Behavior change theories and models, validated within the field of dietetics, offer systematic explanations for nutrition-related behavior change. They are integral to the nutrition care process, guiding nutrition assessment, intervention, and outcome evaluation. The American Dietetic Association Evidence Analysis Library Nutrition Counseling Workgroup conducted a systematic review of peer-reviewed literature related to behavior change theories and strategies used in nutrition counseling. Two hundred fourteen articles were reviewed between July 2007 and March 2008, and 87 studies met the inclusion criteria. The workgroup systematically evaluated these articles and formulated conclusion statements and grades based upon the available evidence. Strong evidence exists to support the use of a combination of behavioral theory and cognitive behavioral theory, the foundation for cognitive behavioral therapy (CBT), in facilitating modification of targeted dietary habits, weight, and cardiovascular and diabetes risk factors. Evidence is particularly strong in patients with type 2 diabetes receiving intensive, intermediate-duration (6 to 12 months) CBT, and long-term (>12 months duration) CBT targeting prevention or delay in onset of type 2 diabetes and hypertension. Few studies have assessed the application of the transtheoretical model on nutrition-related behavior change. Little research was available documenting the effectiveness of nutrition counseling utilizing social cognitive theory. Motivational interviewing was shown to be a highly effective counseling strategy, particularly when combined with CBT. Strong evidence substantiates the effectiveness of self-monitoring and meal replacements and/or structured meal plans. Compelling evidence exists to demonstrate that financial reward strategies are not effective. Goal setting, problem solving, and social support are effective strategies, but additional research is needed in more diverse populations. Routine documentation and evaluation of the effectiveness of behavior change theories and models applied to nutrition care interventions are recommended.
2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.
Rigby RR, Mitchell LJ, Hamilton K, Williams LT. Rigby RR, et al. J Acad Nutr Diet. 2020 Jul;120(7):1172-1197. doi: 10.1016/j.jand.2020.03.019. Epub 2020 May 20. J Acad Nutr Diet. 2020. PMID: 32444328
Henderson JT, Henninger M, Bean SI, Senger CA, Redmond N, O’Connor EA. Henderson JT, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Aug. Report No.: 19-05260-EF-1. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Aug. Report No.: 19-05260-EF-1. PMID: 32970399 Free Books & Documents. Review.
Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Patnode CD, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Jul. Report No.: 15-05222-EF-1. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Jul. Report No.: 15-05222-EF-1. PMID: 29364620 Free Books & Documents. Review.
Robinson K, Rozga M, Braakhuis A, Ellis A, Monnard CR, Sinley R, Wanner A, Vargas AJ. Robinson K, et al. J Acad Nutr Diet. 2021 Mar;121(3):553-581.e3. doi: 10.1016/j.jand.2020.04.001. Epub 2020 Jul 3. J Acad Nutr Diet. 2021. PMID: 32624394
Lemon CC, Lacey K, Lohse B, Hubacher DO, Klawitter B, Palta M. Lemon CC, et al. J Am Diet Assoc. 2004 Dec;104(12):1805-15. doi: 10.1016/j.jada.2004.09.024. J Am Diet Assoc. 2004. PMID: 15565074
Ferraris C, De Amicis R. Ferraris C, et al. Front Nutr. 2024 Aug 16;11:1472316. doi: 10.3389/fnut.2024.1472316. eCollection 2024. Front Nutr. 2024. PMID: 39221166 Free PMC article. No abstract available.
Shibib L, Al-Qaisi M, Guess N, Miras AD, Greenwald SE, Pelling M, Ahmed A. Shibib L, et al. Diabetes Metab Syndr Obes. 2024 Aug 23;17:3111-3130. doi: 10.2147/DMSO.S458894. eCollection 2024. Diabetes Metab Syndr Obes. 2024. PMID: 39206417 Free PMC article. Review.
Ali HI, Al Ketbi LB, Platat C, Abdl El Baki H, Elmi F, Ibrahim W, Zoubeidi T, Al Dhaheri AS, Cheikh Ismail L, Tariq MNM, Souka U, Yasin J, Stojanovska L. Ali HI, et al. PLoS One. 2024 May 31;19(5):e0304639. doi: 10.1371/journal.pone.0304639. eCollection 2024. PLoS One. 2024. PMID: 38820345 Free PMC article. Clinical Trial.
Neri LCL, Mariotti F, Guglielmetti M, Fiorini S, Tagliabue A, Ferraris C. Neri LCL, et al. Front Nutr. 2024 May 9;11:1250683. doi: 10.3389/fnut.2024.1250683. eCollection 2024. Front Nutr. 2024. PMID: 38784136 Free PMC article.
Kihagi GW, Hansen LS, Agure E, Muok EMO, Mank I, Danquah I, Sorgho R. Kihagi GW, et al. BMC Health Serv Res. 2024 May 7;24(1):597. doi: 10.1186/s12913-024-10872-w. BMC Health Serv Res. 2024. PMID: 38715044 Free PMC article.