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Behavioral counseling to prevent CVD not effective or recommended

Clinical Question:
Is brief counseling to promote a healthful diet and physical activity effective in reducing the incidence of cardiovascular disease in primary care patients?

Bottom Line:
The U.S. Preventive Services Task Force recommends against routine behavioral counseling in primary care settings to promote a healthful diet and physical activity as primary prevention for cardiovascular disease in patients without hypertension, diabetes, or hyperlipidemia (grade C recommendation, moderate certainty of a small net benefit). Though seemingly harmless, counseling that is largely ineffective has an opportunity cost, in that it may prevent other, more helpful services from being provided. As primary care office visits get more crowded with effective preventive care services there is less room for ineffective interventions, no matter how seemingly easy or well-meant. (LOE = 5)

Reference:
Moyer VA, on behalf of the U.S. Preventive Services Task Force. Behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults: U.S.Preventive Services Task Force recommendation statement. Ann Intern Med 2012;157:367-372.  [PMID:22733153]

Study Design:
Practice guideline

Funding:
Government

Setting:
Various (guideline)

Synopsis:
This guideline focuses on adults without a known diagnosis of hypertension, diabetes, hyperlipidemia, or cardiovascular disease. Although there is a strong correlation between a healthful diet, physical activity, and the incidence of cardiovascular disease, there is not good evidence that behavioral counseling -- even high intensity -- results in change in diet or exercise or has any meangingful effect on risk factors such as blood pressure, lipid levels, or glucose tolerance. The guidelines suggest that some patients who are ready to change and have the social support and community resources to support the change may benefit from counseling, at least theoretically. In a related recommendation, the task force recommends screening for obesity and treating patients with intensive behavioral interventions (Ann Intern Med 2012;157:373-378).

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