Dietitians as behavior--change agents.

The traditional relationship between the client and the dietitian or nutritionist has been that of student and teacher. In the past, a patient has received excellent dietary counseling and advice from the dietitian, but has often ignored what he or she has taught. Until recently, the referring physician could only blame the patient, the dietitian, or both for this failure. Dietitians needed some new tools. The behavioral sciences have taken a new look at the problems of obesity, including a new assumption, viz.at some time, the obese have learned to eat in a way that results in excess caloric intake. Treatment now includes not only nutritional and caloric instruction, but also an attempt to change eating habits and behaviors. With these new tools, the dietitian-teacher becomes a dietitian-behavior-change agent; in addition to food content, the context of food becomes important in dietary counseling. Although dietitians are not usually trained in behavioral counseling, the weight loss in groups led by dietitans, after only minimal instruction, is comparable to that reported for groups led by psychiatry residents.