A 28-year-old woman comes to the office to establish care. She recently moved to New York to begin a job as a copy editor at a major newspaper. She has no known medical problems. The patient is in a monogamous relationship with her husband. She usually eats fast food for lunch, and she and her husband cook in the evenings. She goes to the gym about once every 2 weeks. The patient's temperature is 36.7 C (98 F), blood pressure is 118/64 mm Hg, pulse is 60/min, and respirations are 14/min. Her BMI is 24.6 kg/m². Physical examination is unremarkable. Laboratory results are within the normal range. Counseling this patient regarding diet and exercise habits would be an example of which of the following?

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11ec160b_3713_f9bc_9249_1d5c8f87d3dc_MD0001_00 According to the World Health Organization, health promotion is "the process of enabling people to increase control over their health and its determinants, and thereby improve their health". Examples include improving dietary habits (limiting fat intake, consuming fruits and vegetables), exercising regularly, abstaining from smoking, and losing weight if needed. Health promotion typically falls under primary prevention, which is preventing a disease process from getting established. Secondary prevention refers to interrupting the disease process before symptoms develop. An example is case finding, which is looking for disease that may be present but asymptomatic in patients receiving medical care (eg, age- and gender-appropriate screening) (Choice A). Community screening is an analogous intervention at the community level (eg, measuring hypertension at a state fair). Tertiary prevention corresponds to treating an established condition with the goal of minimizing its progression or complications (Choice G). (Choice B) Cognitive-behavioral therapy is a standardized psychotherapeutic modality focusing on identifying and addressing persistent maladaptive thought patterns. It is used as monotherapy or in combination with medication to treat a variety of mental illnesses (eg, anxiety, mood, personality, somatic symptom, eating disorders). (Choice C) Interventions such as imposing taxes on cigarettes or soda or mandating smoke-free establishments can be implemented at the community level to improve the health of the public. (Choice E) Health risk assessments rely on questionnaires that use demographic, medical, lifestyle, and family history information to calculate a patient's "risk age". A patient whose risk age is greater than chronological age has a higher risk of death than the average individual of that chronological age. (Choice F) The "stages of change" model (originally developed to help patients quit smoking) assesses an individual's readiness to change a problem behavior. The precontemplative stage is when a patient does not believe there is a problem (eg, smoking) and is unwilling to contemplate a change (eg, quitting). The subsequent stages are contemplation, preparation, action, and maintenance. Educational objective: Health promotion, according to the World Health Organization, is "the process of enabling people to increase control over their health and its determinants, and thereby improve their health."

A 28-Year-Old Woman Comes to the Office to Establish Care