DOC News September 1, 2006
Volume 3 Number 9 p. 6
© 2006 American Diabetes Association
Offering lifestyle advice is Good Clinical Practice
Question: Will diet and exercise advice help a 54-year-old obese
person who currently does not follow a healthful
lifestyle?
Answer: It has been established beyond reasonable doubt that
lifestyle is an important determinant of chronic disease and reduced
longevity. Hundreds, indeed thousands, of reports in the peer-reviewed
literature support the benefits of eating a healthful diet, being physically
active, and not smoking.
Many physicians, however, doubt that providing diet and exercise advice is
worth the effort, perhaps especially in cases such as that of the 54-year-old
obese individual referenced in the question. Frequently mentioned reasons for
not giving diet and exercise advice include:
- Middle-aged obese individuals have not yet made these lifestyle changes, so
why should I expect them to do so now?
- I am not trained in diet and exercise counseling, and it makes me
uncomfortable when patients want specific information related to these
topics.
- There is so much conflicting dietary and exercise advice. How do I separate
truth from hype?
- I have treated obese people who lost weight but put it back on again.
There is some truth in each of these observations. Many patients try and
fail to make lifestyle changes, but others manage to heed a doctor's advice to
become more physically active and eat a healthier diet. Similarly, although
many patients do not take the prescriptions they receive, numerous people do
benefit from the medication their doctor recommends. Just as noncompliance
with recommended drugs should not stop you from writing prescriptions you
think will benefit your patients, some patients' lack of success in making
lifestyle changes should not deter you from providing advice you think will
benefit them.
You do not have to be a registered dietitian or an exercise physiologist to
offer lifestyle advice. Of course there are complicated algorithms and
programs for both diet and exercise, and some patients may need the specific
detailed counseling that other health professionals can provide. For the vast
majority, however, some very simple directions can be useful:
- Focus the diet on fruits and vegetables. Try to get at least 5 servings per
day; 8–10 servings are even better.
- Eat whole-grain cereals, bread, and pasta.
- Limit intake of saturated fat, and try to eliminate trans fat from the
diet.
- Get at least 30 minutes of moderate-intensity physical activity, such as
walking, at least 5 days a week. Remember that three 10-minute walks per day
provide the same health benefits as one 30-minute walk.
All primary care clinicians should provide this simple advice at every
possible opportunity. At follow-up visits, inquire about your patient's
progress. The key to making these lifestyle changes is learning and applying
cognitive and behavioral skills that have been validated in controlled trials.
For example, 25–30% of initially sedentary and unfit adults can meet the
physical activity recommendation above after a 24-month behavioral
intervention.1 If
this seems like a low success rate, think how you would feel about an
intervention where 25–30% of current smokers become nonsmokers in 24
months.
We need to take the view that encouraging patients to make healthful
lifestyle choices is a prerequisite to good clinical practice. Not all will
succeed, but many will, and your advice greatly increases the likelihood of
success. 
Footnotes
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Steven N. Blair, PED, is Fred and Barbara Meyer Chair in Preventive
Medicine at The Cooper Institute in Dallas.
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Timothy S. Church, MD, PhD, MPH, is vice president of research at The
Cooper Institute.
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References
1. Dunn AL, Marcus BH, Kampert JB, et al.: Comparison of lifestyle and
structured interventions to increase physical activity and cardiorespiratory
fitness: A randomized trial. JAMA 281: 327–334, 1999.[Abstract/Free Full Text]
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