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This Academy of Nutrition and Dietetics Position Paper reports current evidence on pediatric overweight and obesity prevention interventions and discusses implications for registered dietitian nutritionists (RDNs). An overview of current systematic reviews provided evidence-based results from a range of nutrition interventions according to developmental age group (ages 2 to 5, 6 to 12, and 13 to 17 years). Twenty-one current systematic reviews of nutrition interventions demonstrated a beneficial effect of nutrition and physical activity interventions on body mass index measures and no adverse events were identified. RDNs impart nutrition expertise in a wide range of settings to provide comprehensive care for children and adolescents as their nutrition and developmental needs change over time. This Position Paper outlines the current roles of, and proposed directions for, RDNs engaged in pediatric overweight and obesity prevention. Prevention of pediatric overweight and obesity requires comprehensive strategies ranging from policy-level to individual-level interventions in settings that will have the most beneficial impact for children according to their developmental stage. This Position Paper advocates for increased availability of nutrition and food access programs and interventions to reduce risk of pediatric obesity and associated adverse health outcomes both now and for future generations., (Copyright © 2022 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Maternal nutrition is essential for the development and lifelong health of the offspring. Antenatal care provides unique opportunities for nutrition communication, and health promotion tools (e.g., guidelines, instruments, packages, or resources) might help to overcome several concurrent barriers. We conducted a systematic literature review to map tools that are available for the promotion of a healthy dietary intake in healthy pregnant women in Western countries, and to identify what makes these tools feasible and effective for these women and their healthcare providers. Seventeen studies were included, evaluating tools with various delivery modes, content, and providers. Nine studies employed multiple, complementary delivery methods and almost all studies (n = 14) tailored the content to varying degrees, based on the individual characteristics and lifestyle behaviors of the participants. We found that the feasibility of a tool was dependent on practical issues, time investment, and providers' motivation, skills, and knowledge, while the effectiveness was related more to the type of provider and the content. Most effective interventions were provided by dietitians and nutritionists, and were highly tailored. Based on the results of this review, we believe that custom tools that are sensitive to inequalities are needed to support all women in obtaining or maintaining a healthy diet during pregnancy.

Background: Although social media such as blogs are still considered innovative communication technologies, some registered dietitians (RDs) are using them to promote healthy eating; however, evidence regarding the effects of healthy eating blogs on users' diet is lacking., Objective: This study evaluated the effects of an evidence-informed healthy eating blog written by an RD on dietary intakes, with a focus on vegetables and fruit and milk and alternatives consumption, and food-related behaviors of Canadian mothers., Design: This study was a parallel, randomized, controlled trial., Participants/setting: Data were collected from 84 French-speaking adult mothers of children aged between 2 and 12 years living in Quebec City, Quebec, Canada, who were recruited between October 2015 and February 2017 using institutional e-mail lists, flyers, newspapers, social media advertisements, and word of mouth., Intervention: The intervention was exclusively delivered through an evidence-informed healthy eating blog-integrating theory-based intervention methods to improve diet quality by increasing vegetables and fruit and milk and alternatives consumption in mothers-for 6 months at a dose of one new post written by an RD each week. Mothers could engage with the RD and fellow participants by posting comments on the blog., Main Outcome Measures: Main outcomes were daily intakes of vegetables and fruit and milk and alternatives. Outcome assessments were performed at baseline, 3 months, and at the end of the 6-month intervention., Statistical Analysis: Differences between the groups were examined using mixed linear models., Results: At 6 months, no significant difference was observed between groups for intakes of vegetables and fruit (P=0.923), milk and alternatives (P=0.271), or food-related behaviors and body weight (P=0.180)., Conclusions: A healthy eating blog, at a dose of 1 post per week, had no effects on dietary intakes, food-related behaviors, and body weight of mothers after 6 months. Methodologic issues are discussed to inform future health behavior research using blogs to promote healthy eating., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Dietetic interventions contribute to certain health objectives and other outcomes, but are mostly part of a multimodal and multidisciplinary approach what makes evaluating the actual effects of dietitians' involvement rather complex. Although monitoring and outcome evaluation (M&OE) can provide routine data to prove the effectiveness of dietetic interventions, this has not been established yet in different dietetic settings., Methods: A comprehensive framework for M&OE in dietetics was developed by dietetic experts from five European higher education institutes for dietetics in the course of the EU sponsored project "Improvement of Education and Competences in Dietetics (IMPECD)"., Results: Firstly, clear definitions on M&OE are proposed to facilitate the use of consistent terminology, with a specific emphasis on the term "impact" covering macro-level outcomes such as cost-effectiveness. Secondly, the Dietetic Care Process (DCP) was merged into a logic model to demonstrate the position of M&OE in relation to intervention planning and implementation, in both group and individual settings. Thirdly, selecting the appropriate indicators is indispensable to monitor and evaluate outcomes, and requires a high level of dietitians' critical reasoning. A categorized overview of indicators is provided to support this process. Lastly, the consortium developed a checklist to give dietitians a handle on what elements could be included in their M&OE plan and trigger them to perform M&OE in practice., Conclusions: Innovative M&OE models may help dietitians to demonstrate their effectiveness in improving clinical outcomes and justify their role in health care., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The SMARTsize intervention embeds an evidence-based portion control intervention in regular dietetic care. This intervention was evaluated to explore (1) which patients participated, (2) the implementation process, and (3) the outcomes of the intervention. The intervention was evaluated with an observational study design including measures at baseline, and three, six, and nine months after the start of the program. Data concerning the process (participation, dose delivered, dose received, satisfaction) and the outcomes (self-efficacy, intention, portion control strategies, and Body Mass Index (BMI) were collected with forms and questionnaires filled out by dietitians and patients. Descriptive analyses, comparison analyses, and cluster analyses were performed. Patients were mainly obese, moderately to highly educated women of Dutch ethnicity. Use of the intervention components varied from 50% to 100% and satisfaction with the SMARTsize intervention was sufficient to good (grades 7.2⁻8.0). Statistically significant ( p < 0.001) improvements were observed for self-efficacy (+0.5), portion control strategies (+0.7), and BMI (-2.2 kg/m²), with no significant differences between patients with or without counselling. Three clusters of patients with different levels of success were identified. To conclude, implementing an evidence-based portion control intervention in real-life dietetic practice is feasible and likely to result in weight loss.

