“Dietary patterns and quality are not sufficiently prioritized when addressing modifiable risk factors during regular health care office visits,” says Maya Vadiveloo, PhD, RD, an assistant professor in nutrition and food sciences at the University of Rhode Island in Kingston and lead author of the new statement. “Given the evidence that diet contributes to disease and mortality, it is a risk factor worth screening for continuously,” Vadiveloo adds. This won’t necessarily be easy, the American Heart Association concedes, noting that a lack of understanding about the role of diet in preventing disease isn’t what stops most doctors from taking about food with patients. What really keeps these discussions from happening is a lack of time during brief office visits, too little training on how to offer nutrition counseling, limited options for referring patients to registered dietitians, and scant insurance coverage, according to the AHA. “However, these barriers can be overcome,” Vadiveloo says. RELATED: Why Are Healthy Eating Habits Important?
How Rapid Screening Tools Can Help Identify Poor Dietary Habits
To make routine diet screenings easier for doctors to do, the AHA vetted 15 different tools that focus on the total diet instead of single food groups or nutrients. The goal was to find screening tools that take less than 10 minutes to complete, can be used by clinicians without nutrition training, provide immediate guidance on healthy dietary changes, and link to electronic health records to track eating habits over time. While the AHA didn’t endorse a specific tool, three options stood out for providing the best rapid snapshot of eating habits:
Powell and Greenberg Screening Tool This asks two questions about fruit and vegetable consumption and sugary food and juice intake.Rapid Eating Assessment for Participants-Shortened (REAP-S) This asks 15 questions that touch on servings of whole grains, fruits, and vegetables, as well as cooking and snacking habits.Mediterranean Diet Adherence Screener (MEDAS) This asks 14 questions that cover consumption of healthy fats like olive oil, fruits and vegetables, fish, and red meat.
RELATED: The Best and Worst Fats for Heart Health
Screening Tools Work, Scientific Evidence Shows
Research dating back several decades has linked diet screening and counseling in the doctor’s office to a range of positive health outcomes, including reductions in body weight, blood pressure, blood sugar, and cholesterol, the AHA notes. Previous research, for example, found that participants who got nutrition counseling from physicians had lower weight, consumed less saturated fat, and had lower cholesterol than individuals who didn’t receive this support. A more recent review by the U.S. Preventive Services Task Force linked diet and exercise counseling with improvements in cholesterol, blood pressure, blood sugar, and weight outcomes in people at high risk for cardiovascular disease. And a study published in April 2019 in Applied Physiology, Nutrition, and Metabolism found dietary assessment and counseling was associated with increased consumption of fruits, vegetables, and nuts, as well as reduced intake of processed baked goods. RELATED: Not Eating Enough Fruits and Veggies Contributes to Cardiovascular Risks
Doctors Need Training in Nutrition Counseling
And yet, for routine dietary screening and counseling to work in a primary care setting, doctors need to know how to give individualized nutrition advice, says Susan Roberts, PhD, a senior scientist at the U.S. Department of Agriculture Nutrition Center at Tufts University in Medford, Massachusetts, and founder of the iDiet weight management program. “Physicians have very little expertise in giving healthy dietary advice beyond generalities, so ideally if physicians are doing this screening, they will receive education to help them provide good advice based on the results,” says Dr. Roberts, who was not an author of the current paper. Otherwise, doctors need to refer patients to a registered dietitian for nutrition counseling, which may be hard for many patients to access or afford, Roberts says. RELATED: A Detailed Guide to Using MyPlate for Healthy Eating
How to Self-Evaluate Your Diet and Improve Your Eating Habits
If your doctor doesn’t offer diet screening or counseling at your next checkup, AHA dietary guidelines available online may help you see where there’s room for improvement in your eating habits, says Vadiveloo. Broadly speaking, the AHA recommends a diet rich in a variety of fruits, vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts, and legumes. A healthy diet also limits saturated and trans fats, sodium, red meat, sweets, and sodas and other sugary drinks. Eating patterns that meet these heart-healthy criteria include the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean eating plans, according to the AHA. RELATED: How to Make Over Your Diet for a Healthier Heart
