Also, in certain communities, it may be beneficial to deliver interventions through a lay health adviser rather than a health professional.
Intervention programs should also be culturally sensitive, Artinian and colleagues wrote.
The researchers also cautioned that persistent barriers remain to successful lifestyle change interventions. These barriers include: low-income neighborhoods with few options for buying affordable and healthful foods, limited options for physical activity (e.g., unsafe streets for walking and lack of public parks), and patient doubts about whether lifestyle changes will result in desired outcomes, as well as lack of reimbursement for lifestyle change interventions and provider time restraints for follow-up.
The American Heart Association called for policy changes on the local and national level, in workplaces, and by the health care and insurance industries to foster healthy lifestyles that reduce cardiovascular risk.
Dr. Cam Patterson, chief of cardiology at the University of North Carolina at Chapel Hill, wrote in an e-mail that physicians aren't surprised by the recommendations, but "maybe we are a little bit embarrassed that we don't already have a plan in place in our practices to meet these obvious needs."
"Until we have fundamental changes in reimbursements to health care providers for longitudinal services that deal with diet, diabetes care, exercise, and other risk factors that can be controlled if we take the time, this message is going to fall on deaf ears," Patterson said.
But, he added, if there is "effective health,care reform that incentivizes everyone -- patients, providers, and employers -- to take heart risk reduction seriously, it will pay for itself many times over."