Background: Healthy eating blogs are knowledge translation tools used by nutrition and dietetics practitioners for helping people improve their health behaviors and food choices., Objective: Our aim was to explore women's perceptions of the usefulness and ease of use of healthy eating blog (HEB) characteristics that might increase potential users' intention to use them as tools to improve their dietary habits., Design: We conducted qualitative research using semi-structured individual interviews., Participants: Thirty-three women (mean age of 44 years; range=27 to 61 years) living in the Quebec City, Canada, metropolitan area were studied., Intervention: Four existing HEBs, written by French-Canadian registered dietitians (RDs) whose main objective was the promotion of a healthy diet, were explored by women during individual interviews. A standardized open-ended interview questionnaire based on the Technology Acceptance Model was used to identify women's perceptions about characteristics of type of blog content delivery, RD blogger's delivery of information, blog layout, and blog design., Main Outcome Measures: Women's perceptions toward the contribution of HEB characteristics to the usefulness and ease of use of those tools to improve their dietary habits were measured., Analyses Performed: Interviews were audiorecorded, transcribed verbatim, coded, and analyzed through an inductive content analysis using NVivo software., Results: The most useful characteristics of type of blog content delivery identified by women were recipes, hyperlinks, and references. Among characteristics of RD blogger's delivery of information, most women reported that interaction between blog readers and the RD blogger created a sense of proximity and of connection that was helpful for improving their dietary behaviors. Women's perceptions toward various characteristics of blog layout and design were also discussed., Conclusions: Incorporating specific characteristics when designing HEBs should be considered by RDs and future research to promote the use of those tools to support dietary behavior change efforts of internet users., (Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Nutrient profiling (NP) models rate the nutritional quality of individual foods, based on their nutrient composition. Their goal is to identify nutrient-rich foods, generally defined as those that contain more nutrients than calories and are low in fat, sugar and salt. NP models have provided the scientific basis for evaluating nutrition and health claims and regulating marketing and advertising to children. The food industry has used NP methods to reformulate product portfolios. To help define what we mean by healthy foods, NP models need to be based on published nutrition standards, mandated serving sizes and open-source nutrient composition databases. Specifically, the development and testing of NP models for public health should follow the seven decision steps outlined by the European Food Safety Authority. Consistent with this scheme, the nutrient-rich food (NRF) family of indices was based on a variable number of qualifying nutrients (from six to fifteen) and on three disqualifying nutrients (saturated fat, added sugar, sodium). The selection of nutrients and daily reference amounts followed nutrient standards for the USA. The base of calculation was 418·4 kJ (100 kcal), in preference to 100 g, or serving sizes. The NRF algorithms, based on unweighted sums of percent daily values, subtracted negative (LIM) from positive (NRn) subscores (NRn - LIM). NRF model performance was tested with respect to energy density and independent measures of a healthy diet. Whereas past uses of NP modelling have been regulatory or educational, voluntary product reformulation by the food industry may have most impact on public health.

