Enhancing the Evidence for Behavioral Counseling: A Perspective From the Society of Behavioral Medicine

[PAPPS expert group: Lifestyle recommendations]

We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.

[PAPPS expert group. Lifestyle recommendations]

Los determinantes de salud primarios y secundarios explican gran parte de la morbimortalidad observada en atención primaria. Se presentan las recomendaciones del Programa de Actividades Preventivas y Promoción de la Salud (PAPPS) de la semFyC, para la promoción de un estilo de vida saludable mediante la metodología de intervención y las actuaciones preventivas en consumo de tabaco, consumo de alcohol, alimentación saludable, actividad física en el tiempo libre, prevención de accidentes de tráfico y sistemas de retención infantil. Se señalan las pautas más comunes de prevención clínica. Se actualizan las recomendaciones, se señalan aspectos novedosos como la definición de consumo de alcohol de bajo riesgo y se pone al día la bibliografía. Para las principales recomendaciones se incluyen tablas específicas que recogen la calidad de la evidencia y la fuerza de la recomendación.

A quantitative, retrospective inquiry of the impact of a provider-guided low-carbohydrate, high-fat diet on adults in a wellness clinic setting

AIMS

Despite the critical status of obesity as an epidemic chronic illness in the United States contributing toward diabetic and cardiovascular disease as well as early preventable death, treatment approaches in primary care remain in conflict; providers lack evidence-based guidelines toward impactful disease management, particularly from dietary approaches. This study aimed to evaluate the impact of initiation of a 5-10% low-carbohydrate, 75-85% high-fat diet on specific clinical indicators of obesity, a metabolic disease associated with increased morbidity and mortality, at baseline and six months in an adult population.

MATERIALS AND METHODS

Utilizing a retrospective electronic medical record data collection protocol, one hundred patients with obesity in a wellness clinic in the Southwestern United States between 2017 and 2018 prescribed a low-carbohydrate, high-fat diet were selected via simple random sampling. Measurements of body mass index, hemoglobin A1C, and lipid levels were extracted at baseline and six months after initiation.

RESULTS

Mean differences of each biomarker at baseline and six months were analyzed utilizing paired samples t-testing in SPSS and demonstrated statistically-significant improvement across each category. Body mass index decreased, hemoglobin A1C decreased, and each of three clinically-relevant lipid level measurements moved numerically toward normal-value ranges.

CONCLUSION

Data from this sample of 100 patients with obesity suggest body weight, diabetic, and cardiovascular status improvement from a low-carbohydrate, high-fat diet over six months, affording a prescriptive nutrition option for primary care providers to consider prior to or as a complement to pharmacologic management.