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Doctors miss chances to provide diet, exercise counseling to patients at risk of heart disease

STANFORD, Calif. - Physicians are missing opportunities to counsel patients already at risk of developing heart disease about the health benefits of improved diet and exercise, according to research from the Stanford University School of Medicine.

In a study that tracked the results of physician office visits between 1992 and 2000, the researchers found that diet counseling was provided in less than 45 percent of visits and exercise counseling was provided in less than 30 percent of visits with patients who had at least one condition that increased their likelihood of developing heart disease.

"This is clearly a population that would benefit from exercise and diet counseling, and yet these services aren't being provided at an optimal level," said Randall Stafford, MD, PhD, assistant professor of medicine at the Stanford Prevention Research Center and senior author of the study published in the October issue of Preventive Medicine.

Despite a wealth of evidence that better diet and exercise habits can help reduce the risk of heart disease, Stafford said he believes physicians feel they lack the tools and training to provide effective lifestyle counseling to their patients. Additionally, he said the current health-care environment aggravates the problem by giving doctors paltry reimbursement for counseling activities while making it financially attractive to prescribe medications or procedures.

"Even in those instances where medications are necessary, the guidelines for doctors still suggest that patients be encouraged to watch their diet and exercise," Stafford said. "Our study shows that there are many missed opportunities in which doctors could reinforce those messages."

Cardiovascular disease affects one in five Americans and remains the No. 1 cause of death in this country. It also carries a hefty price tag, racking up health-care expenditures estimated at $209 billion in 2003. Research over the years has s
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