Maybe behavior change counseling should more often resemble couples counseling?

Spouses and domestic partners are highly likely to report the same cardio-vascular risk factors, according to a study from Harvard published in the JAMA Network.

The cross-sectional study analyzed data from 5364 couples using the American Heart Associations “Life’s Simple Seven” behavior metrics – 1. smoking status, 2. body mass index, 3. exercise, 4. diet, 5. total cholesterol, 6. blood pressure, and 7. fasting glucose – and assigned each individual a “cardio-vascular health score.”

photo of couple eating pancakes
“Unhealthy diet” was the most commonly shared unhealthy habit by couples – Photo by cottonbro on

In 4 out of 5 couples (79%), both members earned a “non-ideal” cardio-vascular health score, with “unhealthy diet” and “inadequate exercise” being the two most commonly exhibited unhealthy behaviors among couples.

Notably, the study found that “within-couple concordance” (i.e. the term used by the author to describe existence of common risk factors between two members of a couple) may vary based on ethnicity, socio-economic status, and geographic location. For example, couples with low socio-economic status were more likely to demonstrate non-ideal within-couple concordance than couples with high socio-economic status.

“These observations may help inform public health initiatives that focus on couples-targeted lifestyle modification and may help improve the probability of successful implementation of programs that would benefit both members of a couple,” concluded the authors.

Why It Matters

The success of a behavior change intervention is highly dependent on the environment of the participant. This study suggests that couples not only share common cardio-vascular risk factors and unhealthy behaviors, but also reinforce environmental factors that support unhealthy behaviors. Whenever practical, in my view, a behavior change intervention should include both members of a couple in some way to optimize the chance for sustainable positive results.