New food guide ought to get you talking turkey

By M M Hannan

Canada's Food Guide has been updated. "So what?" you might be thinking, "my patients aren't interested in changing their lifestyles." Physicians have a tough time talking about diet with their patients. Not only is it a delicate topic to bring up (everybody's sensitive about their weight), most clinicians simply don't have the time to get the message about healthy eating across to their patients. "There's good evidence that people whose physician talks to them about nutrition do better," says Dr Diane Finegood, a scientific director of nutrition at the Canadian Institute of Health Research (CIHR). So while the new version of the 65-year-old food guide isn't going to set the world on fire, its simple, common sense advice is as good a place as any to get a conversation started about healthy food choices.

WHAT'S NEW
The 2007 edition of Canada's Food Guide is the result of four years and $1.5 million worth of work. The authors scoured the latest research and consulted the public, industry and health stakeholders to come up with the recommendations. The four food groupings — milk, meat, fruit & veg and bread & cereals — are the same, but a wider variety of foods commonly consumed by immigrant populations — like tortillas, bok choy and okra — are now included.

The guide has added advice on food intake according to age and gender. It also fingers the junk food that people should "limit" and has a box on the perils of trans fats. Everyone over the age of 50 is advised to take vitamin D supplements.

GET PATIENTS ON BOARD
If anyone knows Canadians are getting fatter, it's you the physician. The bellies you palpate have been getting bulkier for years. But lifestyle issues are hard to change and frustrating to contend with. "The healthcare system doesn't support physicians to spend time on this," notes Dr Finegood. But studies show physicians are well-placed to get patients on the path to lifestyle change. One US study in the Archives of Internal Medicine found that just eight minutes of counselling by nutrition-trained physicians resulted in hyperlipidemic patients reducing their saturated fat intake by 10% and losing over 2kg after a year.

Armed with your shiny new Canada's Food Guide pamphlet, you may want to break the ice by mentioning you too struggle to make healthy choices and that the guide is a timely reminder for everyone. Ask them about their food weaknesses, then negotiate some realistic goals together. For instance, if they're hopelessly tempted by the crullers at Tim Horton's on their way to work, try to get them to drink their coffee at home out of harm's way — and with a good healthy breakfast at hand. Assure them it will be just as fast as waiting in line at the drive through.

Most nutrition experts recommend getting patients to complete a Food Diary to get them thinking about what they're eating. Download a diary off the internet (they're everywhere) and have a stack of photocopies ready to hand out along with a copy of the food guide (send net-savvy patients to www.EATracker.ca for an online diary). Ask patients to be as honest and detailed as they can, to identify their problem areas and to use Canada's Food Guide to make some adjustments. At their next appointment follow up with them and discuss ways to make further improvements.

A useful mnemonic mantra here is the 5As (Address the agenda, Assess, Advise, Assist, Arrange follow up).