(Center for the Advancement of Health) -- While evidence builds that tobacco use, obesity and lack of exercise contribute to the incidence of chronic illness and premature death, a new government report suggests that because patients pay attention to their doctor's advice, doctors should pay more attention to counseling their patients.

But surefire ways to change all forms of unhealthy behavior remain unclear because there is not enough research on the subject, says the U.S. Preventive Services Task Force in a report published in the May issue of the American Journal of Preventive Medicine.

"The unabated impact of health-damaging behaviors among Americans makes it imperative that health care providers and health care systems seriously consider these behavioral issues and accept the challenge of routinely providing quality behavioral counseling interventions where proven effective," the task force says.

One effective method of physician counseling, it recommends, is "engaging patients actively in the self-management practices needed to change and maintain healthy behaviors." The report cites research showing that personalized advice from a doctor about breaking bad habits or adopting a healthier lifestyle enhances the patient's motivation to change.

Citing a shift in medical thinking over recent decades, the task force also recommends "shared decision-making" between doctor and patient, a collaborative approach in which "patient choice and autonomy is critical in behavior counseling intervention, where the patient retains ultimate control."

"Well-delivered advice supports the patient's self-determination," the report says. A message like, "As your physician, I feel I should tell you …" rather than "You should …" is a subtle but powerful way of respecting patient autonomy, according to the panel. Behavioral risks, the panel says, should be reframed as chronic conditions that generally require ongoing contact and support to achieve long-term change "no matter how intensive the initial assistance."

Epidemiological studies have shown that of the top 10 causes of death in the United States, about half are attributable to behavioral factors -- particularly smoking, inactivity, poor diet, alcohol misuse and obesity.

The U.S. Preventive Services Task Force was convened by the Agency for Healthcare Research and Quality. The report's authors are Evelyn P. Whitlock, M.D., MPH, of the Oregon Evidence-Based Practice Center and task force members C. Tracy Orleans, Ph.D.; Nola Pender, Ph.D., R.N., FAAN; and Janet Allan, R.N., Ph.D., C.S.