Exercise and Diet Counseling Trends From 2002 to 2015: A Serial Cross-Sectional Study of U.S. Adults With Cardiovascular Disease Risk

  • Felipe Lobelo
    Address correspondence to: Felipe Lobelo, MD, PhD, Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Office 7051, Atlanta GA 30322.
    Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia

    Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, Georgia

    Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia
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  • Krittin J. Supapannachart
    School of Medicine, Emory University, Atlanta, Georgia
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  • Tianyi Zhou
    Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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  • Jennifer K. Frediani
    Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, Georgia

    Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia

    Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Published:December 17, 2020DOI:


      Exercise and dietary behavioral counseling are effective clinical practices recommended by the U.S. Preventive Services Task Force to reduce cardiovascular disease risk among high-risk individuals.


      Medical Expenditure Panel Survey data from 2002 to 2015 were analyzed in 2018. Prevalence ratios of exercise, dietary, and both types of counseling among individuals with overweight or obesity with additional cardiovascular disease risk factors were calculated and adjusted for demographic covariates (N=116,048). Adjusted prevalence ratios were calculated for sociodemographic and health factors associated with counseling receipt using 2014–2015 data.


      From 2002 to 2015, adjusted prevalence ratios ranged from 43% to 63%. Compared with 2002, receipt of both types of counseling was 6% higher in 2015 (49%, 95% CI=48%, 51%). In 2015, compared with privately insured people, those without insurance (prevalence ratio=0.91, 95% CI=0.84, 0.99) or on Medicare (prevalence ratio=0.77, 95% CI=0.73, 0.82) were less likely to receive counseling. Individuals with 3 (prevalence ratio=1.46, 95% CI=1.39, 1.54), 4 (prevalence ratio=1.74, 95% CI=1.63, 1.85), or 5 (prevalence ratio=1.89, 95% CI=1.67, 2.15) cardiovascular disease risk factors received counseling more frequently than those with 2 cardiovascular disease risk factors. Female participants (prevalence ratio=1.07, 95% CI=1.03, 1.11) and racial minorities (Hispanics: prevalence ratio=1.31, 95% CI=1.24, 1.38; Blacks: prevalence ratio=1.11, 95% CI=1.05, 1.18; Asians: prevalence ratio=1.12, 95% CI=1.01, 1.24) reported higher rates of counseling.


      Despite modest improvements since 2002, up to 37% of individuals at high cardiovascular disease risk were not receiving exercise counseling, and 43% were not receiving dietary counseling in 2015. Continued implementation and scale up of effective programs to increase behavioral lifestyle counseling among high-risk populations are needed more than ever to mitigate the U.S. cardiometabolic disease burden.
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