Tailoring is also possible in group settings. Participants in a group negotiate an area of nutrition lifestyle change they would like to work on, and that becomes the focus. Often persons in the group who are successful in making change in that area become positive leaders for change for group members who are having difficulty. For example, the group decides to focus on portion sizes. One member of the group describes how she reduces portion sizes when she eats out: “I just ask for a take-home container after ordering my meal and then remove 1/3 of everything on my plate.”
The importance of tailoring to patient needs is a paramount feature of nutrition counseling for lifestyle change. The factors discussed above focus on areas to observe and respond to, potentially resulting in the maximum success following nutrition counseling.
REFERENCES
1. Baughcum, A.E. et al., Maternal feeding practices and beliefs and their rela- tionships to overweight in early childhood, J. Dev. Behav. Pediatr., 22, 391, 2001.
2. Melgar-Quiủonez, H. and Kaiser, L., Relationship of feeding practices to over- weight to low-income Mexican American preschool-age children, J. Am. Diet.
Assoc., 104, 110, 2004.
3. Robinson, T.N. et al., Is parental control over children’s eating associated with childhood obesity? Results from a population-based sample of third graders, Obes. Res., 9, 306, 2001.
4. Wardle, J. et al., Parental feeding style and the inter-generational transmission of obesity risk, Obes. Res., 10, 453, 2002.
5. Airhihenbuwa, C.O., Health and Culture, Thousand Oaks, CA: Sage Publica- tions, 1995.
6. Kumanyika, S.K., Minority populations, in Compliance in Healthcare and Research, Burke, L.E. and Ockene, I.S., Eds., Armonk, NY: Futura Publishing, 2001, Chap. 12.
7. Pollard, K.M. and O’Hare, W.P., America’s racial and ethnic minorities, Popu- lation Bulletin 54.3, Washington DC: Population Reference Bureau, 1999.
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8. Kumanyika, S.K. and Morssink, C.B., Cultural appropriateness of weight man- agement programs, in Overweight and Weight Management, Dalton, S., Ed., Gaithersburg, MD: Aspen Publisher, 1997, 69–106.
9. Walden, T.A. et al., Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification and parental support, Pediatrics, 85, 345, 1990.
10. Brownell, K.D., Kelman, J.H., and Stunkard, A.J., Treatment of obese children with and without mothers: changes in weight and blood pressure, Pediatrics, 71, 515, 1983.
11. Women’s Health Initiative Study Group, Dietary adherence in the women’s Health Initiative Dietary Modification Trial, J. Am. Diet. Assoc., 104, 654, 2004.
12. Campbell, M.K. et al., Improving dietary behavior: the effectiveness of tailored messages in primary care settings, Am. J. Pub. Health, 84, 783, 1994.
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EXAMPLES OF DIETARY STRATEGIES BASED ON LONG-TERM RANDOMIZED
CLINICAL TRIALS FOCUSED ON LIFESTYLE CHANGE
It becomes very obvious that nutrition lifestyle change is not an easy process for those patients requiring lifelong change. Just knowing what to eat based on current literature and research has little effect on actual patient eating habits. Changes in nutrition lifestyle to accommodate more healthful eating habits requires that the nutrition counselor understand patient priorities. Most patients have difficulty with change because they are influenced by the meaning food has to them and its effect on their value system. Our goal as nutrition counselors is to meld those individual meanings of food with the scientific knowledge we have of how food affects disease. In our present society the information overload includes so many controversial messages about food that the ability to change lifestyle is further complicated by confusion.
With current media providing the lay person with information that indicates the risks of not eating in a healthy fashion, it might seem obvious that nutrition lifestyle change is a positive. Additionally, one might assume that change would not be contested by patients as we work to modify their lifestyle relative to healthy eating habits. However, the opposite is true.
In a wonderfully written book on nutrition counseling, Katharine R.
Curry and Amy Jaffe put thoughts to text describing why patients have
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difficulty in changing their nutrition lifestyle [1]. A few of the reasons why people have difficulty changing food habits is listed below:
1. Desire to equate food with love 2. Rebelliousness
3. A history of denying problems 4. Psychological illnesses
5. Depression and anxiety
6. Interpersonal relationships that might be affected negatively if nutrition lifestyle changes
7. Lack of immediate results reflecting positive outcomes
8. Overwhelming time and cost associated with extended treatment Given these negatives relative to nutrition lifestyle change, what might the nutrition counselor do to modify a nutrition counseling plan to make it more efficient and effective? Below are four selected strategies that have been used in long-term clinical trials: (1) knowledge and skills, (2) feedback, (3) modeling, and (4) support and patient-centered counseling, which includes self-management and self-monitoring [2].