Healthy Eating 19- The benefits of weight loss on glycemic control will occur within 2 or
3 months. - Patients should not be criticized for failing to lose weight, and weight
cycling should be avoided.
Dietary interventions for diabetes take the form of either primary care
or hospital-based educational input involving one-to-one contact, lectures,
or group discussions. Dietary advice is often given alongside other general
health advice, as those with diabetes are at increased risk of coronary heart
disease. Much research has addressed the effectiveness of these interven-
tions. For example, Beeney and Dunn (1990) evaluated the impact of five
hospital-based diabetes education programs in Australia on 558 patients,
and reported that although the educational interventions resulted in
improved diabetes knowledge, this did not correlate with improved
metabolic control. In an attempt to improve the effectiveness of educational
input for diabetes, Wing and colleagues have varied interventions for
diabetes in terms of a range of factors. For example, they have altered the
intensity of the intervention, the length of follow-up, the type of interventions
used (e.g., a very low-calorie diet versus the usual care), and whether the
intervention is targeted at individuals with diabetes or those at risk due to
familial history (e.g., Wing, 1993; Wing et al., 2001). Evaluations of such
interventions indicate that although they may improve knowledge, change
beliefs, and create some change in diet, weight, and even metabolic con-
trol in the short term, attrition rates are high and levels mostly return to
baseline in the longer term. This pessimistic picture is similar to that for
obesity described in chapter 9, and indicates that improving diabetes self-
care is a difficult task. Recently there has been an interest in developing
interventions for diabetes which are tailored to the individual and draw
upon the theoretical perspectives described by the stages of change model
(Prochaska and DiClemente, 1984) and social cognition theories (e.g.,
Ajzen and Fishbein, 1970; Ajzen, 1985). Such an approach involves brief
but intensive one-to-one interventions and focuses on the motivation and
self-efficacy of the individual (Clark and Hampson, 2001). Analysis of the
effectiveness of this approach remains in its early stages.
In summary, at the point of writing this book there are clear recom-
mendations concerning what constitutes a healthy diet. Whether these
recommendations remain consistent over the next few years remains to be
seen. There is also a substantial literature exploring the impact of diet on
health, and the evidence suggests that apart from weight per se having an