Guidelines Recommending That Clinicians Advise Patients on Lifestyle Changes, 2024, Johansson et al

mango · Sep 24, 2024 at 7:42 PM

Guidelines Recommending That Clinicians Advise Patients on Lifestyle Changes: A Popular but Questionable Approach to Improve Public Health

Minna Johansson, Amanda Niklasson, Loai Albarqouni, Karsten Juhl Jørgensen, Gordon Guyatt, Victor M. Montori

https://www.acpjournals.org/doi/10.7326/ANNALS-24-00283

mango · Sep 24, 2024 at 7:46 PM

This opinon piece is not about ME, but still relevant I think.

Tvinga inte läkare att ge hälsoråd – de hjälper ändå inte
https://www.gp.se/debatt/tvinga-int...nda-inte.ff8e999c-b838-4871-b10d-b506c8fae9c6

Auto-translate said:

Don't force doctors to give health advice - it won't help anyway

Healthcare professionals are increasingly being asked to try to improve our patients' lifestyles by giving advice on topics such as diet, exercise, weight loss and smoking. But our advice rarely helps people change their habits, and can contribute to stigmatisation and crowd out more important and valuable care, write Amanda Niklasson and Minna Johansson.

[...] With the goal of reducing the risk of disease and premature death in the population, an increasing share of health care resources is spent on health professionals trying to change their patients' lifestyles through advice on, for example, diet, exercise, weight loss and smoking. Often, this advice is linked to quality measures and financial rewards for healthcare units, as incentives to make us prioritise the task more.

But just because we know the benefits of being physically active, for example, it is not certain that counselling will help people achieve the health benefits. While the content of the advice may be spot on, there is much more to healthy lifestyles than counselling - and most of it is beyond the control of health professionals.

Societal factors

Social and community factors such as living environment, socio-economics and social networks are strong drivers of lifestyle behaviours. In fact, it seems unlikely that advice from health professionals during brief consultations would help people to change their habits, while they live every day in the social conditions that shaped those habits. In fact, there is often a lack of scientific support that lifestyle advice from health professionals actually helps people change their lifestyle.

Together with research colleagues from the United States, Canada, Denmark and Australia, we reviewed the scientific basis for medical recommendations on lifestyle advice and developed a guide to help policy makers consider the pros and cons of recommending lifestyle advice, which was recently published in the prestigious medical journal Annals of Internal Medicine.

In the UK, for example, 379 different recommendations are made to health professionals to try to change their patients' lifestyles, and nearly 100 of these recommendations should be given to more than 25% of the population. In our review, we found that only 3% of recommendations have reliable scientific evidence that lifestyle advice has a positive effect. A further 13% have some, but uncertain, scientific support. This means that for the vast majority of lifestyle recommendations, there are either studies that show that they do not have a meaningful positive effect, or there are no reliable studies to evaluate the effect [...].

Many people may think that there is no need for scientific support to recommend health professionals to give lifestyle advice and that the risks are low. But we believe that lifestyle advice can cause harm. In the patient encounter, forced prioritisation of unsolicited lifestyle advice risks stealing time and focus from other things that the patient might have wanted or benefited more from help with. There is also a risk of stigmatisation and blame when lifestyle habits are repeatedly to permeate the meeting between patient and healthcare professional. Patients need to feel that they can go to the doctor without necessarily being told every time how wrong their lifestyle is.
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Google Translate, English.

One of the authors was tweeting about it yesterday as well.

mango · Sep 24, 2024 at 7:49 PM

Article published on Gothenburg University's website:

Oklart om livsstilsråd faktiskt fungerar
https://www.gu.se/nyheter/oklart-om-livsstilsrad-faktiskt-fungerar

Auto-translate said:

Unclear whether lifestyle advice actually works

Healthcare providers are increasingly giving patients advice on how to improve their health, but there is often no scientific evidence that this advice actually works. This is shown by a study from the University of Gothenburg, which also guides towards more effective recommendations.

