Delivery of healthcare provider’s lifestyle advice and lifestyle behavioural change in adults who were overweight or obese in pre-diabetes management in the USA NHANES (2013–2018)

By Jun Wu, PhD Professor, Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy

Reference: Davis-Ajami MLLu ZKWu J, Delivery of healthcare provider’s lifestyle advice and lifestyle behavioural change in adults who were overweight or obese in pre-diabetes management in the USA: NHANES (2013–2018),

Prediabetes, a health condition with blood sugar levels higher than normal but not yet high enough to be diagnosed as type 2 diabetes, increases the risk of developing type 2 diabetes and heart disease. In the US, about 11% of people with prediabetes will progress to type 2 diabetes annually. Lifestyle intervention, including weight loss, nutrition, and exercise, has been shown to prevent or delay diabetes occurrence. People who are overweight or obese represent a high-risk population in prediabetes management.  Our study used US National Health and Nutrition Examination Survey (NHANES) to examine whether lifestyle change has been addressed adequately in this high-risk population and how doctors’ advice influences their lifestyle change behavior. NHANES is designed and conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention in the US. NHANES collects data through interviews and physical examination covering two years in the US civilian, non-institutionalized population.

Did doctors deliver advice on lifestyle change to the overweight and obese population adequately in prediabetes management? Our study sample included 1039 eligible adults who were overweight or obese and reported prediabetes from pooled NHANES (2013-2018). Of those, 76.8% received doctors’ and other health professionals’ advice about three aspects of lifestyle change, i.e., controlling or losing weight, increasing exercise, and reducing calorie intake.  Nearly 55% of those were advised to change all three aspects of lifestyle, and 27% received advice to change two aspects. This prevalence (76.8%) is much higher than our previous study reported in a general prediabetes population (23%) in the US. This finding suggested that the health care providers might pay more attention to a high-risk population in prediabetes management. With the growth of prediabetes prevalence in the US, efforts have been made to increase the awareness of prediabetes. However, screening diabetes and prediabetes management delivery are still a challenge in practice for the entire US population.

Did doctors’ advice facilitate people’s practice of lifestyle change? Among those receiving doctors’ advice, 83.8% reported reducing the amount of fat or calories in the diet. Also, 80.1% and 70.9% reported controlling or losing weight and increasing in exercise, respectively. Those not receiving providers’ advice reported lower proportions of ongoing lifestyle change, i.e., 61.8% in the diet, 70.9% in weight reduction or control, and 60.9% in increasing exercise. After adjusting for participants’ demographic and health characteristics, those receiving advice on lifestyle change were three times more likely to reduce their fat or calorie intake and 63% more likely to increase exercise than those not receiving providers’ advice. People could get knowledge of prediabetes and lifestyle management from various sources to develop self-awareness. However, doctors and other health professionals serve as a major resource to help patients learn about diabetes management. In-person communication would be helpful to establish a reliable and trustful relationship between patients and health professionals to address prediabetes, enhance patient engagement, and improve adherence to a lifestyle change. Provider’s advice and person’s perceived diabetes risk would contribute to the lifestyle change behavior.

Who were more likely to receive doctors’ advice on lifestyle change in the overweight and obese population with prediabetes? We found those who were obese and Hispanic, had access to health care, and reported a history of cardiovascular disease were more likely to receive advice from providers on all three aspects of lifestyle change. People with activity limitations were more likely to be advised to increase exercise. 

Primary care providers play an essential role in motivating patients to change their lifestyles to manage prediabetes. However, inequitable access to diabetes care might be a barrier to receiving professional advice to reduce the risk for type 2 diabetes from primary care providers. Understanding patterns of delivering prediabetes management and patients’ behavior associated with adopting providers’ recommendations would help identify socioeconomic disparities and barriers to providing high-quality patient-centered lifestyle interventions to achieve desired treatment goals.


Conflict of Interest: None declared

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