The food industry holds great potential for driving consumers to adopt healthy food choices as (re)formulation of foods can improve the nutritional quality of these foods. Reformulation has been identified as a cost-effective intervention in addressing non-communicable diseases as it does not require significant alterations of consumer behaviour and dietary habits. Nutrient profiling (NP), the science of categorizing foods based on their nutrient composition, has emerged as an essential tool and is implemented through many different profiling systems to guide reformulation and other nutrition policies. NP systems should be adapted to their specific purposes as it is not possible to design one system that can equally address all policies and purposes, e.g. reformulation and labelling. The present paper discusses some of the key principles and specificities that underlie a NP system designed for reformulation with the example of the Nestlé nutritional profiling system. Furthermore, the impact of reformulation at the level of the food product, dietary intakes and public health are reviewed. Several studies showed that food and beverage reformulation, guided by a NP system, may be effective in improving population nutritional intakes and thereby its health status. In order to achieve its maximum potential and modify the food environment in a beneficial manner, reformulation should be implemented by the entire food sector. Multi-stakeholder partnerships including governments, food industry, retailers and consumer associations that will state concrete time-bound objectives accompanied by an independent monitoring system are the potential solution.

Observational evidence suggests that increased whole grain (WG) intake reduces the risks of many non-communicable diseases, such as CVD, type 2 diabetes, obesity and certain cancers. More recently, studies have shown that WG intake lowers all-cause and cause-specific mortality. Much of the reported evidence on risk reduction is from US and Scandinavian populations, where there are tangible WG dietary recommendations. At present there is no quantity-specific WG dietary recommendation in the UK, instead we are advised to choose WG or higher fibre versions. Despite recognition of WG as an important component of a healthy diet, monitoring of WG intake in the UK has been poor, with the latest intake assessment from data collected in 2000-2001 for adults and in 1997 for children. To update this information we examined WG intake in the National Diet and Nutrition Survey rolling programme 2008-2011 after developing our database of WG food composition, a key resource in determining WG intake accurately. The results showed median WG intakes remain low in both adults and children and below that of countries with quantity-specific guidance. We also found a reduction in C-reactive protein concentrations and leucocyte counts with increased WG intake, although no association with other markers of cardio-metabolic health. The recent recommendations by the UK Scientific Advisory Committee on Nutrition to increase dietary fibre intake will require a greater emphasis on consuming more WG. Specific recommendations on WG intake in the UK are warranted as is the development of public health policy to promote consumption of these important foods.

In this paper, I first provide definitions of nutrient profiling and of a nutrient profile model. I set out the purposes of nutrient profiling: both general and specific. I give two examples of nutrient profile models that have been developed for regulatory purposes by the Food Standards Agency (FSA) in the UK and the WHO for its European Region - the UK FSA/Ofcom and the WHO-Euro models - and compare the way the models are constructed and function, how they have been developed, the extent to which they have been tested and validated and their use in regulation. Finally I draw some conclusions about the future use of nutrient profiling for regulatory purposes. I argue that its full potential has yet to be realised and give some reasons why. I pose some urgent research questions with respect to nutrient profiling.

Recent technology advancements are aiding the development of scientific discoveries and changing the methods by which we perform research. In order to gain full benefits for human health, it will be important to embrace these new technologies in nutrition research while also acknowledging their limitations. The present issue covers a range of technological approaches that impact on public health nutrition and molecular nutrition. The critical appraisal of these approaches in the context of nutrition research makes this issue a timely and pertinent addition to the scientific literature.

