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U.S Preventive Services Task Force has shown that counseling makes a difference….
A systematic review of 74 trials found that intensive interventions helped patients lose weight and reduce their lipid levels, blood pressure, and glucose levels. The review was performed by investigators from the Kaiser Permanente Research Affiliates Evidence-based Practice Center (KPRA EPC). Jennifer Lin, MD, MCR, the associate director of the KPRA EPC and one of the authors of the review stated that, "The review solidifies our understanding of good behavioral counseling research over decades."
"It shows us that intensive behavioral counseling focusing on dietary healthy eating and regular exercise especially in persons who have cardiovascular risk factors, can in the long term translate into real health benefits."
Among the findings at 12 to 24 months:
- LDL reduced by levels an average of 3.43 mg/dL (CI, 5.37-1.49 mg/dL)
- Systolic blood pressure lowered by an average of 2.03 mm Hg (CI, 2.91-1.15 mm Hg)
- Diastolic blood pressure lowered by an average of 1.38 mm Hg (CI, 1.92-0.83 mm Hg)
- Fasting glucose reduced by an average of 2.08 mg/dL (CI, 3.29-0.88 mg/dL)
Of the 74 trials reviewed, 49 were combined lifestyle interventions, 18 were diet-only, and 10 were physical activity only. Two were low intensity, 48 were medium intensity, and 37 were high intensity.
In 2012, the USPSTF issued a separate recommendation for people with an average risk for cardiovascular disease. The current recommendation replaces one in 2003 aimed at all adults with known cardiovascular disease risk factors.
Michael LeFevre, MD — who delivered the recommendation for the USPSTF — said that the Diabetes Prevention Program (DPP), a landmark interventional trial attempting to reduce risk of diabetes, could act as a model for implementing behavioral counseling in a way that’s feasible for primary care providers or other specialists they refer patients to.
According to Dr. Lin, the interventions in the review had three major things in common:
- They were intensive, carried out on average over 12 months with several hours of contact.
- They were done by those with training – in programs that, ideally, primary care providers can refer their patients to.
- They included individualized care plans.
"These interventions, they had didactic components to them, but they also were individualized to the patients, or to the participants in each trial," Lin said.
Lin indicated that because the intervention is intensive, many primary care physicians will have to refer to specialists in exercise physiology, behavioral psychology, or health education. Curry, from the task force, said that primary care physicians play an important role in prevention.
"They are necessary but obviously not sufficient — they’re a portal that their patients can get access to other treatments through," she said. "Our expectation is that this will help people think about how to staff and organize the delivery of health care."
There are still research gaps when it comes to examining the effectiveness of behavioral counseling, LeFevre said in the recommendation. Trials should examine the effects of less intensive counseling and the long-term health outcomes, even after intervention ends. Additionally, more research needs to be examining the effectiveness of intervention on physical activity. There’s also a lack of direct evidence of intervention for cardiovascular disease events.
"I believe that we now have a basis to try to get insurance companies to increase their coverage," he said.
- Note that this systematic review of the literature supports a new USPSTF guide stating that overweight and obese adults with one or more cardiovascular risk factors should undergo healthy lifestyle counseling.
- Be aware that the reimbursement structure necessary to implement this policy broadly has not yet been clarified.