Family physicians can provide helpful dietary advice that is efficient and uncomplicated. Key themes include emphasizing whole foods that are primarily made from plants, limiting ultra-processed products, and flexibility to accommodate taste preferences and familiar foods. Healthy eating can be achieved across a range of dietary patterns, cultural traditions, and nutrient distributions. The best diet for any given patient will be one they can maintain. However, the strongest evidence for producing sustained dietary change comes from comprehensive moderate-contact programs, which are generally beyond what primary care physicians can provide. When lack of time, training, and comfort are obstacles to having comprehensive in-clinic conversations about diet, family physicians can refer patients to specialists trained in nutrition and behavior change. For patents with complex needs, collaboration with dietitians can optimize clinical outcomes.
Many conditions that family physicians manage relate to diet, but connections between specific dietary intakes and health outcomes are often uncertain.1 Generally, controlled dietary research lacks blinding and has poor adherence. Many observational studies of diets face significant confounders and various exposure outliers that change over time.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Emphasize minimally processed plant-focused diets to reduce risk of chronic disease and mortality.4,5 | B | Consistent evidence from prospective cohort studies and meta-analyses showing associations with reduced all-cause and cardiovascular mortality |
| Counsel patients to reduce intake of ultra-processed food to improve cardiovascular health and weight management.11,12,17,19,20 | B | Small randomized controlled trials demonstrating changes in calorie intake and weight, as well as systematic reviews of observational data linking intake to chronic disease |
| Use culturally responsive dietary counseling that incorporates traditional food staples to improve adherence.21,22,24 | C | Expert consensus and narrative reviews |
| Refer patients with cardiovascular risk factors to moderate- or high-intensity dietary intervention (≥ 6 contact hours) programs with a registered dietitian nutritionist to reduce cardiovascular events and improve lipid levels and blood pressure.26 | B | US Preventive Services Task Force systematic review with moderate-quality evidence that interventions of ≥ 6 hours improved patient- and disease-oriented outcomes |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
Family physicians can help patients by emphasizing three key themes for healthy eating: prioritizing whole foods that are primarily made from plants; limiting ultra-processed products; and promoting flexible, culturally adapted dietary patterns (Table 12). When patients need more in-depth education, collaboration with dietitians can improve outcomes.
TABLE 1. Key Themes for Healthy Dietary Advice in Clinical Practice
| Advice | Counseling tip | Example counseling prompts |
|---|---|---|
| Favor foods from plants and foods that are no more than minimally processed | Propose striving to eat a green salad every day or a vegetable with every meal Suggest regularly incorporating beans, lentils, and peas into favorite dishes For patients who snack, encourage nuts, seeds, whole fruit, or sliced vegetables Encourage use of herbs and spices |
“Rather than focusing on specific vitamins or macronutrients, let's work toward filling more of your plate with fruits and vegetables.” “Would you be open to trying a new bean recipe, or maybe blending lentils into a dish you already love?” |
| Reduce intake of ultra-processed products | Point out that some of the healthiest foods have labels with only one or two ingredients—or no labels at all Avoid buying ready-to-heat, ready-to-eat, prepackaged items with long lists of nonfood ingredients For thirst, suggest plain water or unflavored seltzer; if desired, fresh fruit (eg, a citrus wedge) or frozen fruit (eg, dark berries) can add healthy color and flavor |
“If the ingredient list is long and sounds like a chemistry experiment, it's probably ultra-processed and a food you want to limit or avoid.” “Eat things your grandmother would recognize as food.” |
| Promote flexible, culturally adapted diet patterns | Avoid prescribing specific macronutrient ratios or various named diets Incorporate culturally familiar foods and embrace cherished food traditions |
“Tell me about the foods you grew up eating.” “What foods do you consider an important part of your heritage?” “Are there comfort foods you just couldn't imagine going without?” |
Information from reference 2.
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