Nutritional Counseling Pocket Guide

Fast Facts

Nutrition is a key determinant in three of the top four causes of death – cardiovascular disease, stroke, and cancer.

Nutrition is a key component of most chronic conditions primary care clinicians treat: diabetes, obesity, hypertension, and hyperlipidemia

One survey of 451 family physicians found that 58.1 percent believed that more than 60 percent of their patients would benefit from nutritional counseling.

What is Nutritional Counseling?

A nutritional consult typically begins with a one-hour evaluation to assess the patient and the patient’s diet. The nutritionist may also assess sleep patterns, physical activity, and other lifestyle factors.

With this information, the nutritionist works with the patient (or client) to identify opportunities for change. This doesn’t always mean starting a diet. It could mean identifying one adjustment – such as giving up soda or adding more fish, nuts, and vegetables – that can have an impact on health and healing.

Next is formulating a plan. For instance, if the patient doesn’t have time to cook and shop, options could include utilizing a service that delivers healthy food to the door or receiving instruction on food selection when eating out. If the patient eats because of stress, the nutritionist works with them to identify the underlying eating urges and strategies for managing them.

What does the science show?

Numerous studies find that improving diet can provide the same, if not better, benefits than medical therapy with less risk, fewer side effects, lower costs, and shorter hospital stays. Most major medical guidelines include nutrition as a key part of managing chronic disease.

The U.S. Preventive Services Task Force found good evidence that dietary counseling for patients with risk factors for heart disease can improve eating habits, particularly if delivered by nutritionists, dietitians, and specially trained primary health care professionals. Similar studies have shown benefits for obesity, diabetes and hypertension.

Is it OK to follow the latest diet trends?

Don’t be fooled by fad diets. Professionals know that the best diets to follow for general health are variations of the Mediterranean and DASH diets, which are based on the Alternate Healthy Eating Index.

Extreme dietary changes can harm you – both physically and psychologically. Cyclical weight loss and regain is bad for health and makes permanent weight loss more difficult.

Who can benefit from nutritional counseling?

Nutritional counseling is used to treat both physical and mental health conditions and address symptoms related to chronic health concerns including, but not limited to:

Obesity
Diabetes/Pre-Diabetes
Heart Disease
Hypertension/High Blood Pressure
Hyperlipidemia
Food Allergies/Sensitivities
Digestive Problems
Eating Disorders
Polycystic Ovary Syndrome
Fatty Liver

Patients who are at a risk for or experiencing significant weight loss should also consider visiting a dietician. This includes people diagnosed with:

HIV
Cancer
Chronic Obstructive Pulmonary Disease
Anorexia

How do I find a quality practitioner?

Check to see if the nutritionist is licensed or certified to practice. The primary organization of qualified nutrition professionals is the Academy of Nutrition and Dietetics. It provides a search by ZIP Code on their website of qualified practitioners:

Look for a registered dietitian or registered dietitian nutritionist (RDN), disciplines that typically require a four-year bachelor’s degree and 900 to 1,200 hours in a dietetic internship through an accredited program, as well as passing a dietetics registration exam and continuing professional education requirements. Some RDNs are certified in a specialized area, including pediatrics nutrition, sports dietetics, nutrition support, and diabetes education.

Does insurance cover it?

Most commercial and government insurances, including Medicare and Medicaid, cover medical nutrition therapy (MNT) for certain conditions including diabetes. Obesity screening and counseling is covered if it is received in a primary care setting. Medicare recipients in rural areas may receive MNT through telehealth.

Precautions

Seeing a dietician/nutritionist is considered to be safe since their qualifications are highly regulated at the state and government level. You may experience some discomfort when beginning a new diet since you will be adjusting to new foods and decreasing your intake of others. It is possible to experience light-headedness, bloating, gas and an upset stomach. Please make sure you alert your care provider of any prolonged discomfort you are experiencing related to dietary changes.

Should I inform my primary care physician that I am practicing nutritional counseling?

Yes, always inform your primary care provider of any major dietary changes or weight losses or gains as adjustments in medications or other therapies may be needed.

Sources

Kris-Etherton PM, Akabas SR, Bales CW, et al. The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Am J Clin Nutr. 2014;99(5 Suppl):1153s1166s.
Crustolo AM, Ackerman S, Kates N, Schamehorn S. Integrating nutrition services into primary care: Experience in Hamilton, Ont. Can Fam Physician. 2005;51:1647-1653.
Wynn K, Trudeau JD, Taunton K, Gowans M, Scott I. Nutrition in primary care: current practices, attitudes, and barriers. Can Fam Physician. 2010;56(3):e109-116.
Nicholas LG, Pond CD, Roberts DC. Dietitian-general practitioner interface: a pilot study on what influences the provision of effective nutrition management. Am J Clin Nutr. 2003;77(4 Suppl):1039s-1042s.
Rosen BS, Maddox PJ, Ray N. A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition. JPEN J Parenter Enteral Nutr. 2013;37(6):796-801.
Lin JS, O’Connor E, Evans CV, Senger CA, Rowland MG, Groom HC. Behavioral counseling to promote a healthy lifestyle in persons with cardiovascular risk factors: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;161(8):568-578.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
Diabetes Prevention Program Research G, Knowler WC, Fowler SE, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677-1686.
Caraci F, Leggio GM, Salomone S, Drago F. New drugs in psychiatry: focus on new pharmacological targets. F1000Research. 2017;6:397.
Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. The American Journal of Clinical Nutrition. 2001;74(5):579-584.
Sotos-Prieto M, Bhupathiraju SN, Mattei J, et al. Association of Changes in Diet Quality with Total and Cause-Specific Mortality. N Engl J Med. 2017;377(2):143-153.

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