Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors

Patnode, Carrie D.; Redmond, Nadia; Iacocca, Megan O; Henninger, Michelle

doi:10.1001/jama.2022.7408

Cited by 40 publications

(71 citation statements)

References 142 publications

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“…Intensity or interaction time with a clinician may range from 30 minutes to 6 hours over 6 months or longer. 1 In determining whether behavioral counseling interventions are appropriate, patients and clinicians should consider the following.…”

Section: What Additional Information Should Clinicians Know About Thi...mentioning

confidence: 99%

“…1,38 All trials reported at least 6 months of follow-up, and many (63 trials) reported 12 months or longer. 1,38 Most trials (73 trials) included men and women. 1,38 The mean age of participants ranged widely, from 18.5 to 79.5 years.…”

Section: Benefits Of Counseling To Change Behavior and Outcomesmentioning

confidence: 99%

“…1,38 Most trials (73 trials) included men and women. 1,38 The mean age of participants ranged widely, from 18.5 to 79.5 years. 1,38 The mean BMI of trial participants across studies was in the overweight range (27.8).…”

Section: Benefits Of Counseling To Change Behavior and Outcomesmentioning

confidence: 99%

“…1,38 The mean age of participants ranged widely, from 18.5 to 79.5 years. 1,38 The mean BMI of trial participants across studies was in the overweight range (27.8). 1,38 Sixty-nine trials reported participant race and ethnicity.…”

Section: Benefits Of Counseling To Change Behavior and Outcomesmentioning

confidence: 99%

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mentioning

confidence: 99%

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Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Disease Risk Factors

Mangione

Barry

Nicholson

et al. 2022

JAMA

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ImportanceCardiovascular disease (CVD), which includes heart disease, myocardial infarction, and stroke, is the leading cause of death in the US. [1][2][3] By 2035, nearly half of US adults are anticipated to have some form of CVD. 4 A large proportion of CVD cases can be prevented by ad-dressing modifiable risk factors, including smoking, obesity, diabetes, elevated blood pressure or hypertension, dyslipidemia, lack of physical activity, and unhealthy diet. 2,4 Adults who adhere to national guidelines for a healthy diet 5 and physical activity 6 have lower rates of cardiovascular morbidity and mortality than those who do not; however, many US adults do not consume healthy diets or engage in physical activity at recommended levels. 7,8 All persons, IMPORTANCE Cardiovascular disease (CVD), which includes heart disease, myocardial infarction, and stroke, is the leading cause of death in the US. A large proportion of CVD cases can be prevented by addressing modifiable risk factors, including smoking, obesity, diabetes, elevated blood pressure or hypertension, dyslipidemia, lack of physical activity, and unhealthy diet. Adults who adhere to national guidelines for a healthy diet and physical activity have lower rates of cardiovascular morbidity and mortality than those who do not; however, most US adults do not consume healthy diets or engage in physical activity at recommended levels.OBJECTIVE To update its 2017 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of behavioral counseling interventions to promote healthy behaviors in adults without CVD risk factors.POPULATION Adults 18 years or older without known CVD risk factors, which include hypertension or elevated blood pressure, dyslipidemia, impaired fasting glucose or glucose tolerance, or mixed or multiple risk factors such as metabolic syndrome or an estimated 10-year CVD risk of 7.5% or greater. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that behavioral counseling interventions have a small net benefit on CVD risk in adults without CVD risk factors. RECOMMENDATION The USPSTF recommends that clinicians individualize the decision to offer or refer adults without CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity. (C recommendation)

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Section: What Additional Information Should Clinicians Know About Thi...mentioning

confidence: 99%

Section: Benefits Of Counseling To Change Behavior and Outcomesmentioning

confidence: 99%

Section: Benefits Of Counseling To Change Behavior and Outcomesmentioning

confidence: 99%

Section: Benefits Of Counseling To Change Behavior and Outcomesmentioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

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Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Disease Risk Factors

Mangione

Barry

Nicholson

et al. 2022

JAMA

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Implications of the New Recommendation on Behavioral Counseling Interventions to Promote Healthy Eating and Physical Activity

Mozaffarian

2022

JAMA

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Lifestyle behaviors, including diet and physical activity, are leading determinants of health in the US and around the world. 1 These behaviors are heavily influenced by sociocultural circumstances, such as levels of education and income, community environment, and prejudice and structural racism. Thus, government, community, and other systems-level approaches are paramount for addressing the disease conditions and health disparities caused by poor lifestyle. 2,3 At the same time, within existing sociocultural circumstances, different people have differing diet quality and activity levels, which can also improve or worsen over time. Furthermore, the behavior of individuals, when summed, can drive the environment by shifting demand and thereby supply of healthier foods and opportunities for exercise and also can influence cultural norms. Thus, a focus on individual behavior change is one part of the solution for achieving better lifestyle and well-being for all.In this issue of JAMA, the US Preventive Services Task Force (USPSTF) presents an updated recommendation, 4 based on an updated systematic evidence review, 5 on behavioral counseling interventions to promote healthy diets and physical activity for primary prevention of cardiovascular disease (CVD) in adults 18 years or older without CVD risk factors. Consistent with a recent government report, 6 the USPSTF recognized that a large proportion of CVD can be prevented by addressing modifiable lifestyle risks and that most US adults do not consume healthy diets or engage in sufficient physical activity.Critically, for this report, the USPSTF focused on adults without known CVD risk factors-ie, without hypertension, dyslipidemia, impaired glycemia, metabolic syndrome, or estimated 10-year CVD risk 7.5% or greater. While this group might seem representative of the general population, lifestyle-related conditions such as high blood pressure, high cholesterol levels, and prediabetes are so common among US adults that the group to whom the USPSTF recommendations apply represents a very small proportion of the US adult population: only an estimated 12.2%, based on national data from 2017-2018; and only an estimated 6.8% of adults with obesity are further excluded. 7 For this segment of healthy adults, the USPSTF "recommends that clinicians individualize the decision to offer or refer adults to behavioral counseling interventions to promote a healthy diet and physical activity (C recommendation)," with moderate certainty for a small net benefit. Intervention deliv-

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