RENO, NEV. — Improving patient adherence to a diet program requires an investment of time that must include providing specific weight loss goals and asking patients about their progress at every visit, Lora E. Burke, Ph.D., said at the annual meeting of the American College of Nutrition.
Checking in with patients regularly by phone is also important in maintaining compliance, though the calls do not have to be made by the physician, said Dr. Burke, who offered evidence-based tips for getting patients to stick to dietary changes.
“There is no segment of the population that is immune to nonadherence,” she said. When assessing adherence to a diet regimen, give patients permission not to be 100% compliant and acknowledge the challenges they face. It's often better to ask tactfully what a patient is doing to comply, and how, than to ask yes-or-no questions, she added.
It is critical to define weight loss goals for the patient. Patients going to a nutritionist will often say that their doctor advised them to lose weight or lower their cholesterol, but that they don't know how to begin. “Patients want very specific directions,” said Dr. Burke of the University of Pittsburgh School of Nursing.
Setting a proximal goal is a good way to motivate a patient. For example, advise substituting fresh fruit for high-salt snacks.
After the goal has been set, have the patient record it and the process for achieving it in a diary. When the patient returns for the next appointment, be sure to be positive about any progress, Dr. Burke advised at the meeting.
Whatever goals are set, practitioners dealing with patient nutrition should also take into account cultural factors and family issues. Ask patients what they are willing to do and then negotiate, she said. “There's no point asking a patient to [give up] something that he or she has no intention of giving up.”
The next step is to give patients the skills they need to make changes. Patients need to learn how to reduce fat, salt, and caloric intake by reading food labels and measuring serving sizes.
Some hospitals and cardiac rehabilitation programs offer instructions on how to cook low-fat meals, eliminate salt, and begin a physical activity program, Dr. Burke said.
Social support is critical to helping patients make dietary changes: The patient may not be the person who does the shopping or cooking in the family. Physicians should therefore get family members on board and give them a chance to hear the dietary advice first hand so that everyone understands the goals. “It's very difficult to ask patients to make these changes in isolation,” Dr. Burke said.