Nutrition-related diseases and conditions include hypertension, obesity, osteoporosis, diabetes, cardiovascular disease, and cancer. Programs such as Lifestyle Heart Trial, DASH, Diabetes Prevention Program all show that lifestyle-based interventions, when maintained, are effective at reducing disease risk and effects (Appel et al, 2006, Ornish et al, 1998, Knowler et al, 2002). Nutrition screening, assessment, diagnosis, and counseling are all integral.
People seen for acute health problems or for health maitenance should be assessed to identify potential nutrition-related problems. If problems are identified, the patient's readiness to change (Wee, Davis, and Phillips, 2005) needs to be taken into account when deciding upon a plan.
The public sees primary care clinicians as important sources of nutritional advice and support (van Binsbergen, Delaney, and van Weel, 2003). However, many primary care providers have difficulties doing so, due to lack of time, lack of nutrition knowledge and confidence, poor patient adherence, and lack of teaching materials.
The following resources can be used by primary care providers in the HRM to nutritionally support their clients.
The first equip providers to assist clients on their own. For more complicated situations, referrals to other providers or programs are suggested.
Practice-Based Evidence in Nutrition (PEN) is a collection of evidence-based practice recommendations and tools synthesized by Dietitians of Canada. It has an associated cost.
Evidence shows brief nutritional counseling in primary care can be effective in reducing risk factors (Eaton, Goodwin, and Strange, 2002). "Obese patients who receive counseling and weight management from physicians are significantly more likely to undertake weight management programs that those who do not." (Rippe, McInnis, and Melanson, 2001)
When helping people make changes in their lives, work on one thing at a time. breakfast is a good place to start.
Practice-Based Evidence in Nutrition (PEN) is a collection of evidence-based practice recommendations and tools synthesized by Dietitians of Canada. It has an associated cost.
"Unfortunately, the literature does not provide us with models that have been shown to be effective, so it is up to each of us to develop our own method of approach to addressing diet and activity counseling for our patients." (Deen D and Margo K, 2007)
Deen D and Margo K. 2007. Nutrition and the Primary Care Clinician. in: The Complete Guide to Nutrition in Primary Care
Eaton CB, Goodwin MA, and Strange KC. 2002.Direct observation of nutrition counseling in community family practice. Am J Prev Med. 39:753-759.
Prochaska JO and DiClemente CC. 1982
Rippe, McInnis, and Melanson, 2001
Truswell AS, Hiddink GJ, Blom J. 2003. Nutrition guidance by family doctors...
van Binsbergen JJ, Delaney BC, and van Weel C. 2003. Nutrition in Primary Care: scope and relevance of output from the Cochrane Collaboration. Am J Clin Nutr. 77(4 Suppl): 1083S-1088S.
Whitlock EP, Orleans CT, Pender N, Allan J. 2002. Evaluating primary care behavioural counseling interventions: and evidence-based approach. Am J Prev Med. 22;267-84.
www.preventiveservices.ahrq.gov
Wee CC, Davis RB, and Phillips RS. 2005