The primary goal of front of pack (FOP) labelling is to help consumers make healthier choices through communication. A secondary goal is to encourage producers to improve the nutritional composition of their products. Evidence has shown that (FOP) labelling can help consumers to make healthier food choices and has been an incentive for producers to improve product composition. As FOP labelling is seen as an important tool to improve food environments for public health purposes, the WHO supports initiatives of governments to implement an FOP labelling system. Based on the experiences of a wide range of countries over many years, possible success factors for such an FOP system have been defined, six of which are discussed in the present paper and used to evaluate the Dutch Choices Programme that was started in 2006. In the course of time a large number of producers joined the programme and the logo was recognised by more than 90 % of the consumers, but by 2016 the Dutch consumer organisation argued on the basis of their own research that a quarter of the consumers did not understand the colour coding of the logo and as a result the Dutch government decided to no longer support this logo and to introduce a nutrition app. The challenge that remains is to find a system that consumers understand well and that still encourages manufacturers of food to improve product composition. New technology-based data collecting initiatives might provide the right tools to develop such a system.

Nutrient profiling aims to classify or rank foods according to their nutritional composition to assist policies aimed at improving the nutritional quality of foods and diets. The present paper reviews a French approach of nutrient profiling by describing the SAIN,LIM system and its evolution from its early draft to the simplified nutrition labelling system (SENS) algorithm. Considered in 2010 by WHO as the 'French model' of nutrient profiling, SAIN,LIM classifies foods into four classes based on two scores: a nutrient density score (NDS) called SAIN and a score of nutrients to limit called LIM, and one threshold on each score. The system was first developed by the French Food Standard Agency in 2008 in response to the European regulation on nutrition and health claims (European Commission (EC) 1924/2006) to determine foods that may be eligible for bearing claims. Recently, the European regulation (EC 1169/2011) on the provision of food information to consumers allowed simplified nutrition labelling to facilitate consumer information and help them make fully informed choices. In that context, the SAIN,LIM was adapted to obtain the SENS algorithm, a system able to rank foods for simplified nutrition labelling. The implementation of the algorithm followed a step-by-step, systematic, transparent and logical process where shortcomings of the SAIN,LIM were addressed by integrating specificities of food categories in the SENS, reducing the number of nutrients, ordering the four classes and introducing European reference intakes. Through the French example, this review shows how an existing nutrient profiling system can be specifically adapted to support public health nutrition policies.

Improving the nutritional health of the public continues to be a major challenge. Our mission of advancing health through food and nutrition has become increasingly complex, particularly as food environments shape the availability, affordability, and social acceptability of food and nutrition "choices". Promoting nutritional health requires that dietitians expand our knowledge in understanding the determinants of healthy eating and of social change strategies that advocates for and acts on improving food environments. While no single strategy can solve the challenges of public health nutrition, we can each identify unique strengths and opportunities. If we practice in complementary ways, using those strengths for collective action will make us stronger together toward social change supporting improved nutritional health of the public.

This paper provides the overview of "Shokuiku" in Japan, and discusses the future perspective on application of its concepts to nutrition education in other Asian countries. In Japan, there has been a growing concern on increase of obesity and the metabolic syndrome among middle-aged men. Additionally, child obesity has also become one of the important health problems. The increased obesity among them is possibly associated with inappropriate dietary habits (eg skipping breakfast, excessive fat intake and insufficient vegetable). Under this circumstance, the "Basic Law on Shokuiku" was enacted in 2005, which was the first law that regulates one's diets and eating habits. For effective implementation of Shokuiku program, dietitians and registered dietitians would play important roles in various settings. Japan has a long history of dietitian system as well as school-lunch programs. Later, in order to further enhance the school-based Shokuiku programs, the Diet and Nutrition Teacher System was established in April 2007. From an international point of view, "nutrition education" programs aim to improve dietary practices so as to ensure adequate energy or nutrient intake and also to reduce obesity and lifestyle-related diseases, whereas the concepts of Shokuiku have very wide approaches. Shokuiku's efforts expand to support food culture, especially through school-based programs, as well as to improve food environment by providing information on appropriate diets. These approaches can be introduced in nutrition education in other Asian countries, not only to improve one's health and nutritional status but also to secure food culture and food safety in each country.

