New heart disease and stroke prevention guidelines not fully supported by health insurance

"Nutrition is at the crux of prevention, management and treatment of chronic diseases. If we want to improve the health of Americans, we must provide the infrastructure to assist people to follow a healthy diet," said registered dietitian nutritionist and Academy President Dr. Glenna McCollum.

Each of the guidelines addressed different aspects of cardiovascular disease -- risk assessment, risk reduction, treatment and weight management -- and all emphasized the importance of developing a healthful eating plan, which is not sufficiently covered by insurers.

"For millions of Americans, health insurance fails to provide sufficient coverage for the nutrition services recommended by the new guidelines. Without coverage, physicians are unlikely to refer patients to registered dietitian nutritionists who have the time and training to effectively provide nutrition therapy and facilitate behavior change," McCollum said. "Despite substantial research and data underscoring the importance of intensive behavioral and dietary counseling provided by a registered dietitian nutritionist, many insurers do not adequately cover visits with the practitioners who have the nutritional expertise for effective dietary management to prevent and treat cardiovascular disease."

This situation stands in contrast to the "gold standard" put forth by medical experts from the U.S. Preventive Services Task Force, which specifically recommends referrals to RDNs for diet counseling to reduce risk factors for cardiovascular disease, McCollum said, and notes that "[m]ore intensive interventions and those of longer duration, are associated with larger magnitude of benefit and more sustained changes in diet."

Numerous studies have confirmed that RDNs are the most effective practitioners -- both in terms of expertise and in cost savings -when it comes to dietary counseling to achieve long-lasting health improvements. The Institute of Medicine has "rate[d] dietary counseling performed by a trained educator such as a [registered] dietitian as more effective than by a primary care clinician."

"RDNs have the qualifications and expertise to help Americans make lifestyle changes to prevent, manage and reverse chronic conditions," said McCollum. "In fact, the new cardiovascular guidelines are based upon research where RDNs provided prevention and treatment of cardiovascular disease. However, RDNs are not sufficiently covered to provide the same care as presented in the recommendations."

"The Academy supports the new guidelines put out by the AHA and ACA. However, if we are truly serious about tackling our nation's greatest killers, then we must get serious about coverage. The discrepancy between our expert guidelines and national coverage must be rectified," McCollum said. "At this point, only a fraction of the recommendations stated in the guidelines are covered by insurance. If we are going to improve the health of the nation and control rising health care costs, then all Americans should have access to RDNs who can provide the nutrition care specified in the guidelines."