Despite its recent recommendation that all adult patients be screened for obesity, the United States Preventive Services Task Force (USPSTF) is also advising primary-care clinicians to be selective about which patients they counsel regarding behavioral interventions to improve diet and physical fitness and ultimately reduce cardiovascular disease (CVD) risk.

In a grade C recommendation published by Annals of Internal Medicine, Virginia A. Moyer, MD, MPH, and her USPSTF coauthors acknowledge that the correlation among healthful diet, physical activity, and CVD incidence is strong. However, the investigators explain, existing evidence indicates that the health benefit of initiating behavioral counseling in the primary-care setting in an effort to promote a healthful diet and physical activity is small.

Therefore, rather than incorporate such counseling into the care of all adults in the general patient population, primary-care clinicians may choose to counsel patients selectively instead, rather than lose the opportunity to provide other services that may have a greater health effect for the patient. 

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To guide the decision regarding which patients should receive counseling interventions, clinicians can consider whether a person has other risk factors for CVD that need to be addressed more urgently, whether the person is ready to make a change, whether the person has social support and community resources to help him or her make behavioral changes, and whether the person has other health-care and preventive-
service priorities.