National Center for Health Research, March 18, 2020
National Center for Health Research’s Public Comments on USPSTF Draft Research Plan for Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Risk Factors
Thank you for the opportunity to express our views on the USPSTF draft research plan regarding healthful diet and physical activity behavioral counseling in a primary care setting for cardiovascular disease prevention. The National Center for Health Research is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We support USPSTF’s efforts to update existing recommendations based on new research. Although we applaud many aspects of the draft research plan, it would benefit from including several additional analyses.
Given what is known about the social determinants of health, we encourage research that evaluates the extent to which demographic characteristics such as age, race, and gender influence the impact of these behavioral counseling interventions on the outcomes under consideration. Accessibility to healthy foods and exercise spaces can differ quite substantially across different groups. Therefore, even if the primary care intervention motivates a patient to eat more nutritious foods and/or exercise more frequently, barriers such as access to fresh fruits and vegetables, affordability of healthy food, and the safety and walkability of one’s neighborhood may have an impact on a patient’s ability to benefit from these interventions.
In addition, there are a range of counseling interventions and the different types may substantially differ in their effectiveness and could lead to different outcomes. Information about the relative benefits (and risks) of intervention types could be helpful for healthcare providers to choose which intervention to implement. Studies that compare interventions to an active comparator could help identify which methods are more appropriate under certain conditions and for which demographic subgroups.
It is unclear if studies will be excluded if they contain weight loss goals as endpoints, or if they will be excluded only if those goals are the primary endpoint. In some other cases, studies “solely focused on…” a non-cardiovascular endpoint are stated to be excluded. Because excess weight is a risk factor for cardiovascular disease and BMI is one of the measured outcomes, some studies may include both cardiovascular disease and weight loss goals. We believe, therefore, that interventions aimed at weight loss in addition to other health goals should not be excluded.
Finally, we urge the inclusion of studies that assess the potential mental health harms associated with this behavioral counseling, in addition to measuring harms that require medical attention. Behavioral counseling regarding nutrition and exercise may have a negative psychological impact on those who are overweight, have body dysmorphic disorder, or have eating disorders. It is important to examine potential harms to mental health in addition to medical harms.
The National Center for Health Research can be reached at info@center4research.org or at (202) 223-4000