Health Care Providers' Advice on Lifestyle Modification in the US Population: Results from the NHANES 2011-2016

Igor Grabovac; Lee Smith; Sinisa Stefanac; Sandra Haider; Chao Cao; Thomas Waldhoer; Sarah E Jackson; Lin Yang

doi:10.1016/j.amjmed.2018.11.021

Health Care Providers' Advice on Lifestyle Modification in the US Population: Results from the NHANES 2011-2016

Am J Med. 2019 Apr;132(4):489-497.e1. doi: 10.1016/j.amjmed.2018.11.021. Epub 2018 Dec 3.

Authors

Igor Grabovac¹, Lee Smith², Sinisa Stefanac³, Sandra Haider¹, Chao Cao⁴, Thomas Waldhoer⁵, Sarah E Jackson⁶, Lin Yang⁷

Affiliations

¹ Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria.
² Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, UK.
³ Institute of Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria; Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria. Electronic address: sinisa.stefanac@meduniwien.ac.at.
⁴ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, StLouis, Mo.
⁵ Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria.
⁶ Department of Behavioral Science and Health, University College London, UK.
⁷ Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada; Preventive Oncology & Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.

PMID: 30521796
DOI: 10.1016/j.amjmed.2018.11.021

Abstract

Objective: Health care providers are encouraged to prescribe lifestyle modifications for preventing and managing obesity and associated chronic conditions. However, the pattern of lifestyle advice provision is unknown. We investigate the prevalence of advised lifestyle modification according to weight status and chronic conditions in a US nationally representative sample.

Methods: Adults ages 20-64years (n = 11,467) from the National Health and Nutrition Examination Survey between 2011 and 2016 were analyzed, with weight status and chronic conditions (high blood pressure, high blood cholesterol, osteoarthritis, coronary heart disease, and type 2 diabetes mellitus). Lifestyle modification advice by health care providers included: increase physical activity/exercise, reduce dietary fat/calories, control/lose weight, and all of the above.

Results: High blood pressure (32.7%) and cholesterol (29.3%) were highly prevalent compared with osteoarthritis (7.4%), type 2 diabetes (5.7%), and coronary heart disease (3.7%). Those with type 2 diabetes received considerably more frequent advice (56.5%; 95% confidence interval [CI], 52.4%-60.6%) than those with high blood pressure (31.4%; 95% CI, 29.3%-33.6%) and cholesterol (27.0%; 95% CI, 24.9%-29.3%). Prevalence of lifestyle advice exhibited substantial increases with graded body mass index and comorbidity (all P < .001). After adjusting for comorbid conditions, advice was more commonly reported among women, those overweight/obese, nonwhite, or insured. A remarkably low proportion of overweight (21.4; 95% CI, 18.7%-24.3%) and obese (44.2%; 95% CI, 41.0%-47.4%) adults free of chronic conditions reported receiving any lifestyle advice.

Conclusions: Prevalence of lifestyle modification advised by health care providers is generally low among US adults with chronic conditions, and worryingly low among those without chronic conditions, however overweight or obese. Prescribed lifestyle modification is a missing opportunity in implementing sustainable strategies to reduce chronic condition burden.

Keywords: Chronic condition; Health care provider advice; Lifestyle modification; NHANES; Obesity.

MeSH terms

Adult
Chronic Disease / prevention & control*
Directive Counseling / statistics & numerical data*
Female
Healthy Lifestyle*
Humans
Male
Middle Aged
Nutrition Surveys
Risk Reduction Behavior
United States
Young Adult