- Jennifer Middleton, MD, MPH
I was surprised to come across the United States Preventive Services Task Force (USPSTF) update in the June 15 AFP this weekend regarding nutrition and physical activity counseling for healthy adults:
[E]xisting evidence indicates that the health benefit of initiating behavioral counseling in the primary care setting to promote a healthful diet and physical activity is small.
And, they listed a potential harm to providing this counseling:
Harms may include the lost opportunity to provide other services that have a greater health effect.
As a family physician, I want to help my patients to live the best lives they can, and I feel strongly that good nutrition and exercise are both critical to doing so. So, this is a difficult USPSTF recommendation for me to absorb.
Of course, to clarify, the USPSTF only said that counseling regarding these matters is not effective. They did not make any value statements about diet and exercise. But given how important many medical professionals feel diet and exercise is to good health, why is our counseling so ineffective? Is it that we just don't counsel well? Or, is something more than just counseling necessary to effect behavior change?
A review article from 1999 and a more recent systematic review suggest that individual, computerized nutrition counseling may result in positive changes. Telephone interventions may also be effective for improving nutrition and exercise habits. Targeting counseling about nutrition that focuses on two concepts from health behavior theory, self-efficacy ("I believe I have what I need to make the change") and outcome expectations ("Making this change will result in a good outcome") also can make a difference.
Perhaps we need to both 1) make our counseling more effective, and 2) employ a more interdisciplinary approach to help our patients make sustainable changes.
This AFP USPSTF update is included in the AFP By Topic for Health Maintenance and Counseling. There is a lot of nice information there about health counseling in general (I especially like this Family Practice Management article on motivational interviewing).
Will this USPSTF update change your approach to diet and exercise counseling in the office?