Research Article
Exercise and Diet Counseling Trends From 2002 to 2015: A Serial Cross-Sectional Study of U.S. Adults With Cardiovascular Disease Risk

https://doi.org/10.1016/j.amepre.2020.07.008Get rights and content

Introduction

Exercise and dietary behavioral counseling are effective clinical practices recommended by the U.S. Preventive Services Task Force to reduce cardiovascular disease risk among high-risk individuals.

Methods

Medical Expenditure Panel Survey data from 2002 to 2015 were analyzed in 2018. Prevalence ratios of exercise, dietary, and both types of counseling among individuals with overweight or obesity with additional cardiovascular disease risk factors were calculated and adjusted for demographic covariates (N=116,048). Adjusted prevalence ratios were calculated for sociodemographic and health factors associated with counseling receipt using 2014–2015 data.

Results

From 2002 to 2015, adjusted prevalence ratios ranged from 43% to 63%. Compared with 2002, receipt of both types of counseling was 6% higher in 2015 (49%, 95% CI=48%, 51%). In 2015, compared with privately insured people, those without insurance (prevalence ratio=0.91, 95% CI=0.84, 0.99) or on Medicare (prevalence ratio=0.77, 95% CI=0.73, 0.82) were less likely to receive counseling. Individuals with 3 (prevalence ratio=1.46, 95% CI=1.39, 1.54), 4 (prevalence ratio=1.74, 95% CI=1.63, 1.85), or 5 (prevalence ratio=1.89, 95% CI=1.67, 2.15) cardiovascular disease risk factors received counseling more frequently than those with 2 cardiovascular disease risk factors. Female participants (prevalence ratio=1.07, 95% CI=1.03, 1.11) and racial minorities (Hispanics: prevalence ratio=1.31, 95% CI=1.24, 1.38; Blacks: prevalence ratio=1.11, 95% CI=1.05, 1.18; Asians: prevalence ratio=1.12, 95% CI=1.01, 1.24) reported higher rates of counseling.

Conclusions

Despite modest improvements since 2002, up to 37% of individuals at high cardiovascular disease risk were not receiving exercise counseling, and 43% were not receiving dietary counseling in 2015. Continued implementation and scale up of effective programs to increase behavioral lifestyle counseling among high-risk populations are needed more than ever to mitigate the U.S. cardiometabolic disease burden.

Section snippets

INTRODUCTION

Cardiovascular disease (CVD) poses substantial health and economic burdens in the U.S.1 The cost of treating CVD was $213 billion in 2015.2 Treating obesity and diabetes, both prominent CVD risk factors, have been estimated to cost $149 billion and $237 billion annually, respectively.3,4 Thus, it is imperative to implement and evaluate large-scale policies and interventions addressing CVD risk factors such as high blood pressure, high cholesterol, obesity, and diabetes.2

Behavioral counseling

METHODS

The Medical Expenditure Panel Survey (MEPS) is run by the Agency for Healthcare Research and Quality. MEPS collects data from a nationally representative sample of individuals and families, medical providers, and employers to provide concrete estimates regarding the use of medical services in the country. The MEPS-Household Component (MEPS-HC) collects nationally representative data on demographic characteristics, health conditions, health status, the use of medical care services, charges and

RESULTS

From 2002 to 2015, there were 346,177 MEPS respondents, and 119,138 (34.4%) were eligible for this analysis. A total of 116,327 (33.6%) eligible respondents had complete data on sociodemographic variables. After excluding respondents missing both exercise and dietary counseling data, the final study sample consisted of 116,048 (33.5%) respondents. The demographic characteristics of the eligible sample with complete sociodemographic variables are shown in Table 1.

In 2002, exercise counseling had

DISCUSSION

When comparing serial cross-sectional data from 2002 to 2015, modest increases in the prevalence of self-reported receipt of diet and exercise counseling among individuals were observed. However, 37% of potentially eligible individuals, on the basis of the current USPSTF clinical recommendations, were still not receiving exercise counseling, and 43% were not receiving dietary counseling in 2015.13 In stratified analyses, individuals who were male, White, uninsured, and with fewer CVD risk

CONCLUSIONS

Despite modest improvements in the last decade, 37% of the U.S. population with overweight or obesity with an additional CVD risk factor were still not receiving exercise counseling, and 43% were not receiving dietary counseling, as per USPSTF recommendations, in 2015. The differences in PRs were associated with important health and sociodemographic factors such as insurance status, number of CVD risk factors, race, and sex. Continued implementation and scale up of effective programs to

ACKNOWLEDGMENTS

No financial disclosures were reported by the authors of this paper.

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