The demand for clinical trials targeting lifestyle intervention has increased as a result of the escalation in obesity, diabetes mellitus and cardiovascular disease. Little is published about the strategies that dietitians have used to successfully screen potential study volunteers, implement interventions and maximise adherence and retention in large multicentre National Institutes of Health funded nutrition and lifestyle intervention clinical trials. This paper discusses an expanded role for the contributions of dietitians as members of an interdisciplinary team based on research experiences in the Diabetes Control and Complications Trial, Diabetes Prevention Program and Look AHEAD (Action for Health in Diabetes). Many of the strategies and insights discussed are also relevant to effective clinical practice. Dietitians need to broaden their scope of practice so that they are integrated proactively into the screening and intervention phases of large clinical trials to maximise retention and adherence to assigned nutrition, lifestyle and behavioural interventions. The skills of dietitians are a unique fit for this work and it is important that investigators and project managers consider including them in both the screening and intervention phases of such clinical trials to maximise retention results.

Background: Both the UK's National Health Service (NHS) and the National Institute of health and Clinical Excellence (NICE) have recommended increased training for health professionals in communication skills. There is evidence to suggest that communication skills are important in helping people to change health-related behaviour, which is a key role for dietitians. This study investigated the views of UK dietitians about their training needs and experience in relation to communication skills in dietetic practice., Methods: In October 2007, a cross-sectional survey was mailed to all British Dietetic Association members (n = 6013). The survey gathered quantitative data and free-text comments to ascertain the level, type and effect of communication skills training received by dietitians at both the pre- and post-registration level., Results: There were 1158 respondents; a response rate of 19.3%. Ninety-eight percent (n = 1117) rated communication skills as either very or extremely important in client consultations. Post-registration training had been undertaken by 73% (n = 904). Of these, over 90% of respondents perceived that post-registration training had led to improvements in their relationships with patients, their confidence in client interviews and their ability to cope with challenging clients. However, 248 (21.4%) felt time keeping in interviews had worsened. Lack of time for client interviews was also the most commonly identified barrier (19%, n = 216) to implementing the skills., Conclusions: This study has explored an important and under-researched area. Respondents strongly endorsed the importance of good communication skills and the benefits of post-registration training in this area. Some felt that good communication was time consuming but others felt that time management had improved. Further research and training is required to support the implementation of these skills into dietetic practice.

The purpose of this study was to evaluate parent response to a clinic-based primary prevention intervention to increase the proportion of 5- to 10-year-old children receiving annual body mass index screening and counseling about physical activity, dietary practices, and sedentary practices. A posttest-only, quasiexperimental design was used. Two clinics that provide routine health care to school-aged children agreed to participate in the pilot study. A multicomponent intervention was implemented in one clinic; the other provided care as usual. A convenience sample of parents (n=117) completed a survey after a clinic visit. Descriptive statistics, Fisher's exact, and chi(2) tests of significance and logistic regression were used to examine study outcomes. Most parents (>80%) believed it was important for health care providers to share information with them about their child's weight and physical activity, diet, and sedentary practices. Intervention parents were significantly more likely to report receiving information from their health care provider about their child's weight and weight-related behavior counseling than control parents. More intervention than control parents reported they intended their child to get five or more servings of fruits/vegetables on most days during the next 30 days (25% vs 9%; P=0.049). Outcomes suggest parents regard the take-home message they receive from health care providers about their child's weight and weight-related lifestyle practices as relevant and a potential motivating factor when considering behavior change. Further development of the intervention and testing in a larger experimental trial are warranted to determine effects on behavior change and body weight.

Telephone counseling is increasingly reported to be an effective behavior change strategy, but more studies in broader populations are needed. This uncontrolled pilot trial investigated whether a 3-month/eight-call telephone counseling intervention could promote dietary changes associated with reduced chronic disease risk in adults consuming <5.0 servings of vegetables and fruits daily. Between 2002 and 2004, 97 adults (mean age 46 years; range 21 to 84 years) completed the intervention and a follow-up assessment at 6 months. Approximately half were of nonwhite ethnicity (53%). The majority were women (95%) and had never had cancer (89%). The intervention promoted daily intakes of three to five vegetable servings, two to four fruit servings, and three whole-grain and/or beans/legumes servings. Average total daily intake of vegetables, fruits, whole grains, beans/legumes, fiber, and fat were assessed at baseline and at 6 months, each by a set of three 24-hour recalls. Plasma carotenoids were measured on a subsample (n=41) as an objective biomarker of vegetable and fruit intake. Change in mean self-reported dietary intake (ie, vegetables, fruit, whole grains, beans/legumes, fiber, and fat) and plasma carotenoids were compared by paired t tests. The intervention was associated with a significant (P<0.001) increase in vegetable servings per day (baseline 2.1 servings per day, 6 months 3.5 servings per day; 67% increase), fruit servings per day (baseline 1.4 servings per day, 6 months 2.4 servings per day; 71% increase), and whole-grain and/or bean servings per day (baseline 1.0 serving per day, 6 months 1.4 servings per day; 40% increase). These changes were corroborated by a significant (P<0.001) increase in total plasma carotenoids. This 3-month/eight-call telephone counseling intervention was associated with dietary change in healthy adults consuming fewer than five servings per day of vegetables and fruit at study entry.

