Counseling urged for obese people at higher odds for heart disease: experts

(HealthDay)—The millions of Americans who are overweight with at least one risk factor for heart disease should be offered "lifestyle counseling" by their doctors or other health care workers, an influential government-appointed panel of experts said on Monday.

This counseling should encourage a healthy diet and regular exercise as a means of dropping excess pounds, the U.S. Preventive Services Task Force said in its draft recommendation.

Risk factors for cardiovascular disease—which includes heart disease and stroke—include high blood pressure, high cholesterol and pre-diabetes. It also includes "metabolic syndrome," a group of symptoms and conditions known to boost the chances of heart trouble.

Timely, intensive counseling on healthy lifestyle changes "can help reduce the risk of cardiovascular disease," task force member Sue Curry said in a panel news release.

Other experts applauded the recommendation. Katherine Farrell Harris called it "an excellent idea."

"We've learned that the vast majority of adults grappling with obesity have difficulty making changes on their own," said Harris, a registered dietitian and director of integrated nutrition at Advantage Care Physicians in New York City. "This kind of behavior counseling includes education, goal setting and ongoing monitoring and support in order to help patients make major lifestyle changes and stick to them."

Dr. Nieca Goldberg, a cardiologist and director of the Tisch Center for Women's Health at NYU Langone Medical Center, New York City, agreed.

"Lifestyle changes such as diet and exercise can make a big impact in improving these risk factors, but many times people can't get started because they don't know where to start," she said. "There is a big dropout rate, greater than 50 percent, six months into a lifestyle program."

Heart disease is a leading cause of death in the United States. The panel noted that in 2012, about 35 percent of American adults were obese, which increases their chance of having cardiovascular disease risk factors such as high blood pressure, high cholesterol and diabetes.

Just what would be involved in lifestyle counseling? According to panel member Curry, "effective counseling services [typically] include education, goal setting, and ongoing monitoring and feedback ... delivered by a trained professional. While there is no magic number of sessions, it is clear that effective counseling is delivered over multiple sessions spread over several months to a year."

Goldberg said that she will "often refer [obese] patients to the psychologist for cognitive behavioral counseling, to help build confidence, work on stress-reduction techniques for high blood pressure and overeating.

She added that, sometimes, "the only problem with this type of counseling is [a lack of] insurance coverage."

The draft recommendation, which is open to public comment until June 9, applies only to overweight and obese adults with a risk factor for cardiovascular disease. The task force has a separate recommendation for people who have an average risk for cardiovascular disease.

"All individuals, regardless of their risk of heart disease, can realize the health benefits of improved nutrition, healthy eating behaviors and increased physical activity," task force member Dr. Mark Ebell said in the news release.

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