Page 213 - Nutrition Counseling and Education Skills: A Guide for Professionals

metabolic syndrome. This in turn increases the risk of cardiovascular disease. All of these diseases are related
to lifestyle. A recent review of lifestyle intervention outcomes in type 2 diabetic overweight and obese adults
required a decrease in at least 5% of body weight to reduce glycemic, lipid, and blood pressure to beneficial
levels.35 These treatment models included structured frequent and regular contacts with clients, self-
monitoring assignments (i.e., food, physical activity, and/or blood glucose records), and learning problem-
solving strategies. Any diet-related chronic disease requires innovative education strategies to keep clients
motivated.

The chronic care model is often used in primary and specialty centers to deliver coordinated education
through healthcare teams. This model works to integrate decisions in an organized manner to achieve higher
outcomes than a single practitioner could deliver alone.36 A nutrition professional is recommended as a fully
involved collaborative team member, particularly in the management of diabetes mellitus and kidney disease.
As an illustration of the importance of providing medical nutrition therapy for these disease conditions, the
Center for Medicare Services (CMS) began to reimburse registered dietitians for medical nutrition therapy of
these conditions in 2002. Reimbursement for other disease conditions and preventive care is still evolving.37

Education Strategies

Terms like “compliance” and “adherence” were often used to describe necessary health behavior changes to
accomplish better health outcomes. A new emphasis has been placed on the concept of “self-management,”
where clients are considered members of the interdisciplinary team that cares for them. As a member of the
team, they participate in goal setting and in identifying problem-solving strategies designed to address barriers
to managing their treatment regimens. Common barriers include remembering to take medications, getting
regular physical activity, monitoring blood glucose, managing a high pill burden, or affording the cost of diet-
related foods.38,39

This emphasis on the client being considered the key player on the chronic disease management team is
very effective for nutrition professionals to use when educating patients with chronic illness. The use of the
electronic medical record may also increase the ability to access clients throughout the life span. Some
healthcare systems are integrating access with education opportunities for health information. The nutrition
and dietetics professional may be able to follow clients over time, removing the barriers of scheduling and
location using evolving information technology advances in healthcare. An electronic reminder can be built
into the electronic record system to remind clients to come for a scheduled clinic visit or remember to refill
medications or complete a diet record.40,41

Specialty Care Strategies

Table 9-3 lists nutrition interventions recommended for care of clients with diet-related chronic diseases. The
Academy of Nutrition and Dietetics regularly convenes evidence-based practice committees that examine the
literature and publish recommendations for nutrition care in specialty areas of practice. Summaries of the
evidence for medical nutrition therapy for chronic disease conditions such as type 1 and type 2 diabetes
mellitus in adults and how to integrate the guidelines into the Nutrition Care Process (NCP) have been
published. Standards of practice and professional performance for all registered dietitians as well as for some
specific diseases including diabetes, cancer, and kidney disease are revised at regular intervals, usually every 5

213