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7. Life Science Research Office, Federation of AmericanSocieties for Experimental Biology. Third Report onNutrition Monitoring in the United States. Washing-ton, DC: US Government Printing Office; 1995.DHHS Publication No (PHS) 89-1255.

8. Food and Nutrient Intakes by Individuals in theUnited States, by Sex and Age. 1994-1996. Washing-ton, DC: US Department of Agriculture, AgricultureResearch Service; 1998. NFS Report No. 96-2.

9. Borra S, Kelly L, Tuttle M, Neville K. Developing ac-tionable dietary guidance messages: Dietary fat as a

case study. J Am Diet Assoc. 2001;101:678-684.

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doi: 10.1016/j.jada.2004.02.020

0. Bandura A. Self-efficacy mechanism in humanagency. Am Psychol. 1982;37:122-147.

1. Bernhard J, Sullivan M, Hurny C, Coates AS, Ruden-stam C-M. Clinical relevance of single item quality oflife indicators in cancer clinical trials. Br J Cancer.2001;84:1156-1165.

2. Tinker LF, Perri MG, Patterson RE, Bowen DJ,McIntosh M, Parker LM, Sevick M, Wodarski LA.The effect of physical and emotional status on adher-ence to a low-fat dietary pattern in the Women’sHealth Initiative. J Am Diet Assoc. 2002;102:789-

794, 799-800.

PPLICATIONS

etting Goals and Empowering Lifestyle Modification

here are many attributes and characteristics thatare important to obtaining success in a dietarychange program, whether it is for participants in a

esearch study, a group of new moms in WIC (the Specialupplemental Nutrition Program for Women, Infants,nd Children), or patients getting ready to go home aftercoronary artery bypass graft. It is important to distin-

uish which characteristics promote the best controllong with assuring that, through dietary adherence to apecific program, overall nutrition quality is maintained.inters and associates showed that strict adherence to a

educed fat program in the Women’s Intervention Nutri-ion Study (WINS) was obtained by following the fiverinciples of the WINS Low-Fat Eating Plan while stillaintaining nutrition integrity (1).Winters and colleagues set out with a group of 163

ostmenopausal women treated for early stages of breastancer. They decided to assess the food choices of thoseho achieved the fat gram goal of 15% of energy from fat,hich equaled approximately 20 to 30 g fat per day.hese women were deemed strictly adherent to the as-igned dietary intervention. These participants achievedhis adherence by reducing intake of subgroups of theood guide pyramid such as sweet breads and pastries,heese, beef, pork, and lamb. The participants accom-lished this without compromising micronutrient intake.he most important strategies utilized by the partici-ants included the elimination of high-fat foods, reducedortion sizes, and a decrease in fat grams per serving.dditionally, self-efficacy played a very important role.he authors found that in this group the strictly adherenteported having less difficulty in following the diet, alongith reporting more satisfaction with their lives. Thisdds to the body of evidence that individuals must per-eive lifestyle modification as accomplishable.

his article was written by Kimberly Thedford, MS,D, acting associate editor of the Journal in Chicago, IL.

This research reinforces the concept of individualizingroad nutrition plans. It is important to understand allspects of the patient to provide them with the tools tobtain success. The primary goal is to tailor the interven-ion to become achievable and encourage the motivatoror adherence. According to Borra and colleagues, nutri-ion messages must engender a sense of empowerment2). They should also build the patient’s confidence in

aking healthy choices.To make a goal achievable, encourage the patient to

reate specific and realistic goals. This process can beone by working with the patient to determine what he orhe considers an obtainable goal. The patient can thenecide, with the dietitian as a guide, how to take steps tochieve dietary adherence. Allowing the patient to sethese goals encourages the sense of empowerment. It ismportant for both the patient and the counselor to un-erstand why the patient chose these goals. Working withhe patient in this process allows the dietitian to under-tand the resources the patient has available to him orer and gives the dietitian insight on the motivator fordherence. Armed with this knowledge, the dietitian canollow up with the patient and provide guidance specifico the patient’s circumstances.

The bottom line for dietitians is that we need to providelear information, encourage specific strategies, and em-ower our patients on how to obtain success with dietaryntervention programs. This research supports this ap-roach in addition to clearly showing how success can bechieved within a free-living population.

eferences. Winters BL, Mitchell DC, Smiciklas-Wright H, Gros-

venor MB, Liu W, Blackburn GL. Dietary patterns inwomen treated for breast cancer who successfully re-duce fat intake: The Women’s Intervention NutritionStudy (WINS). J Am Diet Assoc. 2004;104:551-559.

. Borra S, Kelly L, Tuttle M, Neville K. Developingactionable dietary guidance messages: Dietary fat as a

case study. J Am Diet Assoc. 2001;101:678-684.

Journal of THE AMERICAN DIETETIC ASSOCIATION 559