Tuesday, January 2, 2018

Supporting patients' New Year's resolutions

- Jennifer Middleton, MD, MPH

The beginning of a new calendar year often sparks plans to improve health behaviors. When patients share these goals with us, we have many tools and resources available to help them succeed.

A recent AFP article reviews evidence showing that weight loss may be more successful in patients who set simple dietary goals as opposed to attempting to follow a complex diet regimen. Setting permissive (eat more vegetables) instead of restrictive (eat less sweets) goals may also be more effective for meaningful weight loss. Increasing consumption of nutrient-dense foods (whole grains, vegetables, fruits) benefits all patients, and motivational interviewing by a physician can help patients lose an average of an additional 3.3 pounds. A comprehensive review of available medications for weight loss along with when to consider a referral to bariatric surgery can be found in this article and in the AFP By Topic on Obesity.

Another recent AFP article reminds us that many smokers want to quit and have failed quit attempts in the past. This article reviews the 5 A's framework (ask - advise - assess - assist - arrange) as well as the stages of change model to increase our counseling effectiveness. Just one minute spent in tobacco cessation counseling can increase quit rates. The article also reviews nicotine replacement therapies, which have been shown to increase the success of a quit attempt by 50-70%, and encourages use of dual therapy (for example, patch and gum) for those patients smoking more than 1 pack a day. Calling or contacting patients at least 4 times after their planned quit date increases quit rates; AAFP's Office Champions model is one way of involving the entire office in providing this follow-up and helping patients stay smoke-free for good. The AFP By Topic on Tobacco Abuse and Dependence provides many more helpful resources.

A final recent AFP article cites the disappointing statistic that most individuals do not report ever receiving counseling from their physicians regarding physical activity. Engaging in shared decision making with patients, writing an exercise prescription, and providing handouts with exercise instructions have all been shown to increase physical activity. Patients who feel that they don't have the time for prolonged periods of exercise may be glad to know that even 10-minute bursts of exercise can be beneficial. Patients intimidated by demanding exercise regimens may be relieved to learn that the overall time spent in exercising seems to be more important than overall intensity. Individuals should aim for no more than 2 days off between exercising to prevent losses in metabolic activity gains from a regular exercise program. The AFP By Topic on Health Maintenance and Counseling includes this recent review regarding the United States Preventive Services Task Force (USPSTF)'s report on the benefits of behavioral counseling interventions for physical activity.

Perhaps one of your new year's resolutions is to increase your office's capacity for supporting patients' behavior change efforts; this Family Practice Management article describing the AAFP's "AIM-HI" office intervention model might provide some inspiration. Or, perhaps your office has a successful model already in place that you might share with other AFP Community Blog readers in the comment space below.

Here's to a healthy 2018!

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