This document discusses various aspects of diet counseling including models of behavior change, communication skills for counselors, the nutrition care plan process, and tips for effective counseling. It emphasizes the importance of active listening, asking open-ended questions, reflecting clients' statements, summarizing discussions, and using a caring and non-judgmental approach to help clients make sustainable dietary changes. The overall goal of diet counseling is to build rapport, understand clients' perspectives, and facilitate behavior changes through empathy, education and action planning.

1. DIET COUNSELLING

2. DC
• Definition
• Models of Behaviour Change
• Trans theoretical model of behaviour change
• Motivational Interview-Principles
• Motivational Intervention Model

3. Communication Skills
• Objectives-Verbal & Non-Verbal
• Skills-Listening, Response, action process, Sharing Response,
observing, Paraphrasing , Reflecting
• Behaviour change: Counselling skills for resistance behaviour
• Cultural competence in counselling ABCDE approch

4. • Nutrition Care Plan

5. • Components of Counselling Process
• Strategies to promote change –Food management tools
• Behaviour change stratergy ,Cognitive restructuring
• Education during couselling

6. • Counselling sessions
• Not ready to change
• Unsure abt change
• Ready to change
• Skill Devp for OARS
• Open end questions
• Affirmations
• Reflective Listening
• Client rights

7. Registered Dietician
• A registered dietitian / clinical nutritionist / medical nutrition
therapist is an
expert in the field of food and nutrition
who knows well about food composition
 understands the various economic, social, psychological, and
physiological factors that influence food choices
and the relationship of these factors to health and diseases.
• She / he is the health care professional uniquely qualified for the role
of a nutrition communicator, who is a skilled listener and a translator
of theoretical information and abstract ideas into concrete actions
and practical skills for clients.

8. • Optimal counseling contributes to successful health and nutrition
outcomes.
• Ideally, counseling should be done in a place where the client feels
comfortable and has privacy. This may be more challenging in a busy
health facility than in a community setting, but adjustments can be
made to improve the situation.
• Counselors should be trained to understand and use support
materials such as flipcharts, counseling cards, take-home brochures,
data collection forms, and referral forms effectively.

9. counselling skills
• Counselling skills are a necessity for dietitians
 to build trust and rapport with their patients,
to comply with nutrition therapies and
to improve their dietary behaviors.
Counseling skills include both verbal and non-verbal communication.
1. Verbal communication includes actively listening to patients, using
clear language and limiting the use of nutrition / medical jargon,
expressing compassion, empathy and understanding, and being able to
communicate cross-culturally.
2. Non-verbal communication involves using body language, physical
gestures, eye contact and facial expressions.

10. • If verbal and non-verbal communication are lacking or absent, the
patient may not be motivated to comply with nutrition therapies and
change their dietary behaviors.
• Compliance among patients to comply with nutrition
• therapies and ultimately change patient’s dietary behaviors is a
critical endeavor, which can be fruitful only with good communication
skills.
• Since nutrition counselling is a conversation or dialogue between the
dietitian and client, the dietitian needs the following communication
skills in order to facilitate change:

11. • Since nutrition counselling is a conversation or dialogue between the
dietitian and client, the dietitian needs the following communication skills
in order to facilitate change:
• Attending
• Attending refers to the ways in which dietitians can be “with” their clients,
both physically and psychologically.
• Effective attending allows clients to share their world with the dietitian and
also puts them in a position to listen carefully to what their clients are
saying.
• Adopting a bodily posture and eye contact that indicates involvement with
client helps the client to speak openly.
• Try creating a relaxed or natural environment with the client and listen
carefully to what their clients are saying or not saying.

12. • Listening
• Listening refers to the ability of dietitians to capture and understand the
messages clients communicate as they tell their stories, whether those
messages are transmitted verbally or nonverbally.
• Active listening involves the following skills:
It is very important to listen to and understand the client’s verbal messages.
The dietitian has to listen to the mix of experiences, behavior and feelings
the client uses to describe his or her problems associated with diet and
health.
Also “hear” what the client is not saying (nonverbal messages).

13. • Dietitians should learn how to listen to and read nonverbal messages
such as bodily behavior, facial expressions, voice-related behavior,
observable physiological responses, general appearance, and physical
appearance. They also need to learn how to “read” these messages
without distorting or over interpreting them.
• The dietitian should listen to the whole person in the context of his or
her social settings. Empathic listening involves attending, observing
and listening in such a way that the they develop an understanding of
the client’s food habits, and their eating patterns.

14. • Basic empathy
• Š
Š
Basic empathy involves listening to clients, understanding them and their
concerns to the best possible level, and communicating this understanding
to them in such a way that they might understand themselves more fully and
act as guided by the nutritionist.
Š
• A diet counsellor must temporarily forget about his or her own frame of
reference and try to see the client’s world and the way the client sees him
or herself. This will help formulate best possible and individualized dietary
guidelines to the client.

15. • Probing or questioning
• Probing involves statements and questions from the dietitian, that enable clients to explore more
fully any relevant issue about their dietary patterns. Probes can take the form of statements,
questions, requests, single word or phrases and non-verbal prompts. Probes or questions serve
the following purposes:
• Š
Š
• Help clients to remain focussed on relevant and important issues related to diet and disease.
• Š
Š
• Help clients to move forward in the dietary practices and therapeutic process
• Š
Š
• Help clients understand their dietary patterns and their problem situations to follow dietary
regimens as advised.
• While probing

16. • While probing or questioning, the following have to be practiced:
• Use questions with caution.
• Don’t ask too many questions.
• Don’t ask a question if the answer is not of any importance.
• Although close-ended questions have their place, avoid asking too many
close-ended questions that begin with “does”, “did”, or “is”Š
Š
• Ask open-ended questions ie., questions that require more than a simple
yes or no answer.
• Start sentences with: “how”, “tell me about”, or “what”. Open-ended
questions are non-threatening and they encourage description.

