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Support System Leads to Better Diet, Nutrition

Women who got phone counseling ate more veggies and fiber, less fat, study found

THURSDAY, Sept. 20 (HealthDay News) -- Could better nutrition and diet be as close as a helpful phone call away?

A new study found that women who received telephone counseling about healthy eating habits wound up consuming more vegetables, fruits and fiber and less fat, suggesting that a support system can pay big rewards for people looking to improve their eating habits.

"With proper support, you can make a major change in your diet," said Cheryl Rock, professor of nutrition at the University of California, San Diego, and a study co-author. "A lot of people think it's an insurmountable task. But this study shows that yes, indeed, you can make a big change."

The study is published in the October issue of The Journal of Nutrition.

Rock and her colleagues randomly assigned 3,088 women, all at risk for a recurrence of breast cancer, to either a telephone counseling group or another group that didn't get the phone counseling. The phone counseling group also received newsletters talking about healthy eating and cooking classes. The women were encouraged to use recipes to help them meet their goals for more fruits, vegetables and fiber, and less fat.

The "control" -- or comparison -- group got printed materials about healthy diets and were offered cooking classes, but the themes weren't related to boosting intake of vegetables, fruit and fiber and decreasing fat.

Both groups ate fairly healthful diets at the start of the four-year study. Both ate seven vegetable and fruit servings a day, 21 grams a day of fiber and got 28.7 percent of energy from fat.

Under the 2005 Dietary Guidelines for Americans, those on a 2,000-calorie-a-day diet are advised to eat nine servings of fruits and vegetables a day, 28 grams of fiber, and to keep total fat to 20 percent to 35 percent of calories, most of the fat unsaturated.

The group that received phone counseling did better on their diet than the comparison group at the one-year and four-year mark, the researchers found. At one year, "there was a 38 percent increase in vegetable intake, a 20 percent increase in fruit, 38 percent more fiber" in the group receiving phone counseling, Rock said.

By year four of the study, the counseling group was consuming 65 percent more vegetables, 25 percent more fruit, and 30 percent more fiber. And they were getting 27 percent of their energy from fat, while the comparison group's fat intake was 31 percent.

The researchers verified the findings by taking blood samples.

The phone counseling started out frequently, then declined as people adopted the healthier habits. "The first few weeks, they talked to someone on the phone three or four times," Rock said. "Then for three or four months, they talked once a week. Then it was more like follow-up counseling. They got about 18 calls the first year, six the second year, four in the third year and three in the fourth year."

Trained counselors helped the participants with the dietary changes. "It was like coaching," Rock said. For instance, a woman might say she wanted to improve her breakfasts. A counselor might suggest eating an orange. But if the woman said, no, that wouldn't work because she ate breakfast in the car, the counselor might suggest a smoothie that includes fruits that could be sipped in a travel coffee mug.

Rock said the program has three crucial features: Demanding accountability -- the participants knew they would get another phone call; individualizing it to a person's lifestyle; and setting goals.

Another expert said the study demonstrates that phone counseling works to help people improve their diet.

"The use of phone counseling is growing, and this study shows that it can be very effective in achieving change while controlling costs," said Connie Diekman, director of nutrition at Washington University in St. Louis, and president of the American Dietetic Association.

"The frequency of the calls may make this less practical for large patient care, but it does demonstrate that contact and accountability improve outcomes," she said. "Not only is phone contact growing, but using the Internet for contact is another evolving area.

"The outcomes of the study are significant in that people maintained behavior change for four years, a change that increases the odds that the behavior will become a routine," Diekman added. "The study population, though, started out as healthier eaters, with the majority consuming five [servings of fruits and vegetables] a day, so more studies would be needed to determine if a group with poor diet habits could attain such change."

Could people enlist their family for the same support as the phone counseling, with the same effects? Maybe, Rock and Diekman said.

"Support is key to so many behavior changes. And having a partner, working as a group, or developing phone buddies are steps that many people could take to make eating changes. But the trained interviewer probably helped," Diekman said.

More information

To learn more about improving your diet, visit the American Dietetic Association.

SOURCES: Connie Diekman, R.D., director of university nutrition, Washington University, St. Louis, and president of the American Dietetic Association, Chicago; Cheryl Rock, Ph.D., R.D., professor of nutrition, University of California, San Diego, School of Medicine; October 2007, The Journal of Nutrition

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