Healthy Lifestyle for All Through Patient Care and Policy

To the Editor In an Editorial published in a recent issue of JAMA Internal Medicine, Capewell and Dowrick¹ express concern that the US Preventive Services Task Force (USPSTF) “C” rating of behavioral counseling for diet and physical activity for adults without obesity, hypertension, or hyperlipidemia will have a negative impact by unnecessarily channeling resources toward healthy people. As clinical psychologists representing the Society of Behavioral Medicine, an organization whose members developed the evidence underlying behavioral counseling for diet and physical activity, we can provide some insight into this literature and the role of individual interventions in public health. First, we are concerned about the characterization of patients in these studies as low risk. While they lacked cardiometabolic diagnoses, the majority (70%) of the 88 studies USPSTF reviewed recruited samples with demographic and behavioral characteristics (eg, race/ethnicity, older age, lifestyle factors) associated with elevated cardiovascular disease risk. Second, we are aware of no evidence for the suggestion by Capewell and Dowrick¹ that widespread implementation of behavioral counseling for diet and exercise could fuel health disparities. To the contrary, routine primary care counseling for patients with demographic and behavioral risk factors has been called for as a way to reduce health disparities.²