Science - September 16, 2004

Healthier eating in steps

If doctors want to get their patients to eat more healthily, they should first ask them if they are prepared to do so. ‘It costs hardly any effort,’ says PhD candidate Marieke Verheijden. ‘All it takes is one simple question. And it works.’

In her PhD research Verheijden looked at whether doctors could use the States of Change Model when trying to encourage heart patients to eat fewer fatty foods. ‘The model was developed for research on smokers,’ says Verheijden. ‘It assumes that people go through phases when they are in the process of changing their behaviour. In my research I looked at whether doctors could get more people to eat a healthier diet by taking these phases into account.’

Verheijden compared two groups of patients, both of which were at a high risk of heart attacks from diabetes, high cholesterol levels or high blood pressure, and therefore needed to eat less fat. The doctors approached one group in the traditional manner, giving their patients standard information. For the other group, the doctors first determined in which phase the patients were, and varied their advice accordingly. Verheijden concluded that the latter strategy led to a greater change in the patients’ behaviour than the traditional approach.

The first phase is known as precontemplation. ‘The people in this phase can be divided into two groups,’ continues Verheijden. ‘There is one group who knows very well that foods with high levels of saturated fats are unhealthy, but are not prepared to give up their deep-fried snacks. There’s not much point giving this group information.’ The other group consists of people who have no idea that saturated fats are bad for them. ‘Giving this group information will have an effect. By giving them information on the dangerous effects of saturated fats you are likely to set them thinking.’

Likewise, there is little point giving this kind of information to people who have already changed their eating habits. ‘These people will benefit more from social support,’ says the researcher. ‘For example making sure that there is something healthy on the menu when they go out for a meal. This way you reduce the chance of them slipping back into bad habits.’ This tailor-made approach is not only more effective, she discovered. ‘It is also more efficient, as doctors spend less energy on actions that will have no effect.’ / WK

Marieke Verheijden will receive her PhD on 27 September. Her promoters are Professor Wija van Staveren of Nutrition and Gerontology, and Professor Chris van Weel, Radboud Universiteit, Nijmegen.

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