1. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change
Joanne M. Spahn, MS, RD, FADA: Center for Nutrition Policy and Promotion
Rebecca S. Reeves, DrPh., R.D., FADA: Baylor College of Medicine
Kathryn Keim, PhD, RD, LDN: Rush University
Ida Laquatra, PhD, RD: H.J. Heinz Company
Molly Kellogg, RD, LCSW
Bonnie Jortberg, MS, RD, CDE: University of Colorado Denver School of Medicine
Nicole Clark, MS, RD, CDE, LDN: University of Indiana of Pennsylvania
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

2. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Why Theory-Based Interventions and Strategies
Evidence-base for nutrition counseling
Critical to the nutrition care process (NCP)
Nutrition assessment
Selection of intervention strategies
Monitoring and evaluation indicator use
Enhances provider impact
Builds knowledge-base of the profession
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

3. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Question Format
What is the evidence that nutrition counseling
based on __________results in health/food
behavior change in adults counseled in an out
patient or clinic setting?
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

4. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Cognitive Behavioral Therapy (CBT)
Plethora of evidence (45 articles)
Significant effect with all groups
Strong evidence for interventions
Long-term (>18 months) targeting Cardiovascular Disease (CVD)
Long-term (>12 months) for diabetes prevention
Intermediate length for diabetes management
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

5. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Cognitive Behavioral Therapy
Fair evidence for intervention
Long-term (> 12 months) for weight management
Short-term (< 6 months) for diabetes management
Additional research needed to address:
Maintenance of benefits achieved with CBT
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

6. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Cognitive Behavioral Therapy
Beneficial in facilitating modification of targeted dietary habits
Decreased calories from fat
Decreased sodium
Increased intake of fruits & vegetables
Weight, CVD & diabetes risk factors
Grade 1
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

7. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Group versus Individual Counseling
Research available for diabetes/weight only
Three Randomized Controlled Trials (RCT) evaluated diabetes or weight management for middle aged subjects
Positive quality studies
3-6 month intervention duration
Groups significantly more effective Attrition rates high in two studies
Grade II
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

8. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Transtheoretical Model
One RCT supported
Impact of Stage of Change appropriate counseling
Stage matched materials targeting diabetes
Personalized assessment reports, monthly phone calls and newsletter every other month
Grade III
Much research to validate instruments in dietary context
Little intervention research in adults
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

9. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Social Cognitive Theory
One RCT - positive effect on reducing saturated fat & cholesterol intake
6 telephone sessions
Targeted to self-efficacy
Verbal persuasion
Goal setting
Self-monitoring
Self-reinforcement
One RCT in diabetes – no added benefit to an education intervention
Grade III
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

10. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Question Format
What is the evidence that the behavioral strategy
of _____, used as a component of a behavioral
program, will result in health or food behavior
change in adults counseled in an outpatient or
clinic setting?
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

11. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Grade I
Self-monitoring
Three RCTs, three observational studies
Reward strategies
Two RCTs, one meta-analysis
NOT effective
Motivational Interviewing
Meal replacements or structured meals
Four RCTs
Compared to self-selected diets
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

12. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Motivational Interviewing (MI)
Used alone, no more effective than usual treatment
Four RCTs added MI session(s) to CBT
Enhanced adherence to program
Improved outcomes
MI as “phase one”
CBT as “phase two”
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

13. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Grade II
Problem-solving
Two small RCTs
Social support
Mixed results. More research needed
Client self-selected goal setting
Realistic, measurable
Included goal attainment training
Two RCTs
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).

14. Serum Vitamin C (mg/dl) by Salad Intake
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to
Facilitate Health and Food Behavior Change
Serum Vitamin C (mg/dl) by Salad Intake
Grades III & IV
Grade III
Cognitive restructuring
One RCT
No effect
More research needed
Grade V:
Stress management
Stimulus control
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Spahn, J., et al. J Am Diet Assoc.; 2010; Volume 110 (June).