Page 135 - Nutrition Counseling and Education Skills: A Guide for Professionals

When time is limited, brief interventions have been found to be effective. They include six elements or
components, summarized by the acronym FRAMES.7

Feedback of personal status
Responsibility (personal) for the change
Advice to change
Menu of options from which to choose
Empathy (counseling style)
Self-efficacy support

After the counselor’s initial assessment, feedback about relevant health information is given by the counselor to
the client. Personal responsibility for change is emphasized. “It’s up to you to decide. You’re the one who has to
make changes in your food choices.” Choices must be made freely and decisions to change are made only by
the client.

The client decides what, if anything, to do with the feedback. Clear advice to change or make changes may
be given as a menu of the variety of alternative ways that changes could be accomplished. Motivation can be
enhanced when a person freely makes a decision and feels responsibility for the change. Empathy for the client
is emphasized and expressed. Finally, attempts are included to strengthen the person’s self-efficacy for change,
to reinforce positive thoughts, and to support the ability to succeed.1 Note that since advice is given and MI
excludes advice, this is not a true MI.

When using MI, the nutrition and dietetics counselor partners with the client to “determine the agenda
with empathic, nonjudgmental, supportive, encouraging, and active listening behaviors.”18 For working with
clients not in the action Stage of Change, training in MI is recommended. The MI methods have positive
effects in many situations, but not all. Null finding have been reported with eating disorders, for example.6,17

Applications

A study compared usual care to MI counseling for parents of overweight children ages 2 to 8. At the 2-year
follow-up, there was a statistically significant reduction in BMI (body mass index) percentile using MI.19

A systematic review and meta-analysis investigated MI’s efficacy in 49 studies in medical care settings. The
evidence and results suggested that MI provided a moderate advantage to comparison interventions and could
be used for a wide range of behavioral issues in healthcare.20

A study of parent-involved MI to improve pediatric health behaviors and health outcomes of 5,000 children
up to 18 years old was based on building intrinsic motivation to change. Relative to comparison groups, MI
was associated with significant improvements in health behavior including diet, physical activity, oral health,
and other factors. MI was more successful at improving diets when the intervention included more MI
components.21

Motivation

The counselor needs to increase the likelihood that the person will move toward change and to note and
facilitate any client self-motivational statements.7 First, the client recognizes that a problem exists. (“I guess
my weight is a problem affecting my blood pressure.”) Second, the client may express concern about the
problem nonverbally, for example, by facial expression, sighing, tone of voice, or verbally. (“I’ve got to make

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