Objective: To assess the effectiveness of an intervention aimed to increase adherence to a Mediterranean diet., Design: A 12-month assessment of a randomized primary prevention trial., Subjects/settings: One thousand five hundred fifty-one asymptomatic persons aged 55 to 80 years, with diabetes or > or =3 cardiovascular risk factors., Intervention: Participants were randomly assigned to a control group or two Mediterranean diet groups. Those allocated to the two Mediterranean diet groups received individual motivational interviews every 3 months to negotiate nutrition goals, and group educational sessions on a quarterly basis. One Mediterranean diet group received free virgin olive oil (1 L/week), the other received free mixed nuts (30 g/day). Participants in the control group received verbal instructions and a leaflet recommending the National Cholesterol Education Program Adult Treatment Panel III dietary guidelines., Main Outcome Measures: Changes in food and nutrient intake after 12 months., Statistical Analyses: Paired t tests (for within-group changes) and analysis of variance (for between-group changes) were conducted., Results: Participants allocated to both Mediterranean diets increased their intake of virgin olive oil, nuts, vegetables, legumes, and fruits (P<0.05 for all within- and between-group differences). Participants in all three groups decreased their intake of meat and pastries, cakes, and sweets (P<0.05 for all). Fiber, monounsaturated fatty acid, and polyunsaturated fatty acid intake increased in the Mediterranean diet groups (P<0.005 for all). Favorable, although nonsignificant, changes in intake of other nutrients occurred only in the Mediterranean diet groups., Conclusions: A 12-month behavioral intervention promoting the Mediterranean diet can favorably modify an individual's overall food pattern. The individual motivational interventions together with the group sessions and the free provision of high-fat and palatable key foods customary to the Mediterranean diet were effective in improving the dietary habits of participants in this trial.

After World War II, Japan has imported food from other countries to solve malnutrition, and then dietitians provided nutrition education to people for effective food utilization. Flour and skimmed milk imported from the United State were distributed to the school lunch program. Dietitians were trained to encourage the people to adapt western style dietary habits. The western style dietary habit issues have been brought since in 1980's as overeating and obesity have been considered as nation's health problems. In the 1990's, the prevention and treatment of lifestyle-related diseases became key objects for the nation. Government settled on "Healthy Japan 21" as a preventive policy of the lifestyle-related disease in 2000. In 2006, the middle survey for the effectiveness of the campaign was conducted, but it did not bring a good result as expected. The Ministry of Health, Labor and Welfare made the "Japanese Food Guide Spinning Top" for practical and easy mean to improve eating habits. Dietitians are in the process of developing new nutrition education using this tool. In 2005, the nine specific targets' Basic Law on Dietary Education "Shoku-Iku" was enacted to promote childhood dietary education. The Ministry of Education and Science started the new education to become a teacher called "diet and nutrition teacher" on the professional education programs of registered dietitian in university. "Diet and nutrition teachers" have already started teaching in some schools. From now, the roles of dietitians are not only supervising food preparation and planning meals but also nutrition education as teachers.

