Physicians must intervene more assertively to get patients to adopt healthier lifestyles, directly targeting smoking, obesity, poor diet, and physical inactivity, according to an American Heart Association science advisory published online Oct. 7 in Circulation.
"Providers’ efforts to champion a healthy lifestyle as the norm and healthy behaviors as the default in people’s lives are critical," said Bonnie Spring, Ph.D., and Judith K. Ockene, Ph.D., cochairs of the AHA’s Behavior Change Committee of the Council on Epidemiology and Prevention, the Council on Lifestyle and Cardiometabolic Health, the Council for High Blood Pressure Research, and the Council on Cardiovascular and Stroke Nursing, and their associates.
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A recent AHA advisory says that doctors have to be more assertive in getting patients to adopt healthier lifestyles.
The investigators termed this science advisory "a call to action" for clinicians, citing their vital role in fostering healthier behaviors. They added that system-wide changes also are necessary "to shift the majority of the public toward the next level of improved cardiovascular health," and so also called on "the health care system, insurance companies, employers, and educational institutions" to do so.
The science advisory urged physicians to follow "the 5 As" – a comprehensive, validated treatment algorithm of counseling steps to facilitate patient behavior change that can be completed within the constraints of the typical medical visit. These include Assessing the risk behavior; Advising change, Agreeing on goals and an action plan; Assisting with treatment; and Arranging follow-up.
Most clinicians easily follow the first A, assessing and tracking health behaviors such as smoking habits, weight gain, diet, and exercise over time.
However, "many providers say they omit the last three As because they perceive them as time consuming," and they also feel they lack the necessary counseling skills.
But even taking a single step toward that goal can be extremely helpful to patients. Simple use of patient-centered communication is key: that is, avoiding the use of "commanding language" and instead asking open-ended questions and expressing empathy signals that the physician takes an active interest in the patient’s perspective. It also reveals what actions a patient is willing to take, helping him or her to develop a behavior change plan.
Physicians also can enlist the help of many allied health professionals to take this step, including clinical psychologists, dieticians, health educators, and kinesiologists. They also should be prepared to connect patients to community resources such as park or community-center programs, biking trials, and farmers’ markets.
Direct physician intervention "will undoubtedly also take the form of answering patients’ questions about which of an armory of computer programs, applications, sensors, and online communities they should use to support healthy lifestyle changes," said Dr. Spring of Northwestern University in Chicago and Dr. Ockene of the University of Massachusetts in Worcester (Circulation 2013 Oct. 7 [doi:10.1161/01.cir.0000435173.25936.e1]).
On the population level, physicians should advocate for policies and strategies that support a large-scale shift toward healthier behaviors. Chief among these is the reimbursement for the intensive behavioral counseling and the multidisciplinary provider teams that are required for patients whose poor health habits put them at cardiovascular risk, Dr. Spring and Dr. Ockene said.
Copies of "Better Population Health Through Behavior Change in Adults: A Call to Action" are available at my.americanheart.org/statements.
This science advisory was issued on behalf of the AHA’s behavior change committee of the Council on Epidemiology and Prevention, the Council on Lifestyle and Cardiometabolic Health, the Council for High Blood Pressure Research, and the Council on Cardiovascular and Stroke Nursing. The writing panel’s disclosure questionnaires are available from the AHA.