MKSAP Quiz: Motivating lifestyle change
A 28-year-old man is evaluated during a follow-up visit for hypertension and diabetes mellitus. He works two jobs and eats fast food for most meals. Which of the following is the most appropriate management?
A 28-year-old man is evaluated during a follow-up visit for hypertension and diabetes mellitus. He works two jobs and eats fast food for most meals. He reports that he does not have time to exercise. He states that he is unhappy with his lifestyle. Medications are amlodipine and hydrochlorothiazide.
Which of the following is the most appropriate management?
A. Behavioral counseling
B. Review benefits of a healthy diet
C. Review benefits of exercise
D. Review consequences of hypertension
MKSAP Answer and Critique
The correct answer is A. Behavioral counseling. This content is available to MKSAP 19 subscribers as Question 105 in the General Internal Medicine 2 section. More information about MKSAP is available online.
The most appropriate management is counseling for behavioral change (Option A). Behavioral counseling is an integral part of helping patients attain a healthy lifestyle. The U.S. Preventive Services Task Force (USPSTF) recommends behavioral counseling to promote a healthy diet and physical activity for adults aged 18 years or older who are at increased risk for cardiovascular disease (CVD). Patients at increased risk for CVD are identified by the USPSTF as patients with hypertension or elevated blood pressure; dyslipidemia; or mixed or multiple risk factors, such as the metabolic syndrome or an estimated 10-year atherosclerotic CVD risk of 7.5% or higher. The USPSTF provides suggestions for behavioral change implementation, including a median of 12 contacts, with an estimated 6 hours of contact over 12 months; some one-on-one time with an interventionist; and use of motivational interviewing and behavioral change techniques, such as goal setting, active use of self-monitoring, and addressing barriers related to diet, physical activity, or weight change. The USPSTF suggests that counseling for behavioral change can be done in person or referred to outside counseling services, or patients can be informed about media-based interventions.
Reviewing the benefits of a healthy diet and exercise (Options B, C) is necessary but not sufficient to help this patient achieve healthy lifestyle goals. Behavioral change counseling that includes motivational interviewing and introduction to behavioral change techniques as well as goal setting is more likely to achieve the desired end than solely providing information about the benefits of diet and exercise. The USPSTF notes that there is adequate evidence that counseling interventions reduce overall CVD events (myocardial infarction and stroke); improve blood pressure, lipid and fasting blood glucose levels, and body weight/adiposity; and improve healthy eating habits.
Although it is important that patients understand the long-term complications of their diseases (Option D), providing a stronger means of supporting behavioral change, such as a behavioral counseling program, is more likely to make a significant impact.
Key Point
- The U.S. Preventive Services Task Force recommends behavioral counseling to promote a healthy diet and physical activity for adults aged 18 years or older who are at increased risk for cardiovascular disease.