USPSTF Not Convinced by Lifestyle Counseling for Healthy People

The U.S. Preventive Services Task Force (USPSTF) maintained that while all people can benefit from healthy eating and exercise, it could still give only a C grade recommendation for lifestyle counseling for adults without cardiovascular disease (CVD) risk factors, the group announced in a new draft recommendation statement.

Based on “small net benefit on CVD risk” found in an updated evidence review, the recommendation remains that primary care clinicians should decide together with such patients whether diet and exercise counseling might help them prevent heart attacks and strokes, consistent with the USPSTF’s last recommendation on this in 2017.

“The Task Force recognizes that many people face barriers to healthy eating and physical activity,” said Task Force member Michael Cabana, MD, MPH, of Albert Einstein College of Medicine and Children’s Hospital at Montefiore in New York City, in a press release. “We encourage clinicians to engage patients in a conversation on how best to support them to maintain a healthy lifestyle based on patients’ individual circumstances.”

The draft recommendation applies to relatively healthy patients who have no high blood pressure, unhealthy cholesterol levels, diabetes, or high blood sugar. Although obesity is a risk factor for CVD, overweight or obese individuals do fall into the group targeted by the USPSTF statement; the evidence review supporting the statement included studies with people above normal weight.

This review included 113 randomized trials of nearly 130,000 people followed for at least 6 months.

In these trials, behavioral counseling interventions for a healthy diet and/or physical activity were modestly associated with increased physical activity levels and some changes in dietary health behaviors — for example, people added approximately 33 minutes of exercise per week and ate 1.11 more servings of fruit and vegetables per day.

Behavioral counseling interventions were also linked to modest improvements in other measures such as blood pressure (-0.8 mm Hg), low-density lipoprotein cholesterol (-2.20 mg/dL), and weight (-1.07 kg) after 6 to 12 months.

On the other hand, there was “little direct evidence on the effectiveness of behavioral counseling interventions on all-cause mortality, CVD-related mortality, CVD events (such as myocardial infarction or stroke), or quality of life. In studies, CVD-related fatal and nonfatal events were rare, limiting robust analysis, with few group differences,” the USPSTF wrote.

Comments on the draft recommendation can be submitted through February 14.

Separately, the USPSTF finalized a B grade recommendation for diet and exercise counseling interventions in adults who have risk factors for CVD, regardless of their weight.