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USPSTF recommends intensive behavioral counseling for people with obesity, overweight
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People who are obese or overweight with at least one other cardiovascular disease risk factor should receive intensive behavioral counseling focusing on a healthful diet and physical activity, the US Preventive Services Task Force recommends.
Published in the Annals of Internal Medicine, the recommendation follows a review of 74 studies by researchers at the US Preventive Services Task Force (USPSTF) demonstrating how such interventions support weight loss and reduce lipid levels, blood pressure and glucose levels.
“Intensive diet and physical activity behavioral counseling in people with risk factors for cardiovascular disease (CVD) resulted in consistent improvements across various important physiologic measures of cardiovascular health up to 2 years and reduction in diabetes up to 4 years,” the researchers wrote.
Using MEDLINE, PsycINFO, the Database of Abstracts of Reviews of Effects and the Cochrane Central Register of Controlled Trials, Jennifer S. Lin, MD, MCR, and colleagues reviewed 7,218 abstracts and 553 articles, comparing the data against a set of inclusion and quality criteria; of these 74 were selected. Experts and existing systematic reviews were also consulted.
The researchers stratified analyses based on intervention type — focus on dietary counseling alone, physical activity alone or combined diet and physical activity counseling — and how populations were defined including dyslipidemia, hypertension, impaired fasting glucose or glucose tolerance, or mixed risk factors.
Qualitative synthesis was used to calculate health outcomes, behavioral outcomes and any harms from intervention. Outcome analyses were also stratified by length of follow-up after randomization including short term (<12 months), intermediate term (12 to 24 months) and long term (>24 months).
On average, intensive lifestyle counseling reduced total cholesterol levels by 0.12 mmol/L (95% CI, 0.16–0.07 mmol/L; 4.48 mg/dL, 95% CI, 6.36–2.59 mg/dL]), low-density lipoprotein cholesterol levels by 0.09 mmol/L (0.14–0.04 mmol/L; 3.43 mg/dL, 95% CI, 5.37–1.49 mg/dL]), systolic blood pressure by 2.03 mm Hg (2.91–1.15 mm Hg), diastolic blood pressure by 1.38 mm Hg (95% CI, 1.92–0.83 mm Hg) and fasting glucose levels by 0.12 mmol/L ( 95% CI, 0.18–0.05 mmol/L; 2.08 mg/dL, 95% CI, 3.29–0.88 mg/dL).
Additionally, diabetes incidence decreased by a relative risk of 0.58 (95% CI, 0.37–0.89), and weight outcomes dropped by a mean difference of 0.25 (95% CI, 0.35–0.16). Behavioral changes in diet and physical activity generally aligned with changes in physiologic outcomes.
“We found a wide range of intensity for effective interventions ranging from 2 hours to more than 30 hours of contact time,” the researchers wrote. “Future research should also evaluate whether lower-intensity counseling interventions are as effective as higher-intensity counseling or whether there is a minimum intensity, frequency or duration of contacts required to maintain effectiveness.”
The review complements research backing a 2012 USPSTF recommendation for clinicians to provide or refer adults with no pre-existing CVD risk factors for behavioral interventions, according to a press release. The new recommendation updates one from 2003 targeting diet and activity for those with CVD risk factors, according to the release.
Disclosures: The work was supported by the Agency for Healthcare Research and Quality.
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