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USPSTF Recommends Intense Counseling for Overweight Patients at High CV Risk — Physician’s First Watch

Medical News |
August 26, 2014

USPSTF Recommends Intense Counseling for Overweight Patients at High CV Risk

By Kelly Young

Edited by David G. Fairchild, MD, MPH

The U.S. Preventive Services Task Force recommends intense behavioral counseling for adults who are overweight or obese and have at least one other cardiovascular risk factor (B recommendation). The guideline appears in the Annals of Internal Medicine.

The recommendation applies to adults with a BMI of 25 or greater who also have hypertension, dyslipidemia, impaired fasting glucose, or metabolic syndrome.

The task force evaluated studies on counseling interventions that promoted healthy diet and physical activity. Interventions involved an average of 5 to 16 contacts with patients, including individual or group sessions and telephone contacts, over 9 to 12 months.

The group says that primary care providers could use two interventions — the Diabetes Prevention Program and PREMIER — as models for behavioral counseling.

Reader Comments (6)

Patriick E. McBride, MD, MPH Physician, Cardiology, University Hospital

There is no evidence that the Paleo Diet is safe or effective, and it is certainly not what our ancestors ate (nuts, berry, fresh fish, wild game, etc). In addition, their life span was not long. Our experience with many patients on the "paleo diet" is that their LDL increases substantially. Evidence shows that any structured eating plan can lead to weight loss when combined with physical activity. There is evidence that a diet high in variety, and includes fruits, vegetables, whole grains, and healthy fat and protein sources, i.e. the Mediterranean Diet or DASH diet, is associated with less morbidity and mortality.

Janet Leader, MPH, RD Other Healthcare Professional, Other, UCLA Fielding School of Public Health

Many doctors feel uncomfortable providing this counseling as they do not get much nutrition training nor do they have time in a 20-minute visit. That's why they should refer patients to a registered dietitian nutritionist for expert advise and counseling. All MD's should know how to refer. That's what patients want!!

AF, MD Physician, Psychiatry, Veterans Affairs Hospital

as a physician myself and an avid student fitness/nutrition (since these 2 areas are quite lacking in general in medical school curricula), I have two words for anyone who craves a sustainable, realistic, non-surgical solution to health, normal body weight, and a clean lab profile or for those who look at these guidelines or any others and wonders how and/or why someone gets to a BMI > 25: PALEO DIET.

Our society needs to be honest about fast food, soda, and all this other crap that passes as food/drink for consumption, when all these things are really just combinations of chemicals that are nothing but harmful to our body. So then the solution in modern medicine becomes to devise other chemicals that we take in pill form to attempt to counteract the effects of the first set of chemicals. Notice I said 'attempt'. Eating clean must start in childhood from the parents' influence, can work on a limited budget, and can serve the person well into adulthood and later years, saving much money, stress, etc. over medical bills accrued because of a lifetime of poor food choices, not to mention sparing family members the grief of burying a 40- or 50-something-year-old family member who died from one of our big killers, whether it be heart disease, diabetes, cancer, depression, etc. There is a wealth of research on the connection between eating clean and avoiding the development of debilitating, ugly, slowly killing disease.

It's about time we embrace and implement preventive medicine once and for all, not band-aid medicine.

WILLIAM RENFROE Physician, Family Medicine/General Practice

Certainly very few people would claim that a diet filled with "fast food", sugar and processed foods is healthy. Even so, I doubt that many would regard the claimed superiority of a "Paleo Diet' as settled science. Furthermore, even if one concedes that point there is a very real need for data regarding non-paleo diet alternatives that support weight loss. As Jared Diamond pointed out (http://www.ditext.com/diamond/mistake.html) in his description of "The Worst Mistake in the History of the Human Race" population densities of hunter-gatherer societies tend to be less than about 1 person per 10 square miles. The current world population density is on the order of 35 people per square mile and a good many of those square miles don't offer much in the way of available food. It appears that our current world population density is about 350 times that of the cultures that have traditionally followed paleo diets. As a result it is imperative that we find the healthiest options that are realistic for a planet with our current population density rather than offering up the "Paleo Diet" as the only option even if it were known to be the "optimum" diet.

Lola

I'm a patient who see's over 5 drs and take many meds and not one of them has every talked to me about my overweight condition. What's with that? No time? No money? Don't care? Most likely all of the above.

* * Other, Other, author, former director weight loss center McLean Hospital Belmont, Ma

Diet and exercise counseling are important at the early stage of a weight loss program. Just as important is working with the patient to identify reasons for previous weight gain and failure to maintain previous weight loss. Without that, it is doubtful permanent weight loss will be accomplished.

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