Presentation on theme: "Adherence to Lifestyle Guidelines: Barriers to Reaching 2020 Goals? Lora E. Burke, PhD, MPH, FAHA, FAAN University of Pittsburgh American Heart Association."— Presentation transcript:
Adherence to Lifestyle Guidelines: Barriers to Reaching 2020 Goals? Lora E. Burke, PhD, MPH, FAHA, FAAN University of Pittsburgh American Heart Association NPAM/EPI Spring Meeting March 2011
No Conflicts to Disclose Research is supported by NIH
AHA 2020 IMPACT GOALS By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.
Healthy Lifestyle Healthy diet energy balanced and nutrient dense fruits and vegetables high-fiber whole grains, low-fat milk, seafood reduced added sugars, solid fats, refined grains and sodium Physical activity (PA) 150 min/wk of moderate (MPA) 75 min vigorous (VPA), or combination of two
Shifts in Food Environment 1970 – 2008 19702008 Average daily per capita calories (+30%) 2057 cal2674 cal Added fats and oils (+56%) 56 lbs87 lbs Added sugars & sweeteners (+15%) 119 lbs136 lbs
Shifts in Food Environment 1970 – 2008 Total milk beverage declined 33% Fruit juice increased 25% Carbonated soft drinks increased 20% Diet soft drinks increased 58% Regular soft drinks increased 9% Van Horn et al., 2010 Dietary Guidelines Advisory Committee
Dietary Intakes in Comparison to Recommended Intake Levels/Limits 2010 Dietary Guidelines Advisory Committee Report
Full Adherence to Heart Healthy Behaviors in US Sample 2000 BRFSS data Examined those with & without CHD Excluded those with poor physical health or activity limitations Defined fully adherent as: Diet: 5 servings F & V/day PA: MPA 5 days/wk for 30 min or VPA 3 days/wk for 20 min Smoking: Never or former smoker Miller et al., Prev Chronic Dis, 2005
Percentage of Respondents Adherent to Recommendations 47% 2% 4% 1% 5% 14% 10% Smoking Abstinence (76%) Fruit & Vegetable Intake (18%) Physical Activity (24%) None 18% Without Heart Disease Miller, et al. 2005
Percentage of Respondents Adherent to Recommendations None 16% With Heart Disease Miller, et al. 2005 48% 2% <1% 7% 12% Smoking Abstinence (80%) Fruit & Vegetable Intake (22%) Physical Activity (21%)
Full Adherence to Heart Healthy Behaviors in US Sample cont. Adherence rates similar to earlier BRFSS reports in 1990, 1994, and 1996 1 in 20 adherent to all 3 behaviors > high school education highest income Younger population: better adherence to PA lower adherence to diet and nonsmoking Miller et al., Prev Chronic Dis, 2005
Compliance with PA Guidelines for Americans, NHANES 05-06 Self-Report Data 324.5±18.6 min/wk MPA 73.6±3.9 min/wk VPA 62% met guidelines Accelerometer Data 45.1±4.6 min/wk MPA 18.6±6.6 min/wk VPA 9.6% met guidelines Tucker et al., Amer J Prev Med, 2011
Note: the next 4 slides reflect the success that we achieve in weight loss through behavioral treatment and lifestyle approaches; however, the second part of the curve indicates the high rate of recidivism due to lack of sustained adherence to a healthy lifestyle. The following slide reflects adherence and how it declines over time, depicting four different behaviors. This slope occurs across several behavioral domains, from diet and exercise to medication-taking behaviors.
Trajectory of Weight Loss and Regain Jakicic et al., Arch Int Med 168;1550-1559, 2008
Wadden et al. Gastroenterology Vol. 132, No. 6, 2007 Trajectory of Weight Loss and Regain
Svetkey, et al., JAMA; 299(10): 1139-1148, 2008 Trajectory of Weight Loss and Regain
Decline in Treatment Adherence Over Time PREFER Trial Acharya, Elci, Sereika et al., 2009
Summary of Adherence to Healthy Lifestyle n Adherence to healthy lifestyle guidelines is far below what is needed to achieve the 2020 goals n Adherence to any Tx strategy declines over time, especially after reduced contact n Recidivism and weight regain remain significant problems in the Tx of excess weight
Key Barriers to Adherence to Healthy Lifestyle Access to healthy foods, recreational settings Cost Nutrition knowledge/behavioral skills to implement healthy lifestyle Time required to incorporate behavior change Motivation to change & maintain behavior in a non-supportive environment
Future Directions Address overweight & obesity as a chronic disorder that needs ongoing management Make BMI a vital sign Discuss weight with patients Use technology to: reach a greater portion of the population provide ongoing contact/reinforcement Prevent weight gain!
Call to Action Address lifestyle nonadherence at multiple levels Modify the environment Make healthy lifestyle the norm Translate study findings behavioral Tx Implement evidence-based adherence- enhancing strategies into clinical and public health practice
After assessing 74 studies published between 1997 and 2007, authors concluded that a combination of approaches at the patient, provider, and health-policy level yields better results than any isolated strategy.