INTRODUCTION

Over the past few decades conflicting principles of healthy eating have been proposed, generating diverse opinions on what constitutes healthy food choices. Clinicians find their patients informing them of new diets they would like to try which may conflict with national guidelines [1]. There is confusion in the general population, including the medical profession, as to which dietary components may be most important, and how to integrate these changes within the patient’s current lifestyle.

This confusion has consequences. Clinicians continue to be the most respected source of lifestyle modification information [2] and are exposed to 60 to 70 percent of the United States adult population each year [3]. As an example, a study of clinician attitudes highlights these concerns in the delivery of nutrition advice to their patients [4-6]. Nearly all clinicians were aware of the obesity epidemic and 60 percent of them felt capable of assuming a major role in obesity control, but only 36 percent agreed that they had effective weight-management practices.

Clinicians use several strategies, but there are barriers to nutritional counseling which include skepticism about the effectiveness of nutritional interventions, concerns about patient response and compliance, lack of specific knowledge and training about nutrition as it relates to disease, and the perceived unpalatability of nutritional changes [7-10]. Clinicians are able to identify patients at risk, but encounter time constraints, lack of specialty clinics, absence of guidelines, and an inadequate number of dietitians [4-6]. In addition to appropriate training, physicians need effective nutritional tools and information that can be used in the clinical setting [11].

Dietary choices may help reverse or lessen some common risk factors for the main contributors to morbidity and mortality in the United States, including obesity, coronary heart disease, diabetes, some cancers, and stroke [12,13]. The dissemination of accurate dietary information within a medical setting has become an increasing priority both to the clinician and the patient. Many people believe that a comprehensive plan of complete dietary change is necessary to accomplish goals; however, this is not always the case. Indeed, sometimes simple changes in one area of the diet (such as increasing fiber, or decreasing white flour products) may have a beneficial impact on other areas of the diet [14].

The balance of protective foods is just as important as the avoidance of foods containing excess calories, sugars, saturated or trans fat. Making simple recommendations directed at modifying appropriate risk factors for chronic disease, and providing flexibility within the plan can be more effective over the long term [15]. The goal of nutrition assessment is to identify appropriate and actionable areas of change in the dietary lifestyle.