Medical Training to Achieve Competency in Lifestyle Counseling: An Essential Foundation for Prevention and Treatment of Cardiovascular Diseases and Other Chronic Medical Conditions: A Scientific Statement From the American Heart Association
Authors: Marie-France Hivert, Ross Arena, Daniel E. Forman, Penny M. Kris-Etherton, Patrick E. McBride, Russell R. Pate, Bonnie Spring, Jennifer Trilk, Linda V. Van Horn, William E. Kraus
Journal: Circulation (2016)

Ahealthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs).Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment.The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction.In addition to defining "cardiovascular health" based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight. 1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation. 2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health.Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling. 3Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year.Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians. 4,5owever, data further indicate that lifestyle counseling does not routinely occur in physicians' offices, thereby representing a lost opportunity.Physicians report that they perform lifestyle counseling during ≈34% of clinic visits. 4Patients, in turn, report an even lower frequency of physician lifestyle counseling.For example, obese patients reported receiving physical activity and dietary counseling from their primary care providers during ≈20% and 25% of clinic visits, respectively, 6 despite clear evidence and clinical guidelines. 7Even more worrisome is the downward trend in this type of counseling, as reported by Healthy People 2010 analyses that indicated a 10% decrease in frequency of preventive counseling between 1996 to 1997 and 2007 to 2008. 8 Many factors contribute to this situation.Physicians report they lack the necessary knowledge about how various diet and physical activity regimens affect specific medical conditions.Many doctors also say they lack the competencies needed to perform lifestyle counseling effectively. 9Although a large and convincing body of scientific evidence supports the benefits of a healthy diet, physical activity, and nonsmoking in NCD prevention and management, dissemination of this knowledge during medical training and continuing medical education is marginal compared with the time and