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Diet and exercise counseling for normal weight adults without key cardiovascular risk factors can help but should be offered or referred from primary care only selectively, the .

Behavioral counseling interventions got a " for adults without obesity, hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes. "C" grades in the USPSTF system indicate "at least moderate certainty that the net benefit is small," but the service may still be recommended to certain individual patients "based on professional judgment and patient preferences."

"The USPSTF recommends that primary care professionals individualize the decision" to offer or refer out for such counseling, according to the task force report appearing in the Journal of the American Medical Association. "Persons who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling."

That recommendation was based on an evidence review, published alongside the recommendations, finding a "positive but small benefit" of such counseling for prevention of cardiovascular disease in this population.

Behavioral counseling interventions have been shown to improve fruit and vegetable consumption, total daily calories and sodium intake, and physical activity levels, as well as to reduce blood pressure, LDL cholesterol, BMI, and waist circumference with differences that persisted over 6 to 12 months. However, there was "inadequate direct evidence that behavioral counseling interventions lead to a reduction in mortality or CVD rates," authors David Grossman, MD, MPH, and colleagues wrote in the report.

There was "adequate evidence" of little harm, if any, though, as no serious adverse events turned up in the 14 trials of behavioral interventions that reported on them out of the 88 trials included in the evidence review. Studied interventions typically focused on general heart-healthy eating patterns and gradually increasing aerobic activities to recommended levels, often via walking.

The USPSTF has separately recommended that overweight and obese adults with at least one additional cardiovascular risk factor should get intensive lifestyle counseling on diet and exercise (B recommendation).

For otherwise healthy, low-risk adults, though, Simon Capewell, MD, DSc, and Christopher Dowrick, MD, both of the University of Liverpool, England, agreed that the most good may be done not by focusing on individuals but "upstream" with community-wide interventions.

"Indeed, these comprehensive, policy-based interventions tend to be more powerful, more rapid, and cost-saving," they wrote in an .

But , in JAMA, emphasized that the USPSTF recommendations shouldn't be taken as suggesting lessened attention to diet and exercise among healthy people or that these don't work to prevent cardiovascular disease.

"In keeping with the importance of controlling CVD risk factors in all adults, the guideline states that 'All persons, regardless of their CVD risk status, can gain health benefits from healthy eating behaviors and appropriate physical activity,'" Philip Greenland, MD, of Northwestern University in Chicago, and Valentin Fuster, MD, PhD, of Icahn School of Medicine at Mount Sinai in New York City, noted in the JAMA editorial.