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Serum Vitamin C (mg/dl) by Salad Intake. State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change. Joanne M. Spahn, MS, RD, FADA: Center for Nutrition Policy and Promotion
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Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Joanne M. Spahn, MS, RD, FADA: Center for Nutrition Policy and Promotion Rebecca S. Reeves, DrPh., R.D., FADA: Baylor College of Medicine Kathryn Keim, PhD, RD, LDN: Rush University Ida Laquatra, PhD, RD: H.J. Heinz Company Molly Kellogg, RD, LCSW Bonnie Jortberg, MS, RD, CDE: University of Colorado Denver School of Medicine Nicole Clark, MS, RD, CDE, LDN: University of Indiana of Pennsylvania JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Why Theory-Based Interventions and Strategies • Evidence-base for nutrition counseling • Critical to the nutrition care process (NCP) • Nutrition assessment • Selection of intervention strategies • Monitoring and evaluation indicator use • Enhances provider impact • Builds knowledge-base of the profession JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Question Format • What is the evidence that nutrition counseling • based on __________results in health/food • behavior change in adults counseled in an out • patient or clinic setting? JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Cognitive Behavioral Therapy (CBT) • Plethora of evidence (45 articles) • Significant effect with all groups • Strong evidence for interventions • Long-term (>18 months) targeting CardiovascularDisease (CVD) • Long-term (>12 months) for diabetes prevention • Intermediate length for diabetes management JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Cognitive Behavioral Therapy • Fair evidence for intervention • Long-term (> 12 months) for weight management • Short-term (< 6 months) for diabetes management • Additional research needed to address: • Maintenanceof benefits achieved with CBT JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Cognitive Behavioral Therapy • Beneficial in facilitating modification of targeted dietary habits • Decreased calories from fat • Decreased sodium • Increased intake of fruits & vegetables • Weight, CVD & diabetes risk factors • Grade 1 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Group versus Individual Counseling • Research available for diabetes/weight only • Three Randomized Controlled Trials (RCT) evaluated diabetes or weight management for middle aged subjects • Positive quality studies • 3-6 month intervention duration • Groups significantly more effective Attrition rates high in two studies • Grade II JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Transtheoretical Model • One RCT supported • Impact of Stage of Change appropriate counseling • Stage matched materials targeting diabetes • Personalized assessment reports, monthly phone calls and newsletter every other month • Grade III • Much research to validate instruments in dietary context • Little intervention research in adults JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Serum Vitamin C (mg/dl) by Salad Intake Social Cognitive Theory • One RCT - positive effect on reducing saturated fat & cholesterol intake • 6 telephone sessions • Targeted to self-efficacy • Verbal persuasion • Goal setting • Self-monitoring • Self-reinforcement • One RCT in diabetes – no added benefit to an education intervention • Grade III JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Question Format • What is the evidence that the behavioral strategy • of _____, used as a component of a behavioral • program, will result in health or food behavior • change in adults counseled in an outpatient or • clinic setting? JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Grade I • Self-monitoring • Three RCTs, three observational studies • Reward strategies • Two RCTs, one meta-analysis • NOT effective • Motivational Interviewing • Meal replacements or structured meals • Four RCTs • Compared to self-selected diets JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Motivational Interviewing (MI) • Used alone, no more effective than usual treatment • Four RCTs added MI session(s) to CBT • Enhanced adherence to program • Improved outcomes • MI as “phase one” • CBT as “phase two” JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Grade II • Problem-solving • Two small RCTs • Social support • Mixed results. More research needed • Client self-selected goal setting • Realistic, measurable • Included goal attainment training • Two RCTs JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
Serum Vitamin C (mg/dl) by Salad Intake State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change Grades III & IV • Grade III • Cognitive restructuring • One RCT • No effect • More research needed • Grade V: • Stress management • Stimulus control JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).
