Obese Patients Need Counseling for Heart Health
Written by Editor   
Tuesday, May 13, 2014 12:48 PM

Obese and overweight adults with at least one other cardiovascular risk factor should receive intensive behavioral counseling to promote healthy diet and physical activity for heart disease prevention, according to a U.S. Preventive Services Task Force (USPSTF) preliminary recommendation.

The draft of the grade B recommendation expands on previous guidance from the task force by including a physical activity component and calling for more at-risk adults to receive behavioral interventions.

This draft will be available for public comment on the USPSTF Web site until June 9.

"Medium- and high-intensity diet and physical activity behavioral counseling in persons with risk factors for [cardiovascular disease] resulted in consistent improvements across a variety of important cardiovascular intermediate health outcomes up to 2 years," the USPSTF members concluded. "High-intensity combined lifestyle counseling reduced diabetes incidence in the longer-term."

Past recommendations included behavioral counseling that focused on diet alone for adults with hyperlipidemia or other known risk factors for cardiovascular disease (CVD). The evidence was previously deemed insufficient to recommend for or against behavioral counseling in the primary care setting to promote physical activity.

"The new recommendations build on the new science and focus on overweight or obese people with various cardiovascular risk factors, and they include a physical activity component as well as a dietary component."

Based on self-reported physical activity, the proportion of people who participated in moderate intensity exercise for 150 minutes per week increased from 10% to 25% following counseling.


key components of intensive behavioral counseling include instructional education, an individualized action plan, help with problem solving, and feedback.

Behavioral counseling can include both face-to-face meetings and telephone or electronic contact. In addition to physicians, counseling can be performed by health educators, psychologists, nutritionists, dietitians, exercise professionals, and others in the health field.

For the purposes of the USPSTF analysis, low-intensity interventions were 30 minutes or less, medium-intensity interventions were 31 to 360 minutes, and high-intensity interventions involved over 360 contact minutes.  Specially trained individuals delivered these interventions, including dietitians or nutritionists, physiotherapists or exercise professionals, as well as health educators, nurses, or psychologists.  Counseling interventions generally focused on behavioral change and could include co-interventions.

The USPSTF also recommended screening patients for obesity, and patients with a BMI of 30 kg/m2 or greater should be offered or referred to intensive, multi-component behavioral counseling. The task force also recommends that clinicians selectively initiate behavioral counseling to promote healthful diet and physical activity for adults without increased cardiovascular risk.

Other CVD prevention recommendations include screening for lipid disorders in adults depending on their age and risk factors. The USPSTF also suggested screening for blood pressure in adults, screening for diabetes in patients with elevated blood pressure, and aspirin use when appropriate.

Clinicians are also urged to discuss tobacco use with their patients and provide tobacco cessation interventions to those who smoke cigarettes or use other tobacco products.

The American College of Sports Medicine recommends 150 minutes of moderate-intensity exercise per week and 2 to 3 days of resistance, flexibility, and neuromotor exercises per week.

Source:  http://www.medpagetoday.com/Cardiology/Prevention/45742