Patients more likely to change diet with written plan combined with counseling calls

Combining telephone counseling calls with a daily written diet plan increases a person's success in improving fruit and vegetables consumption, according to research published in Preventive Medicine.

Nutrition often gets neglected in preventive health care for many reasons, including lack of time, lack of training and economic restraints says Zora Djuric, Ph.D., research professor in the department of family medicine at the University of Michigan. But Djuric says a simple thing doctors can do to help patients eat better is to have them write down what they eat each day to identify which changes need to be made.

Djuric and her colleagues evaluated subjects based on one goal: to increase fruit and vegetable consumption by at least two servings a day by replacing one less nutritious item. The subjects - who were age 40 or older, in general health and consuming less than 5.5 servings of fruit and vegetables a day - were randomized into three groups.

Group one received only educational materials containing information on dietary recommendations, suggestions and lists of healthy foods. Group two received the educational materials as well as a form to create a specific daily food plan based on their current habits. Group three received the same materials as group two, including three counseling calls from a registered dietician and a small log book that included check boxes to monitor fruit, vegetables and less nutritious foods. The counseling calls consisted of reviewing the written plan, reviewing the self-monitoring logs and discussing any progress made towards the goal.

"People need more support than educational materials," says Djuric, lead author of the study. "Everyone knows what healthy foods are, but it's hard to make the changes needed to break old habits, such as the familiar grocery shopping routine and the usual chips and soda for a snack."

At the end of 12 weeks, all of the subjects were assessed through unannounced telephone calls from a registered dietician asking them to recall everything they had consumed in the past 24 hours. Subjects in group three increased their fruit and vegetable intake significantly compared to those in groups one and two.

"Sometimes it's difficult to find accountability within yourself to make changes," Djuric says, "but if someone is checking up on you, you're more motivated to do the right thing."

A person who consumes a healthy diet has a lower risk of chronic disease. Some people don't realize they need to modify their eating habits, she says.

For the next study being conducted at U-M, Djuric is seeking volunteers who have a family history of colon cancer or have had a colon polyp to participate in a study to compare two different diets for possible colon cancer prevention. Both diets will emphasize fruits and vegetables with attention to fat intake.