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:

1. Middle-aged obese individuals have not yet made these lifestyle changes, so why should I expect them to do so now?

2. I am not trained in diet and exercise counseling, and it makes me uncomfortable when patients want specific information related to these topics.

3. There is so much conflicting dietary and exercise advice. How do I separate truth from hype?

4. 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:

1. Focus the diet on fruits and vegetables. Try to get at least 5 servings per day; 8–10 servings are even better.

2. Eat whole-grain cereals, bread, and pasta.

3. Limit intake of saturated fat, and try to eliminate trans fat from the diet.

4. 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. ▪