The researchers do not criticise the content of the advice - it is good if people lose weight, stop smoking, eat a better diet or exercise more. However, there is no evidence that patients actually change their lifestyle after receiving this advice.

- There is often a lack of research showing that counselling patients has an effect. It is probably rare that the advice actually helps people,’ says Minna Johansson, associate professor at Sahlgrenska Academy at the University of Gothenburg and general practitioner at Herrestad's health centre in Uddevalla, who is the study's lead author.

Little advice is well-founded

The study, published in the journal Annals of Internal Medicine, was conducted by an international research team. They have previously analysed medical recommendations from the National Institute for Health and Care Excellence (NICE) in the UK. This organisation is responsible for 379 recommendations for healthcare professionals to give to patients to change their lifestyle.

In only 3% of cases were there scientific studies showing that the advice has positive effects in practice. A further 13% of these recommendations had some evidence, but with low certainty. The researchers also reviewed additional guidelines from other influential institutions around the world and found that these often overestimate the positive impact of the advice and rarely take into account the drawbacks.

- Trying to improve public health by giving lifestyle advice to one person at a time is both expensive and ineffective. Resources would probably be better spent on community-based interventions that make it easier for all of us to lead healthy lives,’ says Minna Johansson, who also believes that the advice can increase stigmatisation for people with obesity, for example.

Showing the way forward

It would be impossible for today's healthcare professionals to give all the advice recommended and at the same time manage to maintain other care. The researchers' calculations show that in the UK, for example, five times as many nurses would need to be employed compared to current levels to fulfil the task.

The study also presents a new guide to help policy makers and guideline writers consider the pros and cons of the intervention in a structured way before deciding whether or not to recommend it.

Victor Montori, Professor of Medicine at the Mayo Clinic in the US, co-authored the study:

- ‘The guide consists of a number of key questions, which point the way to adequately evaluate the likelihood that the lifestyle intervention will lead to positive effects or not,’ says Victor Montori.
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Hutan · Sep 24, 2024 at 10:05 PM

A great find @mango.

Interesting to see Gordon Guyatt of McMaster University as a co-author.

Relevant to the Cochrane Exercise Therapy review @Medfeb

rvallee · Sep 24, 2024 at 10:52 PM

Oh, so just like they've done for decades. But more? Or with a different tone? I guess?

But yeah we know this is ineffective and mostly useless, even counterproductive at times.

Creekside · Sep 25, 2024 at 4:32 PM

I think lifestyle change is unlikely to succeed without some sort of immediate reward. Punishments for being overweight, underexercised or having a less than ideal diet would result in major social unrest. I think there are plenty of science fiction stories about that sort of thing.

Magic wand: that's what we need!

Nightsong · Sep 25, 2024 at 10:10 PM

I was surprised to read in the Annals paper just how little consideration is given by NICE guideline panels to the potential harms of such interventions:

Finally, guideline panels should consider potential harms and opportunity costs of lifestyle interventions. Of all lifestyle interventions recommended by NICE, only 5% considered psychosocial harms and none considered practical burdens [1]. This is concerning considering the evidence around weight stigma in health care, and a plethora of testimonies in social media from people with overweight who report receiving unrequested lifestyle advice that they found humiliating [9].
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Reference [1] is to this 2022 paper (BMJ Med, open access):

Within 57 guidelines, 379 NICE recommendations were found for IOLIs; almost all (n=374; 99%) recommended the lifestyle intervention and five (1%) recommended against the intervention. Of the 379 recommendations, 13 (3%) were supported by moderate or high certainty evidence of a beneficial effect on patient relevant outcomes (n=7; 2%) or surrogate outcomes (n=13; 3%). 19 (5%) interventions considered psychosocial harms, 32 (8%) considered physical harms, and one (<1%) considered the opportunity costs of implementation. No intervention considered the burden placed on individuals by these recommendations.
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