Nutritional Counselling

Nutritional counseling professionals help clients to master one of the most important prerequisites for good health: a balanced diet

Nutrition Counseling

Nutritional counseling professionals help clients to master one of the most important prerequisites for good health: a balanced diet. Whether patients hope to lose weight, compete in sports or manage a chronic illness, their eating habits can mean the difference between failure and success. Nutritional counselors are experts of behavioral change and nutritional knowledge. They guide clients toward their goals by developing a plan that promotes healthy eating while also strengthening their clients’ motivation. The nutrition counselor provides information, educational materials, support, and follow-up to help the individual make and maintain the needed dietary changes.

Nutrition counseling is generally provided by professionals such as registered dietitians, who are experts in food chemistry, disease process and physiology. Dietitians usually work in clinical settings such as hospitals or nursing homes developing individualized meal plans for patients. They oversee food service operations in institutional settings such as schools or correctional facilities. Dietitians also partner with private businesses aimed at the health market. Community agencies and government outreach programs often employ dietitians to educate the public about the importance of nutrition and healthy eating as well.

Nutrition counseling usually begins with an interview in which the counselor asks questions about a person's typical food intake. Nutrition counselors use different methods to assess typical food intake.

The 24-hour recall method is a listing of all the foods and beverages a person consumed within the previous 24-hour period. The nutrition counselor may ask a person to recall the first thing he or she ate or drank the previous morning. The counselor then records the estimated amounts of all the foods and beverages the person consumed the rest of the day. The 24-hour food recall can be used to provide an estimate of energy and nutrient intake. However, people tend to over- or underestimate intake of certain foods, and food intake on one day may not accurately represent typical food intake.

A food frequency questionnaire can sometimes provide a more accurate picture of a person's typical eating patterns. The nutrition counselor may ask the client how often he or she consumes certain food groups. For example, the counselor may ask a person how many servings of dairy products, fruits, vegetables, grains and cereals, meats, or fats he or she consumes in a typical day, week, or month. Daily food records are also useful in assessing food intake. An individual keeps a written record of the amounts of all foods and beverages consumed over a given period of time. The nutrition counselor can then use the food records to analyze actual energy and nutrient intake. Three-day food records kept over two weekdays and one weekend day are often used.

Nutrition counselors may assess an individual's body weight by comparing his or her weight to various weight-for-height tables. Body mass index, or BMI, is another indicator used to assess body weight. BMI is calculated as weight in kilograms divided by height in meters squared. A BMI of 20 to 25 is considered normal weight, a BMI of less than 20 is considered underweight, and a BMI of greater than 25 is considered overweight.

The initial dietary assessment and interview provide the basis for identifying behaviors that needs to be changed. Sometimes a person already has a good idea of what dietary changes are needed, but may require help making the changes. Other times the nutrition counselor can help educate a person on the health effects of different dietary choices. The nutrition counselor and client work together to identify areas where change is needed, prioritize changes, and problem-solve as to how to make the changes.

Making dietary change is a gradual process. An individual may start with one or two easier dietary changes the first few weeks and gradually make additional or more difficult changes over several weeks or months. For example, an easy change for a person might be switching from 2% to skim milk, or taking time for a quick yogurt or granola bar in the morning instead of skipping breakfast. More difficult changes might be learning to replace high-fat meat choices with leaner ones, or including more servings of vegetables daily.

In making dietary changes, each individual's situation and background must be carefully considered. Factors that affect food decisions include an individual's ethnic background, religion, group affiliation, socioeconomic status, and world view.

Once the needed changes have been identified, the client and nutrition counselor think through potential problems that may arise. For example, changing eating behaviors may mean involving others, purchasing different foods, planning ahead for social events, or bringing special foods to work. Some common barriers to changing eating habits include:

  • inconvenience
  • social gatherings
  • food preferences
  • lack of knowledge or time
  • cost

The nutrition counselor and client set behavior-oriented goals together. Goals should focus on the behaviors needed to achieve the desired dietary change, not on an absolute value, such as achieving a certain body weight. For a person working to prevent weight gain associated with certain medications, for example, his or her goals might be to increase the amount of fruits, vegetables, and whole grains consumed each day. Such changes would help prevent weight gain while placing the emphasis on needed behaviors rather than on actual weight.

Family members are encouraged to attend nutrition counseling sessions with the client, especially if they share responsibility for food selection and preparation. Although the individual must make food choices and take responsibility for dietary changes, having the support and understanding of family and friends makes success more likely.

The challenge for the nutrition client lies not in making the initial dietary changes, but in maintaining them over the long term. Self-monitoring, realistic expectations, and continued follow-up can help a person maintain dietary changes.

Self-monitoring involves regularly checking eating habits against desired goals and keeping track of eating behaviors. Keeping a food diary on a daily or periodic basis helps the individual be more aware of his or her eating behaviors and provides a ready tool to analyze eating habits. Sometimes a simplified checklist to assure adequate intake of different food groups may be used.

Individuals and nutrition counselors should not expect perfect dietary compliance—slips inevitably occur. The goal is to keep small slips, such as eating a few extra cookies, from becoming big slips, like total abandonment of dietary change. The counselor can help the client identify situations that may lead to relapse and plan ways to handle the situations ahead of time.

Nutrition counseling is an ongoing process that can take months or years. In follow-up nutrition counseling sessions, the individual and counselor analyze food records together and problem-solve behaviors that are especially difficult to change. Follow-up counseling also allows the opportunity to reevaluate goals and strategies for achieving those goals.