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Diet, exercise key for improving heart health

By Kathryn Doyle

NEW YORK (Reuters Health) - The American Heart Association wants to improve the heart health of all Americans by 20 percent 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 in Circulation.

Researchers said few U.S. 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, mandates insurance companies cover intensive behavioral 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 recognizing that many systems changes needed to facilitate provision of such counseling are not under the clinician's control," the recommendation states.

"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 dieticians, 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 Dr. Aaron Folsom. He studies heart disease and community health at the University of Minnesota in Minneapolis.

"Much has been achieved already," Folsom told Reuters Health.

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 behaviors," 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 dieticians 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 behaviors.

SOURCE: http://bit.ly/GH7X7F Circulation, online October 7, 2013.

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