The American Heart Association wants to improve the heart
health of all Americans by 20% by 2020.To meet that goal, treating unhealthy
habits will be just as important as treating high blood pressure and
cholesterol, it said.
Those habits include having a poor-quality diet, eating too
much, not exercising enough and smoking, according to a position statement published
Researchers said few US adults are in good heart health
based on a measure that considers seven factors: diet, exercise, smoking,
weight, blood pressure, cholesterol and blood sugar.
The Patient Protection and Affordable Care Act, commonly
known as Obamacare, mandate insurance companies cover intensive behavioural
treatment for unhealthy habits without co-pays. But it will take more than that
to significantly improve Americans' heart health, according to the AHA. "We
call on practitioners to encourage patients toward healthy lifestyle change,
while recognising that many systems changes needed to facilitate provision of
such counselling are not under the clinician's control," the recommendation
"Consequently, we also call on the healthcare system,
insurance companies, employers, and educational institutions to institute
policies that align to help shift all sectors of the population toward a
healthier lifestyle. "Tackling unhealthy habits will need to be a team
effort. That means insurance reimbursement policies should be improved so
registered dietitians, psychologists and others can become part of the primary
care team, according to the AHA.
That team could then link patients to community diet and
exercise resources and sort through new health apps and other technologies to
see which might be helpful. From a policy angle, the AHA says doctors will need
simple ways to measure diet and exercise and should be paid for helping
patients meet their goals.
Those aims "are feasible in the long term, if there is
a collective medical will to do them," according to D Aaron Folsom. He
studies heart disease and community health at the University of Minnesota in
Minneapolis. "Much has been achieved already," Folsom told Reuters
But diet and exercise are still tough for people to change,
despite all the research showing the benefits of a healthy lifestyle, Dr
Richard L Brown, director of the Wisconsin Initiative to Promote Healthy
Lifestyles in Madison, said. "We need more research on how better to help
patients modify these behaviours," he told Reuters Health.
Both Brown and Folsom were not involved in the new policy statement.
Brown agreed with the AHA statement overall, but said he would count alcohol as
an additional heart health risk to consider. "Many studies have found that
moderate drinking can reduce the risk of heart disease, while more than
moderate drinking raises the risk," he said.
"Similarly, the literature is clear that risky and
problem drinking are more amenable to measurement and change than diet and
physical activity." He also said expanding healthcare teams to include
dietitians and psychologists could fragment care and wouldn't be feasible for
most primary care practices. What are needed instead, Brown said, are people
like health educators or health coaches trained to promote healthier behaviours.