The effectiveness of the nutrition assessment and counseling session is based on the adequacy of the interview process and communication skills of the educator. The dietary counseling process will be most effective when the nutritionist does not evaluate diet habits but provides new guidelines in an effort to minimize defensiveness about habits that contributed to weight gain. Each person knows they need to change lifestyle habits but encouragement and support for the change will be more effective than judging previous mistakes .
Instead of judging poorly controlled diabetes, a better approach is to discuss which foods in the diet need to be changed or reduced. An example from the author’s experience over 20 years ago is telling an obese patient that “they were being irresponsible” because they ate a whole box of chocolates instead of one or two pieces. The patient went back to the physician complaining about, “how judgmental I was and never wanted to see me again.”
A person-centered approach to nutrition counseling advocated by Carl Rogers, PhD [13,14] needs to be the norm for helping obese individuals adjust to new guidelines for a healthier life. Behavior modification with self-monitoring and record keeping of a diet and weight journal can increase counselor-patient interaction, which allows a better self-monitored behavior for long-term success . Unfortunately, insurance companies require only one nutrition counseling session for the patient prior to surgery and nothing postsurgery when behavior changes are most critical.