How do you help a patient understand they need to change their diet?

First understand why the patient's current diet is important to them. Cultural patterns come in strongly here. In our medical office we saw many patients with diabetes (1 and II) who are from countries where rice is paramount and may be eaten with every meal during the day. These patients are NOT going to give up eating rice, so we try to get them to decrease the amounts first, and then only eat it once daily eventually. Scientific explanations and ocnsutls with dieticians only go so far. Food is such an emotional issue that modification takes a long time and needs to be approached with sensitivity to cultural norms. Also consider the patietn's economic status. Often patients will eat cheap and filling food because that's all they can afford. What are community supports or resources for them? Can they grow their own vegetables in the summer (adds exercise as well!) as some of our patients do? Can they cook? Do they have the necessary skills or are they relyingon prepared (high fat and high carb) foodstuffs? Do they have an adequate kitchen where they reside? Who does the cooking if they don't? This means getting more than the patient involved in your discussion. The most important thing before any change can take place is understanding why they are happy(or complacent) where they are in their dietary patterns.

Don’t waste your time. But when a patient asks, I tell them to eat “clean”. I am an old man, 12% body fat, workout 3 times a week, and take no medications. I tell them I eat whatever I want because I stay away from processed foods. I buy my meat from a butcher and get veggies from a farmers market. No more expensive than the crap sold in stores. Don’t tell them “stop eating” whatever. I have no idea how effective this is because I never see them again, but that is what I tell them if they ask.