Diet, Exercise Counseling Urged for Overweight Americans With Heart Risks
TUESDAY, Aug. 26, 2014 -- Overweight Americans with risk factors for heart disease should be offered "intensive" counseling on diet and exercise, according to new guidelines released this week.
The recommendations come from the U.S. Preventive Services Task Force, an independent panel that reviews medical research and makes recommendations on preventive care.
The group's latest guidelines are aimed at a large swath of the U.S. population: overweight adults who have at least one risk factor for heart disease and stroke, such as high blood pressure, high cholesterol or current smoking.
According to the task force, doctors should offer intensive lifestyle counseling, or referrals for counseling, to all of those patients. Nearly half of all U.S. adults have at least one risk factor for cardiovascular disease while roughly 70 percent are overweight or obese, according to the task force.
And what does "intensive" mean? In studies, it has typically meant five to 15 sessions with a dietitian, exercise specialist or other health professional -- usually in-person, though sometimes over the phone.
"But we don't want to be too draconian," said task force member Susan Curry, dean of the University of Iowa College of Public Health. "We're not saying it has to be a certain number of sessions."
It does, however, mean getting individualized help in making diet and exercise changes. This might involve education, goal-setting and monitoring progress. "Just talking with your doctor is good," Curry said. "But it's probably not sufficient."
Dr. Suzanne Steinbaum, a preventive cardiologist who was not on the task force, said she's happy to see the new recommendations.
"It's easy for a doctor to say, 'Change your diet. Get exercise,' " said Steinbaum, of Lenox Hill Hospital in New York City. "But the problem patients have is compliance. They need to get support."
The recommendations, published Aug. 26 in the Annals of Internal Medicine, add to past advice from the task force, Curry said.
For more than a decade, the group has said adults with risk factors for cardiovascular disease should get "intensive" counseling on diet from their doctor or a nutrition specialist. And in 2012, the task force said all obese adults should be offered counseling on weight loss, she said.
"What's different now is that we're bundling diet and exercise together," Curry said.
The recommendation is based on a review of 74 clinical trials, most of which tested the effects of combined diet-and-exercise programs. On average, people in the studies attended from five to 16 one-on-one or group sessions, over nine months to a year.
In the end, participants typically saw "modest" improvements in their blood pressure, cholesterol and blood sugar levels, Curry said. But in the longer trials -- which followed people beyond three years -- lifestyle programs cut the risk of developing type 2 diabetes by as much as 42 percent.
"A 42 percent reduction in diabetes is astounding," Steinbaum said.
The recommendations are intended for primary care doctors to put into practice. But, Curry said, if your doctor doesn't bring up lifestyle counseling -- and you think you're in the category of people who could benefit -- don't be afraid to ask.
Some doctors have nutrition experts on staff. In other cases, community centers offer help. As an example, the task force points to the National Diabetes Prevention Program, led by the U.S. Centers for Disease Control and Prevention. A large government study found that the lifestyle program slashed the risk of diabetes in people at risk of the disease.
Programs based on the diabetes prevention program are offered at hospitals and community centers, such as YMCAs, throughout the country. Medicare and some private insurance plans cover the cost.
Hospitals also frequently offer their own lifestyle programs, Steinbaum noted. "All you have to do is ask," she said.
For people who find the idea of intensive lifestyle counseling daunting, Curry said it's simply about getting some personalized attention -- beyond the quick talk a doctor and patient might have.
"And you can change your lifestyle without having to join a gym or take spin classes," she said. "To me, this is a good-news recommendation."
Steinbaum agreed. "I tell people, you're not training for a marathon. You're just going to get some help in fitting exercise into your life. It's baby steps."
Visit the U.S. Preventive Services Task Force for the full recommendation statement.
Posted: August 2014
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