Michael L. LeFevre, MD, MSPH; on behalf of the U.S. Preventive Services Task Force *
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Disclosures: Dr. Gillman reports royalties from Cambridge University Press and UpToDate outside the submitted work. Authors not named here have disclosed no conflicts of interest. Authors followed the policy regarding conflicts of interest described at www.uspreventiveservicestask force.org/methods.htm. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1796.
Requests for Single Reprints: Reprints are available from the USPSTF Web site (www.uspreventiveservicestaskforce.org).
Update and refinement of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on dietary counseling for adults with risk factors for cardiovascular disease (CVD).
The USPSTF reviewed the evidence on whether primary care–relevant counseling interventions for a healthful diet and physical activity modify self-reported behaviors, intermediate physiologic outcomes, diabetes incidence, and cardiovascular morbidity or mortality in adults with CVD risk factors, as well as the adverse effects of counseling interventions.
This recommendation applies to 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).
The USPSTF recommends offering or referring adults who are overweight or obese and have additional CVD risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. (B recommendation)
Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: clinical summary of U.S. Preventive Services Task Force recommendation.
Appendix Table 1 What the USPSTF Grades Mean and Suggestions for Practice
Appendix Table 2 USPSTF Levels of Certainty Regarding Net Benefit
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Complementary or Alternative Counseling Interventions to Promote Healthy Diets and Physical Activity
The article recommends intensive behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease (CVD) prevention through direct delivery or referral among adults who are overweight or obese and have additional CVD risk factors. Lifestyle behavioral counseling is a commendable entry point. However, individual behavior change is affected by a multitude of factors that behavioral counseling may not be able to address among different segments in the population. Motivational interviewing (MI) is recommended as a complementary or alternative strategy. MI is grounded in a respectful stance focusing on rapport building in the early stages of the counseling relationships. One of the main tenets of MI is the discovery, exploration, and resolution of ambivalence about changing behavior. Traditional counseling techniques have often been top down. For people who show less initial motivation to change (precontemplation), feedback can provide useful material for MI, and often reveals possible reasons for change that had not been apparent before. Its use with lay workers explains how to negotiate for effective behavior change in the early stages of the change process [2-4]. The main components of MI to enhance personal motivation to change include: express empathy; roll with resistance; support self-efficacy; and develop discrepancy . MI is a strategy that can be easily incorporated on a daily basis in client provider interaction, wherein the client drives the behavior change, in turn resulting in possibly longer term and more effective behavior change and practices among the target population. 1. Rollnick, S., W.R. Milller, and C.C. Butler, Motivational Interviewing in Health Care: Helping Patients Change Behavior. 2008, New York: The Guilford Press.2. Resnicow, K., et al., A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: results of the Eat for Life trial. Am J Public Health, 2001. 91(10): p. 1686-93.3. Whaley, S.E., et al., A WIC-based intervention to prevent early childhood overweight. J Nutr Educ Behav, 2010. 42(3 Suppl): p. S47-51.4. Larimer, M.E., et al., Evaluating a Brief Alcohol Intervention with Fraternities. J. Stud. Alcohol, 2001. 62: p. 370-380.
LeFevre ML, on behalf of the U.S. Preventive Services Task Force. Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2014;161:587–593. doi: 10.7326/M14-1796
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Published: Ann Intern Med. 2014;161(8):587-593.
Cardiology, Coronary Risk Factors, Guidelines, Prevention/Screening.
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