The U.S. Preventive Services Task Force (USPSTF) issued new guidelines on August 26, 2014, recommending intensive behavioral counseling interventions promoting healthy eating and increased physical activity to help prevent cardiovascular disease (CVD) in overweight or obese adults who have at least one other risk factor for CVD, such as hypertension, high cholesterol, or impaired fasting glucose, also known as “pre-diabetes.” The recommendation applies to the primary care setting.
Intensive behavioral counseling interventions, delivered by a specially trained professional, should focus on behavior change and may include didactic education and other components such as audit and feedback, problem-solving skills, and individualized care plans.
Supporting evidence for the recommendation comes from a systematic review that included 74 trials evaluating healthy lifestyle counseling in participants with CVD risk factors. Intensive counseling programs included 9 to 31 sessions over the course of 8 to 18 months. Experts in nutrition and exercise conducted the counseling sessions. The effectiveness of counseling was measured by changes in intermediate cardiovascular health outcomes, including total cholesterol levels, low-density lipoprotein cholesterol levels (LDL), high-density lipoprotein cholesterol levels (HDL), triglyceride levels, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose levels, incidence of diabetes, and weight.
The data from the trials reviewed showed intensive lifestyle counseling interventions reduced total cholesterol levels by 4.48 milligrams per deciliter (mg/dL), LDL by 3.43 mg/dL, SBP by 2.03 millimeters of mercury (mm Hg), DBP by 1.38 mm Hg, and fasting glucose levels by 2.08 mg/dL. Incidence of diabetes diagnosis was also decreased. The greatest effects were seen after 12 to 24 months. The data also indicated evidence that intensive lifestyle counseling interventions cause little to no harm.
Based on the data presented in the systematic review, the USPSTF determined that there is adequate evidence to conclude that intensive behavioral counseling interventions have moderate benefits for CVD risk reduction in overweight or obese adults at increased risk for CVD. The USPSTF also found, however, that there is inadequate direct evidence showing that intensive behavioral counseling interventions decrease CVD rates or mortality.