Food and nutrition professionals can play a major role in reversing the diabetes epidemic by helping patients reduce their risk for diabetes and prevent its onset. The Diabetes Prevention Program (DPP) clinical trial, spearheaded by the National Institutes of Health, has provided the research-based evidence needed to demonstrate that type 2 diabetes can be delayed or prevented through a 5% to 7% weight loss and regular physical activity, such as 150 minutes a week of brisk walking. The National Diabetes Education Program, through its "Small Steps. Big Rewards. Prevent Type 2 Diabetes" initiative, has translated the lifestyle intervention used in the DPP for health care professionals. The initiative includes a health care professional toolkit, user-friendly weight-loss materials for patients, and a mass media campaign to increase awareness that diabetes can be delayed or prevented. Food and nutrition professionals can access these materials free of charge online or through the National Diabetes Education Program clearinghouse. By applying the lessons learned from the DPP to patients at risk for diabetes, food and nutrition professionals can make a substantial contribution to reversing the diabetes epidemic.

Nutritionists working in food manufacturing and retailing are potentially in a more powerful position than any other professional group to contribute towards achieving the national targets for nutrition and the reduction of nutrition-related diseases, set out in The Health of the Nation (DoH, 1992) and in Scotland's Health, A Challenge to Us All (Scottish Office, 1993). The present paper sets out the details of this argument. First, a review is given of the functions and types of activities carried out by nutritionists in industry. Then a number of key practical ways in which nutritionists, through their activities and functions, can help towards achieving national targets for nutrition and nutrition-related diseases are described. Finally, suggestions are made about the knowledge, skills, and personal attributes needed by nutritionists who intend making successful careers in industry and who wish, at the same time, to contribute towards improving the health of the nation.

The Hamilton Health Service Organization Nutrition Program integrates nine registered dietitians (RDs) into the offices of 80 family physicians (FPs) at 50 sites in Hamilton, Ontario. The program is based on a shared care model, in which FPs and RDs work collaboratively to provide nutrition services aimed at prevention, treatment, and management of nutrition-related problems. In addition to their clinical role, dietitians in the program are involved in health promotion, disease prevention and early intervention strategies, interdisciplinary collaboration, building links with community services, and research. The RDs' specialized knowledge, skills, and experience allow them to provide a wide range of services that complement and augment those of the FP. This model is consistent with Canadian health care reform recommendations and offers significant benefits for both health care providers and consumers.

Purpose: How Canadian dietitians define and use non-dieting and size acceptance approaches (SAAs) in the context of weight management was explored., Methods: Fifteen focus groups with 104 dietitians were conducted in seven Canadian cities. Questions were designed to explore participants' understanding and use of non-dieting and SAAs, including counselling goals, techniques, and outcome measures. Sessions were tape-recorded, transcribed verbatim, coded, and analyzed using qualitative methods., Results: Participants generally agreed that non-dieting involves promoting healthy lifestyles and avoiding restrictive diets. Participants also agreed that size acceptance means accepting all body shapes and sizes and promoting comfort with one's body. Many dietitians said they use size acceptance only with appropriate clients, most often with those who are lighter or without other health risks. Others said that size acceptance, by definition, is appropriate for everyone. Opinions varied about the appropriateness of teaching portion sizes or using meal plans, and whether weight loss could be a goal of non-dieting and SAAs., Conclusions: Views on the usefulness of non-dieting and size acceptance strategies in weight management counselling were related, at least partially, to the different understanding that dietitians had of these approaches. Terminology needs to be clarified when we speak about non-dieting and SAAs. The varied understanding about these concepts should help dietitians reflect on their own perspectives and practice.

Background: The transtheoretical model of change (TTM) is an approach to behaviour change, which has been successful in increasing physical activity levels. This study examined the application of a TTM approach to increase physical activity in people with type 2 diabetes by a specialist dietitian., Methods: Forty participants were recruited to either an exercise consultation interview (ECI) or a control group. All participants received a physical activity leaflet and those in the ECI group also received a one-to-one interview with a dietitian a week after their routine appointment. Both self-reported physical activity levels and stage of change were measured at baseline and after 6 weeks., Results: Thirty-four participants (17 in each group) completed the study. Both groups showed an increase in physical activity levels. However, there was a significant difference in change of physical activity levels in the ECI group alone [F(1,32)=15.99;P

Background: Dietitians are in an opportunistic position to promote healthy eating and active living. The purpose of this study was to determine counselling strategies of dietitians 1 year after attending a workshop designed to strengthen dietitians' self-efficacy for promoting physical activity (PA) as an adjunct to regular nutrition practice., Methods: A convenience sample of Registered Dietitians (RDs) in Alberta, Canada (n=103) responded to an invitation via an electronic newsletter to complete a web-based survey that asked about counselling practices related to PA., Results: Thirty-seven workshop attendees (n=37) were compared with a group of dietitians (n=66) who completed the survey but who did not attend the workshop. Nearly all (91%) respondents reported promoting PA in daily practice. Those who attended the workshop were more likely to refer clients to PA professionals (chi2=12.68, P<0.05) than those who were not workshop attendees., Conclusions: Despite a relatively modest response rate, there were clear suggestions that RDs in Alberta, Canada promote PA in daily practice and attending a workshop designed to facilitate the use of specific tools and strategies for promoting PA in daily practice resulted in increased referral of their clients to exercise specialists.