17. • Ask open-ended questions ie., questions that require more than a
simple yes or no answer.
• Start sentences with: “how”, “tell me about”, or “what”. Open-ended
questions are non-threatening and they encourage description.

18. • Tips for Effective Counseling
• Do more listening than talking.
• Ask open-ended questions, not just questions clients can answer with “yes” or “no.”
• Repeat what clients say to make sure you understood them correctly.
• Show interest in and empathy for clients’ problems and situations.
• Avoid judging clients.
• Listen to what clients think and respect their feelings, even if information may need correction.
• Recognize and praise what clients are doing correctly.
• Suggest actions that are possible for clients given their situations.
• Give only a little bit of information at a time.
• Use simple language.
• Give suggestions, not commands.

19. Nutrition Care Plan
• After discussing the results of a client’s nutrition assessment and
agreeing on one or two achievable goals to improve his or her
nutritional status (other goals can be added later, after the first ones
are reached), counselors should help the client make a nutrition care
plan to achieve the goals, considering challenges the client might
face. This can be kept in the client’s file or given to the client to take
back to the health facility on follow-up visits. Below is a sample
nutrition care plan.

20. What can Nutrition Counselling focus On
• The causes of malnutrition are directly related to inadequate dietary
intake and disease but indirectly related to many other factors,
including child care and feeding, sanitation, and hygiene. Counseling
should address these various factors to result in sustainable change.
This section presents guidance on the content of nutrition counseling.

21. • Summarizing
• It is always useful for the diet counsellor to summarize what was said in a
session so as to provide a focus to what was previously discussed, and so as
to challenge the client to move forward with the prescribed dietary
practices. Summaries are helpful under the following circumstances:
• At the beginning of a new diet counselling session, summary can give
direction to clients who do not know where to start; it can prevent clients
from merely repeating what they have already said, and it can direct a
client to move forward.
• When a session seems to be going nowhere, a summary may help to focus
the client.
• When a client gets stuck, a summary may help to move the client forward,
so that he or she can investigate other aspects of diet and health.

22. • Communication is an essential dietetic practice competency. The goal of client-RD relationship is a
mutual understanding of client-centred nutrition services, to communicate and effectively implement
dietary changes for a positive health outcome. Effective communication include establishing
rapport, speaking clearly, listening, having empathy and knowing how to give and receive feedback
and making sure clients understand dietary treatment options for reported health issues. It is also
important to have awareness of how much information a client can handle. This requires identifying
barriers in communication by listening to clients and carefully observing how they react to a given
volume of information. Communication skills along with dietetic knowledge and skills, attitudes,
values, and goals, all contribute to the quality of dietary treatment.

23. • Counseling on how to increase energy intake
• Eat mashed bananas, baked bananas, sweet potatoes, nuts, or porridge enriched with oil and sugar. Add
honey to staple foods.
• Add milk, cheese, or oil to foods.
• Fortify milk by adding 4 spoons (15 ml) of milk powder to 500 ml of milk. Stir well and keep in a cool place.
Use full-fat milk powder if available instead of skim milk powder. Use this fortified milk in tea, on cereals, and
in cooking.
• Add yogurt to soups, puddings, cereals, and drinks.
• Stir a beaten egg into porridge or mashed potatoes and cook for a few minutes more to cook the egg. Do not
eat raw eggs.
• Put nut paste, jam, butter/margarine, or tinned fish on bread.
• Eat nuts as a snack and put chopped nuts on food or add nut paste to food.
• Eat foods rich in fat, such as avocado, fatty fish, coconut, oil, and fried foods, if tolerated.
• Eat fermented and germinated (sprouted) foods.

24. • Counseling on how to address moderate malnutrition
• Eat regular meals, even if you have been prescribed fortified blended food, which is meant to supplement
the home diet.
• Eat not only cheap staple foods to provide energy and protein, but also foods from all food groups.
• Eat foods with essential fatty acids (fish and shellfish, oil, pumpkin seeds, sunflower seeds, and leafy
vegetables).

25. Nutrition counseling for people with non-communicable
diseases
• There is a rising global epidemic of non-communicable diseases (NCDs), including
cardiovascular disease, stroke, hypertension, cancer, and metabolic diseases such
as diabetes and obesity. It is projected that by 2030, NCDs will account for 46
percent of all deaths in sub-Saharan Africa.12 Nutrition therapy is part of
treatment guidelines for cardiovascular disease, diabetes, hypertension, kidney
disease, and chronic obstructive pulmonary disease (COPD). Nutrition counseling
for people with NCDs should focus on the following recommendations:
• 1. Eat less sugar and avoid sugary drinks.
• 2. Avoid processed foods.
• 3. Eat plenty of fruits and vegetables to get needed vitamins and minerals.
• 4. Get regular exercise.
• 5. Eat more fiber from fruits, vegetables, whole grains, pulses, and nuts.
• 6. Eat fewer fatty and fried foods.