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USPSTF recommends behavioral counseling for obese, overweight people at risk for CVD

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The United States Preventive Services Task Force recommended that adults who are overweight or obese and have at least one risk factor for CVD be offered or referred to intensive behavioral counseling interventions to promote healthy diet and physical activity.

According to the statement, overweight or obese adults should receive counseling if they have at least one of the following risk factors: hypertension, dyslipidemia, impaired fasting glucose or the metabolic syndrome.

A systematic review of 74 trials for the USPSTF yielded adequate evidence that intensive behavioral counseling interventions have moderate benefits for CVD risk in overweight or obese adults at increased risk for CVD, USPSTF chair Michael L. LeFevre, MD, MSPH, professor, vice chair and director of clinical services, department of family medicine, University of Missouri School of Medicine, and colleagues wrote. A substantial majority of the trial participants had BMI >25 kg/m².

The moderate benefits for CVD risk include decreases in BP, lipid and fasting glucose levels and BMI, and increases in levels of physical activity, according to the statement.

Combined, the studies reviewed demonstrated that at 12 to 24 months, intensive lifestyle interventions reduced total cholesterol levels by 4.48 mg/dL (95% CI, 2.59-6.36), LDL by 3.43 mg/dL (95% CI, 1.49-5.37), systolic BP by 2.03 mm Hg (95% CI, 1.15-2.91), diastolic BP by 1.38 mm Hg (95% CI, 0.83-1.92), fasting glucose levels by 2.08 mg/dL (95% CI, 0.88-3.29), weight outcomes by a standardized mean difference of 0.25 (95% CI, 0.16-0.35) and diabetes incidence (RR=0.58; 95% CI, 0.37-0.89).

Moreover, the review found adequate evidence of little to no harm of intensive behavioral counseling interventions.

None of the dietary intervention studies explicitly reported any adverse events, while physical activity intervention studies reported mostly minor adverse events, while intense physical activity was rarely associated with CV events, according to the authors.

The interventions reviewed involved an average of five to 16 contacts during 9 to 12 months, depending on their intensity, according to the report. Most included in-person sessions and many included telephone follow-ups.

The USPSTF identified the following research gaps:

• Trials examining less-intensive counseling that can be delivered in the primary care setting, including the minimum intensity, duration and number of sessions required for effectiveness.
• Trials studying the duration of effect beyond 2 or 3 years of the intensive counseling period.
• Studies of the effectiveness of interventions for physical activity alone.
• Trials analyzing the interaction or potentiation of clinical counseling and community-based lifestyle interventions.
• Trials providing direct evidence of the effect of interventions on CVD events.

For more information:

LeFevre ML. Ann Intern Med. 2014;doi:10.7326/M14-1796.

Lin JS. Ann Intern Med. 2014;doi:10.7326/M14-0130.

Disclosure: The members of the USPSTF report no relevant financial disclosures. Some members of the systematic review team report receiving grants from the Agency for Healthcare Research and Quality.