Nutrition Counseling: Getting a Food Guru (cont.)

Luckily for Bilyeu, her insurance company covered the cost. Most insurers don't. And with visits to a dietitian costing anywhere from $50 to $125 an hour, many people who might benefit from such counseling hesitate to shell out for it.

A landmark report by the National Academy of Sciences' Institute of Medicine (IOM) concludes that getting nutritional therapy is often well worth the cost. Released in December, the report cites evidence showing that dietitians can help people -- both old and young -- to manage conditions such as high blood pressure, diabetes, high cholesterol, and heart and kidney problems. For example, a study by the Department of Veterans Affairs Medical Center in Long Beach, Calif., showed that more than half the people who saw a dietitian just three or four times reduced their cholesterol so much that they didn't need cholesterol-lowering medication. What?s more, the nutrition therapy saved the health care system about $60,000 per year in prescription drug costs.

On a national level, according to the IOM report, such savings can translate into millions. If Medicare beneficiaries with high blood pressure received nutrition therapy, health care costs over a five-year period could be cut by an estimated $52 million to $167 million for hypertension alone. Findings like this led the IOM report?s authors to conclude that Medicare should cover physician-ordered nutrition counseling.

A Tailor-Made Plan

At the root of a dietitian's effectiveness is the personal attention he or she can give. Nutritional counseling provides people with an eating plan designed around their own particular likes and dislikes, making it more likely they'll stick to it.

Dietitians start by learning what their client typically eats and then suggest small changes he or she can live with. That approach is vital because most people find it hard to stick to drastic dietary changes for the long haul. Dietitians also carefully review the client's medical history, looking for any medications that might be affected by certain foods or eating patterns, and any problems with swallowing, nutrition, or digestion.

Bilyeu kept a food diary for two weeks, "so we could pinpoint where I needed to tweak my diet," she says. Most dietitians use food diaries because they help people tune in to what they're eating, how much they're eating, and even the emotions or other cues that prompted them to reach for food. "It's an awareness-raising activity," says registered dietitian Cindy Moore, director of nutrition therapy at the Cleveland Clinic Foundation and a spokesperson for the American Dietetic Association.

Many people who try nutrition therapy notice a change in their condition within a few weeks. And some find that they only need two or three visits.

Under her dietitian's guidance, Susan Bilyeu lost 20 pounds, began exercising regularly, and brought her blood sugar under control -- without expensive medications.

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