Effecting Dietary Modifications in Patients: 5 Things to Know

Amit Khera, MD, MSc, FACC; Susan G. Rodder, MS, RDN, LD


January 28, 2020

Editorial Collaboration

Medscape &

4. Physicians should discuss the latest guideline recommendations and findings with patients.

As evidence-based studies continue to provide insight into factors that increase and decrease the risk for CVD, it is important that physicians relate this information to patients to ensure comprehension and facilitate adherence. Patients may have questions and comments about topics like dietary patterns, consumption of eggs and other high-cholesterol foods, lower-sodium foods, and low-carbohydrate diets. One such example is the 2019 American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease, which now recommend plant-based and Mediterranean diets that emphasize intake of vegetables, fruits, legumes, nuts, whole grains and fish, and the replacement of saturated fat with dietary monounsaturated and polyunsaturated fats. In addition, consumption of processed meats, refined carbohydrates, and sugar-sweetened and artificially sweetened beverages is strongly discouraged so as to reduce ASCVD risk.[9]

An open conversation with patients can go a long way in dispelling myths and providing comprehension and clarity.

5. Cognitive-behavioral therapy (CBT) techniques can help effect positive, lasting dietary changes in patients.

Studies have shown that CBT increases patient adherence to dietary interventions.[10] CBT techniques can easily be incorporated into dietary counseling in a stepwise approach:

  • Set a dietary goal(s) for patients;

  • Encourage patients to set and follow a SMART (specific, measurable achievable, realistic, time-limited) goal checklist[11];

  • Enable patient self-care monitoring (eg, use of pedometer and other technology to track progress and encourage motivation)[12]; and

  • Use motivational interviewing to encourage patient motivation and commitment to dietary modifications.[8]

The patient's goal is a broad statement of the desired change or outcome—eg, "to help my heart by improving my diet." The goal is followed by the SMART objectives to prevent the patient from feeling overwhelmed by these dietary improvements. The goal and objectives are reinforced by self-monitoring—ie, the patient's increased awareness of physical cues and or behaviors, including the identification of any barriers to changing behavior. All of the above are enhanced by motivational interviewing by the physician and dietitian to help the patient explore and resolve their ambivalence, if any, to healthier eating.[8]

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