Healthcare Providers’ Advice on Lifestyle Modification in the US Population: Results from the National Health and Nutrition Examination Survey 2011-2016

Objective: Healthcare providers are encouraged to prescribe lifestyle modifications for preventing and managing obesity and associated chronic conditions. However, the pattern of lifestyle advice provision is unknown. We investigate the prevalence of advised lifestyle modification according to weight status and chronic conditions in a US nationally representative sample. Methods: Adults 20-64 years (n=11,467) from National Health and Nutrition Examination Study between 2011 and 2016 were analyzed, with weight status, and chronic conditions (high blood pressure, high blood cholesterol, osteoarthritis, coronary heart disease and type 2 diabetes mellitus). Lifestyle modification advice by healthcare providers included increase physical activity/exercise, reduce dietary fat/calories, control/lose weight, and all of above. Results: High blood pressure (32.7%) and cholesterol (29.3%) were highly prevalent compared to osteoarthritis (7.4%), type 2 diabetes (5.7%) and coronary heart disease (3.7%). Those with type 2 diabetes received considerably frequent advice (56.5%; 95%CI: 52.4%-60.6%) than those with high blood pressure (31.4%; 95%CI:29.3%-33.6%) and cholesterol (27.0%; 95%CI:24.9%-29.3%). Prevalence of lifestyle advice exhibited substantial increases with graded BMI and comorbidity (all P<0.001). After adjusting for comorbid conditions, advice were more commonly reported among women, those overweight/obese, non-white, or insured. Remarkably low proportion of overweight (21.4: 95%CI: 18.7-24.3%) and obese (44.2%;95%CI:41.0%-47.4%) adults free of chronic conditions reported receiving any lifestyle advice. Conclusions: Prevalence of lifestyle modification advised by healthcare providers is generally low among US adults with chronic conditions, and worryingly low among those without chronic conditions however overweight or obese. Prescribed lifestyle modification is a missing opportunity in implementing sustainably strategies reducing chronic condition burden.