18 Healthy Eating
intervention had an improved impact on eating habits over standard
medical care and physical training, some changes in lifestyle were more
pronounced in the patients who had received only the latter. For example,
receiving health education and psychological intervention seemed to make
it more difficult to quit a sedentary lifestyle, and receiving health education
seemed to make it more difficult to stop smoking. Therefore, although
some work supports the addition of health education and counseling to
rehabilitation programs, at times this may have a cost.
In 1999, Dusseldorp et al. carried out a meta-analysis of 37 studies examin-
ing the effects of psychoeducational programs (health education and stress
management) for coronary heart disease patients. The results indicated that
such programs produced a 34 percent reduction in cardiac mortality, a
29 percent reduction in recurrence of heart attack, and significant positive
effects on blood pressure, cholesterol, body weight, smoking behavior,
physical exercise, and eating habits. However, the educational programs had
no effects on whether the patient had subsequent surgery, or on their mood.
Therefore changing diet as part of a complex series of lifestyle changes seems
to result in improved health in both the short and longer term.
Diabetes mellitusDietary change is central to the management of both Type 1 and Type 2
diabetes. At times this aims to produce weight loss, as a 10 percent decrease
in weight has been shown to result in improved glucose metabolism
(Blackburn and Kanders, 1987; Wing et al., 1987). Dietary interventions
are also used to improve the self-management of diabetes, and aim to encour-
age diabetic patients to adhere to a more healthy diet. Patients with Type 1
diabetes should receive individualized dietary advice from their health
professionals. More general advice can be given to those with Type 2
diabetes. In 1998, Nuttall and Chasuk reviewed the literature on dietary
management and diabetes and described the following as “general principles”
of the nutritional management of Type 2 diabetes:
- Dietary recommendations for diabetes patients should reflect those for
healthy eating aimed at the general population. - These recommendations should be flexible and target the individual needs
of each patient. - Sugar does not need to be restricted more than for a healthy diet.
- Readily digestible starches raise the blood glucose more than sugars.