New Diagnoses May Provide Window of Opportunity for Health Behavior Change


Older adults appear more likely to quit smoking or lose weight following a recent diagnosis of heart disease, diabetes or another serious condition, according to a report in the February 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals1.


“Smoking and patterns of diet and activity are the two leading underlying causes of death in the United States, yet the factors that prompt individuals to adopt healthier habits are not well understood,” the author writes as background information in the article. One-fifth of U.S. adults older than 25 smoke, and two-thirds of adults age 20 to 75 years are overweight or obese. Clinical guidelines recommend weight loss and smoking cessation to prevent health risks in these individuals, and advise physicians to counsel their patients about these options.


Patricia S. Keenan, Ph.D., M.H.S., of Yale School of Medicine and Yale School of Public Health, New Haven, Conn., analyzed data from the Health and Retirement Study, a survey of middle-aged and older adults. Participants were first surveyed in 1992 and subsequent surveys have been conducted every other year. A total of 20,221 overweight or obese individuals younger than 75 years and 7,764 smokers were surveyed at least twice between 1992 and 2000.


Over the course of the surveys, 18 percent of smokers quit and average body mass index increased by 0.04 units in the overweight and obese group. About 13 percent of smokers were diagnosed with stroke, cancer, lung disease, heart disease or diabetes, while 8 percent of overweight or obese individuals received a diagnosis of lung disease, heart disease or diabetes.


“Individuals with new diagnoses were more likely to adopt healthier habits than those without recent new diagnoses,” Dr. Keenan writes. Smokers had 3.2 times the odds of quitting if they had received at least one of the five diagnoses vs. no new diagnoses. The overweight or obese individuals who were diagnosed with lung disease, heart disease or diabetes lost an average of 2 to 3 pounds more than those who were not diagnosed with any of these conditions.


Multiple diagnoses were associated with a greater magnitude of behavior change—compared with smokers who received no new diagnoses, those with one diagnosis had 2.9 times greater odds of quitting and those with multiple new diagnoses had 6.1 times greater odds of quitting. Overweight or obese individuals with one new diagnosis decreased their body mass index (BMI) by an average of 0.34 units, while those with more than one diagnosis lost an average of 0.64 units.


“Changes were particularly pronounced in smokers with stroke, cancer or heart disease and in overweight individuals with diabetes mellitus,” Dr. Keenan writes.


“Targeting individuals with recent new diagnoses may be particularly effective in middle-aged and older individuals, who are increasingly likely to receive a major diagnosis or to be hospitalized as they age,” she continues. “Individuals with new adverse health events are accessible through contact with the health care system or through the Internet or other written information about their disease, and this study suggests that they are more motivated to change health habits.”

“Identifying windows of opportunity for patient receptiveness to lifestyle changes could help guide physicians as to when counseling will have the greatest effect,” write Sherry Pagoto, Ph.D., and Judith Ockene, Ph.D., of the University of Massachusetts Medical School, Worcester, in an accompanying editorial2.


“However, the effect of physician advice might only be as good as the availability of supportive services to which patients can be referred for specialized preventive care. Our health care system is incomplete to the extent that patients and healthy subjects do not have affordable access to evidence-based preventive services,” they conclude.





1. Arch Intern Med. 2009;169[3]:237-242. 


2. Arch Intern Med. 2009;169[3]:217-218.