Nutrition counseling and health behavior change should become key elements of patient care for healthcare professionals working with patients who have or are at risk for nutrition-related chronic disease, according to an article published in JAMA.

At this time, only 12% of office visits include a discussion of diet, and only 20% of patients with cardiovascular disease, diabetes, or hyperlipidemia receive nutrition counseling. Yet evidence suggests that even small dietary changes can significantly improve overall health.

However, only 25% of medical schools provide a dedicated nutrition course, and few schools offer the 30 hours of nutrition education recommended by the National Academy of Sciences. Other barriers to counseling include time constraints and the failure of government programs and insurance companies to reimburse for these services. Only 1% of Medicare recipients receive counseling, and Medicare only provides dietitian counseling to those with diabetes or renal disease.

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Scott Kahan, MD, MPH, from Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and JoAnn E. Manson, MD, DrPH, from Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, suggest clinicians can take the following steps to integrate nutrition counseling into everyday clinical practice.

  • Start the conversation and assess the need for nutrition counseling.
  • Structure the encounter using the 5 A’s: assess, advise, agree, assist, and arrange.
  • Focus on small steps, such as increasing fruit intake by 1 serving per day.
  • Use available resources, including tools from the Nutrition in Medicine program or the Dietary Guidelines for Americans.
  • Do not expect major changes with a single counseling session.

Finally, the authors suggest that the primary care physician does not need to be the sole clinician who offers nutrition counseling: Use of physician assistants, nurses, medical assistant, and health coaches can reduce the burden for physicians.

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Kahan S, Manson JE. Nutrition counseling in clinical practice: How clinicians can do better. JAMA. 2017;318(12):1101-1102.