Missed opportunities for health promotion and disease prevention: lifestyle interventions in primary care for individuals with hypertension, hyperlipidemia, obesity and type 2 diabetes

Non-communicable diseases (NCDs) like hypertension, type 2 diabetes, hyperlipidemia, and obesity, are a leading cause of mortality and have shown rising prevalence trends over the last few decades. Lifestyle interventions, particularly diet and physical activity, are an effective approach to addressing the underlying risk factors of these preventable NCDs, but their integration into the primary care practice remains underutilized. This review synthesizes evidence from systematic reviews and meta-analyses published between 2019 and 2024 to provide evidence-based recommendations for the integration of lifestyle interventions into primary care pathways. The included articles were noted for their risk of bias because of poor study design. While consideration must be given to the quality of evidence for these interventions because of the risk of bias, there is good evidence to support the use of several types of interventions including: diet modification (e.g. food replacement, calorie restriction, intermittent/periodic fasting); diet education and counselling; individual and group-based exercise interventions; interventions that aim to promote general physical activity in daily life; as well as combined dietary and physical activity interventions delivered individually, in groups, at a community level as well as through smartphone-supported applications. It is important for the health and care community to explore and implement alternative means of generating evidence, integrating lifestyle interventions into care pathways and increasing investment in the lifecycle of these interventions, which can promote health and prevent disease.