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Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale.

The USPSTF found fair evidence that brief, lowto mediumintensity behavioral dietary counseling in the primary care setting can produce small to medium changes in average daily intake of core components of an overall healthy diet (especially saturated fat and fruit and vegetables) in unselected patients (see “Scientific Evidence” for discussion of patient populations and intensity of interventions). The strength of this evidence, however, is limited by reliance on self reported diet outcomes, limited use of measures corroborating reported changes in diet, limited follow up data beyond 6 to 12 months, and enrollment of study participants who may not be fully representative of primary care patients. In addition, there is limited evidence to assess possible harms (see “Clinical Considerations”). As a result, the USPSTF concluded that there is insufficient evidence to determine the significance and magnitude of the benefit of routine counseling to promote a healthy diet in adults. Although community-based studies have evaluated measures to reduce dietary fat intake in children, no controlled trials of routine behavioral dietary counseling for children or adolescents in the primary care setting were identified.