There are a number of different ways to engage patients to make dietary behavior change. Dietary behaviors are among the most complex of health behaviors and require long-term commitment to be successful in changing them. Sometimes, patients will do well with a prescriptive model such as in prescribing medications; if the "doctor tells me to do it, I will". A dietary prescription can be as simple as instructing the patient to switch from regular coffee to decaffeinated coffee or as complex as writing a prescription for a calorie controlled, electrolyte and protein restricted diet for end-stage renal disease. Simple issues can be easily handled in the office by the physician and nursing staff. There are fact sheets that accompany the nutrition screening tool "How Does Your Pyramid Stack Up?" and example fact sheets are shown here.

How does your pyramid stack up? Grain facts Each day your body uses more than 40 different nutrients to stay healthy. Foods are the cheapest and best way to get them. No one food is perfect. The wider the variety of foods that you eat every day, the better your chances are of getting what you need to stay fit. Breads, cereals, and other grain products give us complex carbohydrates, B-vitamins, iron, and fiber. They are naturally low in fat and have about 80-100 calories per serving. Choose products made from whole grains at least half of the time. Most adults should eat between 6-11 servings of grain products daily. Choose: Food Item Serving Size Healthful Additions Whole grain or enriched breads, rolls, tortillas 1 slice/roll Low-fat or fat free margarine or sandwich spreads. Buns, bagels, English muffins 1/2 Low-fat meats, fish or poultry; mustards. Whole grain or enriched cereals 1/2 cup cooked 1 cup ready-to-eat Cinnamon, nutmeg, raisins, fruit, low-fat or skim milk. Rice or pastas 1/2 cup cooked Broth-based, tomato or low-fat cheese/cream sauces. Low-fat crackers, cookies, rice or popcorn cakes 3-6 Low-fat or fat free cheeses, reduced fat peanut butter, jelly or jam. Pretzels or bread sticks Popcorn 1 ounce 3 cups Herbs or spice flavorings. Tips to improve your grain intake Eat products made from many different grains, such as wheat, rice, oats, or corn. Eat whole grain or enriched cereal with skim milk and fruit for breakfast or snacks. Add a slice of whole grain bread or a roll to your meals. Eat low-fat cookies, crackers, rice cakes, or pretzels as snacks. Blend whole grain or enriched cereal with a low-fat yogurt and fruit for a meal or treat. Eat a whole grain bagel or English muffin sprinkled with cinnamon and raisins or spread with fat free cream cheese for a quick breakfast or snack. Air pop popcorn and sprinkle with an herb mix, spice mix or parmesan cheese. Soft tortillas are a good wrapping for lots of fillings like beans, vegetables, lean meats. Remember the hidden fats in biscuits, doughnuts, muffins, croissants and pancakes and eat them less often. As an initial goal, try one of these tips twice a week. Keep it up for 2 weeks. Sit back and see how you feel. As you feel comfortable with one tip, add another! Go slowly and keep track of your success! Let your doctor know you're trying. Small changes can make a big difference in the long run. What Counts as a Serving? Bread Group 1 slice of bread 1 ounce of ready-to-eat cereal 1/2 cup of cooked cereal, rice, or pasta 1/2 bagel or hamburger bun Used with permission from the Learning Center at the American Dietetic Association

Content questions should be directed to: Marilyn.S.Edwards, Ph.D., R.D.
or Maggie McQuiggan, M.S.
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