Telephone Counseling/Coaching Effective At Upping Clients’ Fruit & Vegetable Intake

National and international health organizations advise increasing fruit and vegetable intake to prevent and reduce chronic diseases, such as heart disease, diabetes and cancer. But getting people to change longstanding eating habits that are low in fruits and vegetables is challenging and often ineffective.

Numerous studies show that telephone counseling, especially regular telephone counseling over a concentrated period of several months, is effective at significantly increasing people’s fruit and vegetable intake and improving several health indicators. Ongoing written material and group support also offer positive effects in promoting and sustaining health-promoting eating habits. This research gives scientific justification to the components of my nutrition coaching programs, which have become the fastest-growing and most well-received nutrition services that I offer.

Eating more fruits and vegetables ranks among the most important nutrition recommendations for health improvement, but only about 20 percent of U.S. adults eat the recommended daily amount of fruits and vegetables. Telephone nutrition counseling is a way to counteract that. According to a 2006 review of nine studies that looked at telephone counseling that focused on eating more fruits and vegetables, the weight of the evidence indicates that “…telephone-based counseling promotes significantly greater improvements in fruit/vegetable consumption…relative to usual care…. In some studies, telephone-based counseling was also associated with greater improvements in blood lipid levels and weight.”

Additional benefits of regular telephone contact include boosting motivation, helping prevent relapses of old, less-healthy eating habits, and offering and reinforcing nutrition advice, especially for people with limited access to medical services. Also, compared to other behavioral medicine programs, telephone counseling is associated with a low rate of attrition (or giving up and going back to unhealthy eating habits).

However, the length of interaction between the client and counselor and the number of telephone calls are important. The most favorable outcomes occur with several months of ongoing contact and numerous telephone calls between the nutrition counselor and client – which is the set-up of my coaching programs.

In a Journal of Nutrition study that showed long-term adherence to a high-vegetable dietary pattern over four years, the main nutrition strategy used was telephone counseling. It was most intensive in the early months of the program. As telephone contacts decreased over time, monthly newsletters (which is similar to what I offer in my Going Against the Grain Group) assumed a greater role in helping clients get additional information and food ideas to maintain their healthier diet. After clients participated in nutrition coaching, reading ongoing written material was a cost-effective way to maintain a vegetable-rich diet and prevent relapses of old eating habits. By itself or in conjunction with an Initial Consultation and Follow-Up (what I call my “Get Started Combo”), ongoing written material can help achieve small increases in fruit and vegetable consumption, though it is not as effective as a multi-faceted nutrition coaching program.

Telephone counseling is not only helpful for individuals who have or at risk of serious health conditions. It also works for people who don’t have serious health conditions but consume fewer than five servings per day of vegetables and fruit. A study published in the August issue of the Journal of the American Dietetic Association found that for people who participated in a telephone counseling program over three months, their intake of vegetables over six months increased 67 percent, their intake of fruit 71 percent, of “bold” (phytochemical-rich) vegetables 83 percent, and of “bold” fruit 167 percent, whereas their intakes of the less nutrient-dense iceberg lettuce, white potatoes, and fruit juice, which had been discouraged, decreased.

Increases in blood carotenoid concentrations are considered objective indicators of vegetable and fruit intake – and blood concentrations of virtually all carotenoids increased in this study.

Study references:

Eakin EG, Lawler SP, Vandelanotte C, Owen N. Telephone interventions for physical activity and dietary change: a systematic review. American Journal of Preventive Medicine, 2007;32:419-34.

Newman VA, Flatt SW, Pierce JP. Telephone counseling promotes dietary change in healthy adults: Results of a pilot trial. Journal of the American Dietetic Association, 2008;108:1350-4.

Pierce JP, Newman VA, Natarajan L, et al. Telephone counseling helps maintain adherence to a high-vegetable dietary pattern. Journal of Nutrition, 2007;137:2291-6.

Pomerleau J, Lock K, Knai C, et al. Interventions to increase adult fruit and vegetable intake can be effective: A systematic review of the literature. Journal of Nutrition, 2005;135:2486-95.

Vanwormer JJ, Boucher JL, Pronk NP. Telephone-based counseling improves dietary fat, fruit, and vegetable consumption: a best-evidence synthesis. Journal of the American Dietetic Association, 2006;106:1434-44.

Melissa’s comments:

I developed my nutrition coaching programs and the other nutrition services I offer based on what I learned to be most effective after 15 years of counseling people in my practice. How gratifying it is to see that the nutrition services my instincts told me were the best ways to help people are well backed up by research!

My nutrition coaching programs include frequent telephone and email sessions usually over several months as well as a free one-year, online Going Against the Grain Group membership that provides informative articles, meal ideas, recipes, and answers to questions about food. I knew from experience that clients who did more intensive telephone coaching with me at the beginning were the most apt to make health-promoting changes with their diet that continued over the long term. I also knew that people who participated in my Tucson Going Against the Grain Group were the most likely to stick to a vegetable-rich, against-the-grain diet and make it a diet for life. To provide the same service to people all around the country, I started an online Going Against the Grain Group earlier this year. As you learned in this story, ongoing written material like the information I offer in my Group plays a greater role in helping people stay motivated and keep learning how to go against the grain and eat more vegetables after telephone coaching has ended. For people who don’t participate in a nutrition coaching program but have an Initial Nutrition Consultation and a Follow-Up Consultation (a Get Started Combo with me), becoming a member of the Going Against the Grain Group can be a cost-effective additional service to help improve their diets over the long term.

If you’re having trouble adopting a health-promoting, against-the-grain diet rich in vegetables and making it a diet for life, my nutrition services can help. Check out these links for more info:

Nutrition Coaching Programs for New Clients

Nutrition Coaching Programs for Existing Clients

A one-year Going Against the Grain Group membership (with or without Counseling Services)

© Copyright 2008 Melissa Diane Smith

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