 24 phone sessions or 1 to 8 in-person sessions. High-intensity behavioral counseling consisted of 4 to 20 in-person group sessions. This medium- to high-intensity style of behavioral counseling was the only intervention to report sustained benefits beyond 12 months.
This evidence demonstrates the effectiveness of medium- to high-intensity behavioral counseling in making small but important changes in health behavior outcomes. Even small improvements in lipid levels, blood pressure, glycemic control, and weight (all known risk factors for CVD) can decrease risk of CVD. Effective counseling sessions may be provided to patients in primary care settings, or in other settings as referred by a primary care physician. Primary care providers and/or behavioral health specialists can also refer patients to community-based resources to improve the delivery of these services.
The resulting USPSTF recommendation (Level B) is to offer overweight or obese adults with additional CVD risk factors the opportunity for intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. The population this recommendation applies to is adults aged 18 years or older in primary care settings who are overweight or obese and have known CVD risk factors (hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome).
Complete information on this review is at: Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors
Access to the full article published in the Annals of Internal Medicine is found at: http://www.ncbi.nlm.nih.gov/pubmed/25155419