The Psychology of Eating: From Healthy to Disordered Behavior

Healthy Eating 17

chapter 9, and the treatment of eating disorders is examined in chapter 11.
There is no substantial evidence for the impact of dietary change on cancer;
therefore this chapter will examine the impact of dietary change on coronary
heart disease and diabetes.

Coronary heart disease

Patients diagnosed with angina or heart disease, or who have had a heart
attack, are recommended to change their lifestyle, with particular emphasis
on stopping smoking, increasing their physical activity, and adopting a
healthy diet. The effectiveness of such rehabilitation interventions has been
assessed using randomized control trials. For example, van Elderen, Maes,
and van den Broek (1994) developed a health education and counseling
program for patients with cardiovascular disease after hospitalization, with
weekly follow-ups by telephone. Thirty CHD sufferers and their partners
were offered the intervention and were compared to a group of 30 control
patients who received standard medical care only. The results showed that
after 2 months, the patients who had received health education and coun-
seling reported a greater increase in physical activity and a greater decrease
in unhealthy eating habits. In addition, among those subjects in the experi-
mental condition (receiving health education and counseling), those whose
partners had also participated in the program showed greater improvements
in their activity and diet and, in addition, showed a decrease in their smok-
ing behavior. At 12 months, subjects who had participated in the health
education and counseling program maintained their improved eating
behavior. The authors concluded that although this study involved only a
small number of patients, the results provide some support for including
health education in rehabilitation programs.
More recently, however, van Elderen and Dusseldorp (2001) reported
results from a similar study which produced more contradictory results.
They explored the relative impact of providing health education, psycho-
logical input, and standard medical care and physical training to patients
with CHD and their partners after discharge from hospital. Overall, all
patients improved their lifestyle during the first 3 months and showed extra
improvement in their eating habits over the next 9 months. However, by
one-year follow-up, many patients had increased their smoking again and
returned to their sedentary lifestyles. In terms of the relative effects of the
different forms of interventions, the results were more complex than in the
authors’ earlier work. Although health education and the psychological