The menu of lifestyle intervention

The primary individuals involved in lifestyle intervention are the patient and the clinician. Family and friends are also important in providing social support if the patient consents to their involvement. Furthermore, research has shown that the involvement of family and friends in lifestyle intervention is more successful compared with participating in interventions alone. The centre of lifestyle intervention is the patient, as their needs and behaviours directly lead the programme. A complete nutrition assessment is the foundation of the programme, such as the anthropometric and biochemical measurements, clinical signs and symptoms, dietary assessment, medical history, and family history. Secondly, a registered dietitian and nutritionist should be involved.

A dietitian is a qualified health professional who can provide general health advice and also work with people who have special dietary needs due to their health conditions. In comparison, a nutritionist can advise on food and healthy eating, but not on special diets or medical conditions. Other patient’s medical team members who overlook the patient’s medical care should be involved in the intervention. For example, the patient’s endocrinologist may need to be included in the programme if the patient has diabetes. Or a cardiologist may need to be involved if the patient has cardiovascular disease. There are two important components for lifestyle intervention. One is diet and the other is physical activity. Dietary modification is fundamental for treating metabolic disease.

For example, an energy restricted diet is designed for the patients who require a weight management programme. Salt reduction and limiting protein intake is encouraged in patients with chronic kidney disease. Foods that are high in fibre, low in carbohydrates, reduced saturated fats and trans fats, and low sodium are recommended to patients with type 2 diabetes. Physical activity is the main modifiable factor in energy expenditure. Daily activities should be tailored individualised plans based on patient’s health status and current activity level. An endorsed health care specialist in exercise and physical activity should be included as part of the programme.

Other components, such as when the intervention should be initiated, the duration and frequency of the intervention, and where the intervention will take place would also need to be considered and agreed upon between the clinician and the patient. Sustainable diet and physical activity changes can be challenging, as it’s influenced by several factors, such as the patient’s knowledge and attitudes towards food and nutrition, psychological disturbances, and environmental factors. All of these influential factors should be examined and monitored carefully. There are recommended behavioural modification strategies that can maximise the programme’s effectiveness. Goal setting can be a valuable process to help people make changes to their lifestyle.

For example, goals for achieving a healthy body weight should be set once a patient enrols in a weight management programme. Secondly, motivational interviewing is led by a clinician who asks a series of open-ended questions to help the patient fully explore his or her motivations or hesitations to participate in the programme. Thirdly, self-monitoring. Throughout intervention patients are asked to actively monitor various target behaviours and related factors by using a patient log. It can be used as a tool for reflection and could be analysed for nutrient and food intake by the nutritionist. Another strategy is cognitive restructuring and advanced psychotherapy technique for reframing negative thoughts and emotions, unrealistic expectations, and all or nothing thinking.

During the process the clinician helps the patient identify their negative thoughts towards the intervention goal and helps the patient think more rationally. In addition to cognitive restructuring, using a strategy of relapse prevention and problem-solving to prevent the patient from returning to old habits is also essential. Usually, the clinic sets up questions by creating hypothetical situations and discussing what behaviours he would perform when encountering new situations and problems. So this strategy of relapse prevention and problem-solving aims to ensure the patient has the appropriate skills to cope with potential relapses and difficulties. In summary, a comprehensive lifestyle intervention should consider who and what should be involved in the intervention duration and location.

To improve the patient’s adherence to the intervention programmes, the clinician should attempt to implement the behaviour modification strategies. Although it may not be effective for all patients.