Counselling on weight loss is key, recommends US health task force.
Overweight patients with risk factors for heart disease should be sent by their doctors for intensive behavioural counselling about diet or exercise, according to new recommendations from the United States Preventive Services Task Force (USPSTF).
That includes overweight people with high blood pressure, high cholesterol, ‘metabolic syndrome’ or blood sugar levels higher then normal and on the cusp of type-2 diabetes.
“My message for patients would be that we have the ability by changing our behaviour to modify our risk for heart disease and stroke and your doctors can help you do that,” says Dr Michael L LeFevre, the chair of the Task Force.
LeFevre is also vice chair in the Department of Family and Community Medicine at the University of Missouri School of Medicine in Columbia. The recommendations are targeted to health care providers more than to patients, LeFevre admits.
To the patients, he says, “The most important thing that we can do right now is have you lose some weight, be more active but just offering that advice and giving you a pamphlet, we don’t really find any evidence that that’s helpful.”
Instead, the Task Force’s research review found that intensive behavioural counselling - involving multiple sessions with experts in nutrition and exercise over an extended period, for several months to a year - can help people lose weight and bring down their blood pressure and cholesterol.
The researchers reviewed studies of various lifestyle interventions and found that with intensive counselling, many health markers were improved one and two years later, and the risk of diabetes decreased.
“This crystallises 25 years of research and a huge number of studies but I don’t think this is new or earth-shattering information,” says Dr Jennifer S Lin of the Kaiser Permanente Center for Health Research in Portland Oregon. Lin was the lead author of the review.
There is a great deal of data on people with heart attack and stroke risk factors and most of those studies focused on a combination of diet and exercise counselling, so those kinds of programmes have the most evidence behind them at this point, she says.
“On average we’re talking about a few milligrams of cholesterol per decilitre of blood or a couple of millimetres of Mercury decrease in blood pressure,” Lin says.
“We’re calling that a modest benefit applied to a population but even these modest benefits translate into health outcomes that patients can actually feel,” she explains.
Patients can’t necessarily feel when their blood pressure goes down, but they can feel if they do or do not have a heart attack, she says.
The best counselling interventions are not only frequent but conducted by trained dieticians, nutritionists, health educators and physiologists, she says.
“They’re more than just didactic, more than classroom-based interventions, they’re individualised,” she says.
One-on-one counselling gives experts time to assess the barriers to healthy diet and exercise for each person and help them overcome them, LeFevre says.
“We need to see people repeatedly, to work with them and reinforce what’s going on,” LeFevre says. – Reuters