I uploaded this blog post the other day, then accidentally deleted it. So this is a "repost".  

Time is a limited commodity in health care. Those involved in health education are trying to improve patient behaviors in the least amount of time. That is why I especially enjoyed a presentation about effective counseling techniques at the 2009 Food & Nutrition Conference & Expo (FNCE) held in Denver last month. Using Evidence-based Strategies for Nutrition Counseling outlined the most effective counseling strategies based on published research in the American Dietetic Association's Evidence Analysis Library. I found this information especially useful since I am involved in the development and evaluation of the Dairy Council of California nutrition education programs.   

The health theory deemed most effective is Cognitive Behavioral Theory (CBT). It attempts to change learned behaviors while addressing internal factors such as thoughts and feelings. Goal setting is central to this theory and is most effective when the client focuses on personalizing small steps toward healthier living. Computerized CBT is another option that is found be be effective. The strongest evidence for CBT relates to specific dietary interventions, diabetes prevention and management and cardiovascular disease. CBT works best in group settings and most evidence of success is with short-term interventions lasting six months.

I was pleased to learn that there is strong evidence to support the behavior change techniques included in Dairy Council of California programs. Strategies that received high marks for effectiveness include:

• Self-monitoring, such as using food records, received the highest rating for weight loss interventions. Dairy Council of California programs employ self-monitoring in our upper elementary, middle school and high school nutrition education programs and in the Calcium Connection and Activity & Eating adult programs. 
• The use of open-ended questions, affirmations and exploration of barriers via Motivational Interviewing (MI) is no more effective than usual treatment when used alone. Adding MI at the beginning of a CBT program improved results. MI requires a great deal of training to be used successfully. 
• Meal replacements or structured meal plans that dictate to patients what to eat helps patients control food intake as they attempt to modify their eating habits. Creating a meal plan along with your client to help them plan healthier meals might be a more realistic long-term solution. 
• Interestingly, extrinsic rewards and reinforcement was not effective even in the short-term. Although not studied, the presenters thought internal rewards could be useful.
   

There is a great need for ongoing research to investigate the effectiveness of current and potential counseling methods. Although not as much research is available to show effectiveness, strategies such as problem-solving, collaboration, social support and goal setting all seem appropriate to incorporate to improve client outcomes along with the bulleted strategies with more documented success.  

Dairy Council of California is committed to embedding evidence-based strategies in our print and online programs to help health professionals achieve behavior change with their clients. We strive to create quality, afforable programs that fit the needs of time crunch professionals that value helping patients improve their food and activity choices. I welcome and appreciate comments of what would make our programs more effective in your practice.

Trina Robertson, M.S., R.D.

Project Manager