Healthy eating and active living have become key concepts in health promotion, and, increasingly, the two messages are being combined. Dietitians are in an ideal position to promote physical activity as an adjunct to nutrition counselling. Focus group interviews were used to identify dietitians' perceptions and needs related to incorporating active living messages into their practices. Six focus groups, involving 42 participants (40 registered dietitians and two dietetic interns), were conducted in cities throughout Alberta. Issues explored during the interviews included the dietitian's role in promoting active living, barriers to promoting physical activity, opportunities for collaboration between dietitians and exercise professionals, and dietitians' perceived needs for integrating active living messages into their practices effectively. Findings indicate strong support for incorporating active living messages into nutrition counselling. However, lack of knowledge was identified as a barrier to dietitians' proactive role, and concerns were raised about public and professional perceptions if dietitians counselled on this issue. Participants felt that they required additional knowledge and training in physical activity in order to promote it effectively. Development and implementation of programs designed to meet these needs would help dietitians integrate active living messages into their practices.

Background: Convincing evidence has emerged in recent years for the role of physical activity (PA) in the prevention and treatment of many chronic diseases. These include both physical and mental health problems, which are likely to be encountered by practicing dietitians. This study aimed to identify whether NHS based Registered Dietitians (RDs) currently promote PA to their patients and if so, how they do it and with which patients., Method: An anonymous questionnaire sent to 516 RDs in NHS teaching hospitals achieved a 77% (n = 397) return rate., Results: Ninety-three per cent of respondents reported regularly promoting PA particularly with new patients. Among active PA promoters, 87% reported encouraged daily accumulation of PA, 50% focused on sport and exercise and 52% referred patients to GPs or Physiotherapists for advice. Distinctive levels and styles of PA promotion were found to be related to levels of recent training in the field although fewer than one in four had actually received any formal training., Conclusions: A high interest in further PA-specific training (95% of all respondents), together with high variability in the type and quality of advice suggests the need to develop further in-service training specifically for RDs.

The objective of this preliminary study was to apply the theory of planned behavior to explain dietitians' intentions to promote whole-grain foods. Surveys were mailed to a random national sample of registered dietitians to assess knowledge and attitudinal, normative, and control beliefs regarding intention to promote whole-grain foods, with a 39% return rate (n=776, with 628 usable surveys from those working in direct patient care). About half of the respondents had a master's degree, and 58% had substantial experience in the dietetics field. The theory of planned behavior explained intention to promote whole grains to a moderate extent (df=3, F=74.5, R(2)=0.278, P<.001). Most were positive about the health benefits, and few perceived barriers to promotion. However, many had low levels of knowledge and self-efficacy regarding ability to help clients consume more whole-grain foods. Continuing education for dietitians should use strategies that enhance self-efficacy regarding ability to promote whole-grain foods.

In the United States, the leading determinants of morbidity and mortality are rooted in behavioral choices related to eating habits, exercise, tobacco, alcohol consumption, and stress reduction. Scientific data consistently provide evidence that diet plays an important role in health promotion and disease prevention. Healthy eating habits--coupled with other healthful lifestyle behaviors--have the potential to reduce the risk of chronic disease. Health care typically assumes a curative or treatment role in the United States. However, dietetics professionals are shaping an alternate view of health, which includes developing healthy public policies, creating safe and supportive environments, building communities and coalitions, and reorienting health services to include health promotion as a primary approach to delivering health care. Individual-level approaches, such as counseling and group education, have been employed most often in modifying health behaviors. However, population-level approaches that affect availability of or access to healthy foods, opportunities for physical activity, and other healthy lifestyle determinants also are important. Dietetics professionals have pivotal roles in both individual- and population-level approaches.