Dietary Counseling Health Article

Definition

Dietary counseling provides individualizing nutritional care for encouraging modification of eating habits. It may also assist in prevention or treatment of nutrition-related illnesses such as cardiovascular disease, cancer, obesity, diabetes, and hyperlipidemia.

Purpose

Today's major health care problems are increasingly the result of acute and chronic conditions related to poor nutrition and/or overconsumption. A large proportion of coronary disease and cancer can be attributed to unhealthy eating habits and obesity. Chronic diseases continue to increase due to such factors as the rise in obesity in the American population.

Individualized nutritional counseling can provide the patient important insight into food-related illnesses and education regarding how various nutrients (protein, carbohydrate, fat, alcohol) affect illnesses or obesity. Alternatively, dietary counseling can provide prevention of nutrition-related conditions such as the need for weight management. Dietary counseling can be tailored to meet the treatment needs of patients at diagnosis of specific illnesses, can help reduce complications and/or side effects, and can improve general well-being. Prevention at all levels: primary (preventing disease), secondary (early diagnosis), and tertiary (preventing or slowing deterioration) requires active patient participation and guidance and support from the dietician or physician. Education, motivation, and counseling are needed for effective patient participation. In addition to patient education, dietary counseling often includes meal planning.

A guide to the amount an average person needs each day to remain healthy has been determined for each vitamin and mineral as well as macronutrients. In the United States, this guide is called the recommended daily allowance (RDA). The RDA is under revision and will become the Dietary Reference Intakes, and will be applicable to Canadians and Americans. Dietary counselors may use the RDA as a guide when providing counseling. Consumption of too little or too much of certain vitamins and minerals may lead to a nutrient deficiency or a nutrient toxicity respectively. A dietitian can advise the patient about any vitamin or mineral inadequacy concerns during the dietary counseling session.

Precautions

When providing dietary counseling, registered dietitians and nutritionists should recognize the benefit of individualizing nutritional care and that a "one-size-fits-all" approach to modifying eating habits cannot be effective.

Description

Effective dietary counseling includes a comprehensive evaluation that considers presence of disease, lipid profile, blood pressure, and weight history and goals. In addition, factors such as lifestyle, time available for food preparation, work schedule, and personal food preferences must be considered. Food choices are driven not only by the physiological necessity for nutrients, but also by the social aspects of food consumption, i.e. gathering with friends at a restaurant. This complex relationship concerning food choices often makes dietary counseling a challenge for managing specific nutrition-related disease or conditions. For example, a patient with cardiovascular disease may need to select low-fat foods when attending a social dinner or party.

There are many issues related to nutrition goal outcomes that need to be considered when planning appropriate dietary counseling. When considering the appropriate counseling approach for an individual with a specific illness, particular attention needs to be given to usual food choices, food likes and dislikes, learning style, cultural issues, and socioeconomic status.

Other factors that may be assessed during dietary counseling include:

• medical history, including assessment of any nutrition-related illnesses, and biochemical and anthropometric measures
• dietary assessment (dietary analyses)
• psychosocial evaluation, including food-related attitudes and behaviors
• sociological evaluation, including cultural practices, housing, cooking facilities, financial resources, and support of family and friends
• nutrition knowledge
• readiness to learn or change; as well as learning style analyses
• current exercise and activity level

Preparation

A dietary assessment is often conducted to determine the macronutrient (energy or caloric, protein, and fat) content and the micronutrient (vitamin and mineral) content of the diet to assist in providing dietary counseling. The validation of dietary assessment instruments is important to evaluate the diet in terms of chronic disease risk factors such as a high fat diet or a diet low in antioxidants and/or fruits and vegetables.

Some of the most common dietary assessment tools that assist in providing dietary counseling include food records, dietary recalls, food frequency questionnaires, diet histories, and several other methods including biochemical indices. A scientific assessment of nutritional status may be made by using a combination of the information collected from clinical evaluations, biochemical tests, and dietary information. The clinical evaluation includes measurements of various anthropometric parameters such as height, weight, and percent body fat (determined by skinfolds or hydrostatic weighing). In addition, a clinical evaluation may also include observations for signs of nutrient deficiencies in the mouth, skin, eyes, and nails. The information collected from a clinical evaluation can be compared with that obtained from the dietary assessment and biochemical tests to provide a comprehensive picture of the patient's current nutritional status and relative risk factors for diet-related illnesses.