The Practice Gap: National Estimates of Screening and Counseling for Alcohol, Tobacco, and Obesity

This is a great study reporting the rates of screening and counseling for tobacco use, obesity, and alcohol misuse. Poor diet, sedentary lifestyle, tobacco use, and alcohol misuse contribute to 40% of excess mortality. Addressing obesity is difficult. Effective counseling often takes 25 hours of face to face contact over 6 months. My guess is that this is not the counseling patients are reporting receiving. Nevertheless, the rates of counseling for obesity are higher than I would expect.

Counseling for tobacco use and alcohol use can be much easier. Even simple advice works. The tobacco use counseling seems stuck at around two thirds of users. This seems like a ceiling primary care cannot break through for more than a decade. The alcohol misuse counseling seems better (being less then a quarter of at risk drinkers in the past), but it is still far from a good counseling goal for primary care.

These are hard topics and primary care needs to continually innovate to learn how to address these root causes of poor health better.

Competing interests: I am the Vice Chair for the USPSTF and contributed to the recommendations to screen and counsel for these topics. I have no financial interests.