Counseling encouraged for overweight patients at risk for heart disease, task force says

Overweight and obese adults at risk for heart disease should be referred to or offered intensive behavioral counseling for diet and exercise interventions, a U.S. Preventive Services Task Force recommendation concludes.

The task force had previously recommended only adults with known risk factors be sent for dietary counseling, but now says the evidence shows these interventions offer preventive benefits for all overweight patients.

Some experts in obesity management caution, however, that not all providers have the training needed to offer this type of counseling. Misguided efforts can curtail weight loss attempts among patients, they warned.

Heart disease is the leading cause of death for men and women in the U.S., according to the Centers for Disease Control and Prevention. About 600,000 people die of the condition every year. Use of healthcare services, medications and lost productivity associated with coronary heart disease costs the nation $108.9 billion each year, the CDC estimates.

Intensive behavioral counseling, defined as interventions designed to help a patient get unhealthy behaviors under control, have been proven to help patients improve cardiovascular disease risk factors such as high blood pressure, high cholesterol, pre-diabetes, metabolic syndrome or a BMI greater than 25 kg/m2, according to the USPSTF review of 74 trials.

More than 77 intervention groups were included among the trials reviewed. The new recommendation applies to all overweight and obese adults who visit a primary-care physician. The task force found no direct evidence that the interventions reduced cardio vascular disease death rates, however. Findings were published this week in the Annals of Internal Medicine.

Several organizations over the past few years have encouraged the use of evidence-based strategies for dietary and physical activity interventions to help patients who often struggle with adopting and maintaining healthy behaviors.

For example, in 2013, American Heart Association, American College of Cardiology and the Obesity Society jointly offered recommendations urging healthcare providers to actively help their patients get healthier. Providers were encouraged to develop individualized weight-loss plans for patients that included a moderately reduced calorie diet, increased physical activity and use of behavioral strategies, such as two to three in-person meetings a month for at least six months. In 2011, the CMS began offering billing benefits for physicians who offered regular behavioral therapy for obese patients with a BMI of 30 kg/m2 or greater.

Though many agree that these types of strategies are needed and can be effective, some caution that providers may need to boost their skill set to engage patients in this type of counseling.

“I am not totally convinced that all primary-care providers are set up for this,” said Dr. Kimberly Gudzune, assistant professor in the Division of General Internal Medicine at Johns Hopkins University School of Medicine. Her recent report in the journal Preventive Medicine found a negative encounter with a physician could stifle patient attempts at weight loss.

Many of the most effective strategies outlined in recent recommendations have focused on providers with specialized training in obesity and dietary counseling. But there is wide variability among PCPs in terms of training to engage patients in this area, said Gudzune, who recommends physicians without training refer patients to certified obesity management specialists.

“We can help patients achieve clinical significant weigh loss, but we need the right people delivering the service,” Gudzune said.

Follow Sabriya Rice on Twitter: @MHSRice