Nutrition Notes #6: Making Changes that Stick

Strategies for Improving Adherence to Nutrition Recommendations

Last week I provided an overview of the Dietary Guidelines and what we are supposed to eat for optimal health. I also shared that most people get nowhere near the recommendations. At any given time, millions of people are trying to make nutrition changes to better support health. Some succeed at this. But many struggle. The science is far from complete, but a growing body of research offers clues to piece together how to help people make nutrition changes that stick. 

This week’s post highlights 9 scientific-based strategies to help improve adherence to nutrition changes. It is targeted towards clinicians, dietitians, health coaches, and other allied health professionals who provide nutrition coaching and support to help people eat better.

1.     Assess readiness to change and tailor any nutrition recommendations to a person’s stage of change

The stages of change (transtheoretical) model can help tailor behavior change recommendations.

1The transtheoretical model was first described by James Prochaska. The credit for the creator of this image is in the footnote.

Studies suggest that low adherence to a nutrition recommendation is likely when a person is not motivated to change (precontemplation), has lack of family support, or has a negative view or understanding of the recommended nutrition changes. On the other hand, research supports that individuals most likely to adhere to a nutrition change are in the action or maintenance stage of change and often are of older age, higher education, and have better eating and physical activity behaviors at baseline.

2.     Use “elicit-provide-elicit” to share nutrition information. “Elicit” uses open-ended questions to identify baseline level of knowledge about the topic. “Provide” offers information with permission, building off the person’s baseline knowledge. “Elicit” assesses a person’s understanding of the information provided. Low nutrition knowledge is associated with poor adherence while increased knowledge is associated with better adherence.  Elicit-provide-elicit is a technique first described by Miller and Rollnick, the founders of motivational interviewing.

3.     Offer more flexible nutrition recommendations. Low adherence is associated with inflexible dietary plans that do not take personal preferences into account and the restrictive view some people have about eating plans. A more successful program takes a person’s beliefs, customs and concerns about treatment into account.

4.     Teach how to self-monitor dietary intake. Strong evidence supports that self- monitoring is one of the most important factors to improve adherence to nutrition recommendations. Apps such as MyFitnessPal and MealLogger can help.

5.     Teach how to set SMART goals. Specific, Measurable, Attainable, Relevant, and Time-bound goals lead to positive outcomes and behavioral changes. Initially aim for small, fairly-easily achievable behavior-oriented goals that focus on adding a new desired behavior, rather than taking away an old behavior. This helps to create early successful experiences. For example, a SMART goal might be to eat a fruit and/or vegetable at each meal for the next week.  

6.     Prepare for lapses and practice problem-solving. Lapses are a normal part of making any behavior change. Help identify scenarios which may trigger a lapse such as a vacation or having certain foods in the home and then problem solve how to address the potential hazard.

7.     Provide long term follow up. Adherence is improved with programs that include follow up one to two times per month in the year following an initial intervention. This follow up need not be in person as studies suggest that phone or online follow up are nearly as effective and decrease costs to provide additional counseling. Also, programs that supervise and monitor attendance have improved adherence due to the improved accountability.

8.     Build social support into every program. Social support is a critical factor in sustaining any type of behavior change. Recruiting friends or family, joining a group-based intervention, connecting with peer coaches or “buddy programs”, or creating new networks with social tools are all effective strategies to increase social support.

9.     Model adherence to the desired nutrition behavior. Models who already practice the desired behavior can help to increase motivation and self efficacy, especially if the model is considered to be trustworthy, admirable, and respected. Also, the modeled behavior needs to be perceived as doable.

A more detailed version of this post first appeared in IDEA Fitness Journal.

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Image credit: y A8younan - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=29216725

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