Introduction
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.
Methods
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.
Results
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.
Conclusions
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- The state of U.S. health, 1990-2016: burden of diseases, injuries, and risk factors among U.S. states.JAMA. 2018; 319: 1444-1472
- Heart disease and stroke statistics-2019 update: a report from the American Heart Association [published correction appears in Circulation. 2020;141(2):e33].Circulation. 2019; 139: e56-e528
- Estimating the medical care costs of obesity in the United States: systematic review, meta-analysis, and empirical analysis.Value Health. 2016; 19: 602-613
- Economic costs of diabetes in the U.S. in 2017.Diabetes Care. 2018; 41: 917-928
- The new ACC/AHA hypertension guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults.Am J Hypertens. 2018; 31: 133-135
- 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society[published correction appears in J Am Coll Cardiol. 2014;63(25 Pt B):3029–3030].J Am Coll Cardiol. 2014; 63: 2985-3023
- Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association.Diabetes Care. 2007; 30: S48-S65
- Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).Diabetes Care. 2018; 41: 2669-2701
- Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness.Lancet. 2010; 376: 1775-1784
- A randomized intervention of physical activity promotion and patient self-monitoring in primary health care.Prev Med. 2006; 42: 40-46
- Managed-Medicare health club benefit and reduced health care costs among older adults.Prev Chronic Dis. 2008; 5 (Accessed May 20, 2020): A14
- Cost-effectiveness of a national exercise referral programme for primary care patients in Wales: results of a randomised controlled trial.BMC Public Health. 2013; 13: 1021
- U.S. Preventive Services Task Force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force Recommendation Statement.Ann Intern Med. 2014; 161: 587-593
- Routine assessment and promotion of physical activity in healthcare settings: a scientific statement from the American Heart Association.Circulation. 2018; 137: e495-e522
- Final recommendation statement: healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: behavioral counseling.U.S. Preventive Services Task Force, Rockville, MDAugust 26, 2014https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/healthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd(Published)Date accessed: July 22, 2020
- Modifiable cardiovascular risk factors in adults with diabetes: prevalence and missed opportunities for physician counseling.Arch Intern Med. 2002; 162: 427-433
- Trends in lifestyle counseling for adults with and without diabetes in the U.S., 2005-2015.Am J Prev Med. 2019; 57: e153-e161
- Trends in adults receiving a recommendation for exercise or other physical activity from a physician or other health professional.NCHS Data Brief. 2012; : 1-8
- Use of Clinical Preventive Services in the United States: Estimates From the Medical Expenditure Panel Survey (MEPS), 2015.Agency for Healthcare Research and Quality, HHS, Rockville, MDMay 2019https://meps.ahrq.gov/data_files/publications/rf41/rf41.pdf(Published)Date accessed: July 22, 2020
- Medical Expenditure Panel Survey, household component.Agency for Healthcare Research and Quality, June 25, 2019https://meps.ahrq.gov/mepsweb/survey_comp/household.jsp(Updated)Date accessed: July 22, 2020
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies [published correction appears in Ann Intern Med. 2008;148(2):168].Ann Intern Med. 2007; 147: 573-577
- Self-reported prediabetes and risk-reduction activities–United States, 2006.MMWR Morb Mortal Wkly Rep. 2008; 57 (Accessed May 20, 2020): 1203-1205
- No adjustments are needed for multiple comparisons.Epidemiology. 1990; 1: 43-46
- A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group.N Engl J Med. 1997; 336: 1117-1124
- Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.Lancet. 2004; 364: 937-952
- The Affordable Care Act's impacts on access to insurance and health care for low-income populations.Annu Rev Public Health. 2017; 38: 489-505
- Health care provider counseling for physical activity or exercise among adults with arthritis - United States, 2002 and 2014.MMWR Morb Mortal Wkly Rep. 2018; 66: 1398-1401
- If exercise is medicine, where is exercise in medicine? Review of U.S. medical education curricula for physical activity-related content.J Phys Act Health. 2015; 12: 1336-1343
- Medical students around the world poorly trained in nutrition.JAMA. 2019; 322: 1852
- Nutrition education in medical training-reply.JAMA. 2019; 322: 784-785
- Physical activity counseling in medical school education: a systematic review.Med Educ Online. 2014; 19: 24325
- Physical activity habits of doctors and medical students influence their counselling practices.Br J Sports Med. 2009; 43: 89-92
- Trends in obesity among adults in the United States, 2005 to 2014.JAMA. 2016; 315: 2284-2291
- Social influence and motivation to change health behaviors among Mexican-origin adults: implications for diet and physical activity.Am J Health Promot. 2012; 26: 176-179
- Trends and disparities in the prevalence of physicians’ counseling on diet and nutrition among the U.S. adult population, 2000-2011.Prev Med. 2016; 89: 70-75
- Racial disparities in the utilization of preventive health services among older women with early-stage endometrial cancer enrolled in Medicare.Cancer Med. 2017; 6: 2153-2163
- Effects of sex, age, and visits on receipt of preventive healthcare services: a secondary analysis of national data.BMC Health Serv Res. 2006; 6: 15
- Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons With Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force.Agency for Healthcare Research and Quality, Rockville, MD2014 (Accessed May 20, 2020)
- Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?.Prev Med. 2015; 78: 85-91
- The quality of care delivered to patients within the same hospital varies by insurance type.Health Aff (Millwood). 2013; 32: 1731-1739
- Factors associated with patient recall of key information in ambulatory specialty care visits: results of an innovative methodology.PLoS One. 2018; 13e0191940
- Trends in health care expenditure among U.S. adults with heart failure: the Medical Expenditure Panel Survey 2002-2011.Am Heart J. 2017; 186: 63-72
- Trends in adherence to the Physical Activity Guidelines for Americans for aerobic activity and time spent on sedentary behavior among U.S. adults, 2007 to 2016.JAMA Netw Open. 2019; 2e197597
- Lifestyle medicine: successful reimbursement methods and practice models.Am J Lifestyle Med. 2019; 13: 246-252
- Preventing type 2 diabetes in communities across the U.S.: the National Diabetes Prevention Program.Am J Prev Med. 2013; 44: S346-S351
- The exercise is medicine global health initiative: a 2014 update.Br J Sports Med. 2014; 48: 1627-1633
- Making physical activity counseling a priority in clinical practice: the time for action is now.JAMA. 2015; 314: 2617-2618
- The American Heart Association 2030 Impact goal: a presidential advisory from the American Heart Association.Circulation. 2020; 141: e120-e138
Article Info
Publication History
Published online: December 17, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
