When it comes to behavioral nutrition management, a patient-centered model that includes ongoing education, a nutrient-dense diet, and a process approach to behavior change can lead to success.

For patients with type 2 diabetes, a multi-prong management approach that includes diet, exercise, medications, and behavioral changes is common. While medications designed to help patients manage their blood-glucose levels (e.g., metformin, semaglutide, or insulin) can be critical pieces of a type 2 diabetes management plan, nutrition management is also a critical component to type 2 diabetes management. A behavioral approach to nutrition can empower patients to take ownership of their health, because it can offer insight into the underlying thoughts and behaviors that may be influencing food choices. This applies to both GLP-1 and non-GLP-1 patients.

A behavioral approach to nutrition management for patients with type 2 diabetes has been shown to facilitate weight loss when certain conditions are met. For example, the most successful models are patient-centric and include ongoing patient education. A patient-centered approach to behavioral nutrition management must include consideration for a patient’s culture, social, economic, and environmental characteristics.¹ Working with patients to build a nutrient-dense eating plan coupled with a process-oriented approach (e.g., mindful eating and eating competence) to behavior change could better support patients with type 2 diabetes through their weight loss journey.

Nutrition Management for Type 2 Diabetes

One overarching goal of type 2 diabetes management is improving long-term glycemic control such that the risk for premature death or complications is mitigated.² Calorie restriction and carbohydrate-related macronutrient recommendations are two strategies that are commonly proposed for the nutritional management of type 2 diabetes.

Low glycemic diets are commonly suggested for patients with type 2 diabetes because they offer a framework for managing carbohydrate intake. A low glycemic index diet awards points to foods, and patients are counseled to select foods that generally have lower points assigned to them to minimize negative effects on their blood sugar.

While research has shown that a low glycemic index diet can lower A1c, it is important to consider that a patient may struggle with tracking low glycemic and high glycemic foods. Patients may also struggle with disambiguating the relative importance of an individual food and its importance to their total diet.¹ This is not to say that low glycemic diets do not have value. Working with a registered dietician/nutritionist can help patients identify foods and build meal plans while educating patients on the effects of food on their blood sugar.¹

Patient-Centered Behavioral Approaches to Nutrition

When considering nutrition interventions for patients with type 2 diabetes, patient-centered behavioral approaches that afford patients the opportunity to make informed decisions about their food choices while also taking into consideration social determinants — such as a patient’s culture, environment, social, and economic contexts — have been shown to be successful. Strategies like mindful/intuitive eating and eating competence, are two such strategies.

Mindful Eating

Developing a mindful eating practice can help patients bring their focus and attention to the present moment while eating. Mindful eating involves paying attention to the act of eating wherein individuals take note of hunger cues, satiety cues, the texture and taste of food, and the mouth feel of food. A mindful eating practice is beneficial for patients with type 2 diabetes, regardless of whether or not they are taking a GLP-1 medication. Because mindful eating focuses on hunger and satiety cues, patients taking a GLP-1 medication could really benefit from this practice because of the medication’s appetite suppressing effect. All patients with type 2 diabetes could mitigate the risk of overeating by being present in the moment and cultivating intentional awareness of what they are eating and how they feel.

Intuitive Eating

Intuitive eating is different from mindful eating, though each practice focuses on internal cues.¹ Intuitive eating is a framework wherein patients give themselves permission to eat, enjoy food, and exert intentional efforts to limit emotional eating. Research on intuitive eating in the context of type 2 diabetes is limited,¹ though a recent study found that intuitive eating was associated with a decreased risk of poor glycemic control.⁴

Eating Competence

Eating competence is another behavior-based strategy that has been linked to positive health outcomes in patients with type 2 diabetes. Eating competence emphasizes attention to internal regulation cues that are paired with skills to make eating enjoyable while opting for more nutritious choices.¹ The four domains of eating competence, outlined by the Satter Eating Competence Model (ecScatter), are: (1) flexible and positive attitude toward food, (2) food acceptance, (3) internal regulation, and (4) planning meals.⁵ Within this model, patient education and counseling can help patients acquire necessary skills to manage daily eating habits. Research has shown that higher levels of eating competence are associated with a desire for positive health outcomes, particularly in relation to consuming high fiber foods, fruits, vegetables, nuts, and reduced sugar intake.^6,7,8 Registered Dietician/Nutritionists can also play a key role in patient education and support.

Implications for Clinical Practice

Behavior-based approaches like mindful eating and intuitive eating practice are two strategies to help elicit and sustain behavior change; they represent a patient-centered approach to behavioral nutrition management that offers respect for a patient’s culture, social, economic, environmental characteristics while helping them develop self-efficacy and empowering them to effect change. Mindful eating and intuitive eating as well as eating competence are strategies for non-GLP-1 and GLP-1 patients to introduce into their daily routine. These approaches are not premised on overly restrictive dietary parameters and offer patients with type 2 diabetes an opportunity to cultivate the skills and self-efficacy needed for long-term success.

Working collaboratively with patients to implement sustainable lifestyle changes can help them achieve long-term weight loss and glycemic control. Supporting a nutrient-dense diet with a scientifically formulated meal replacements can shore up positive outcomes and can help patients not only meet their RDAs for micro- and macronutrients but also support healthy food choices. Health care professionals should talk with patients about strategies for selecting nutrient-dense foods and supplementing these choices with scientifically formulated meal replacements.

Source(s):

1 Behavioral approaches to nutrition and eating patterns for managing type 2 diabetes: A review

2 Dietary patterns and management of type 2 diabetes: a systematic review of randomised clinical trials

3 Low-carbohydrate diets and type 2 diabetes treatment: a meta-analysis of randomized controlled trials

4 Intuitive eating is associated with glycemic control in type 2 diabetes

5 Eating competence: definition and evidence for the satter eating competence model

6 About Eating: An online program with evidence of increased food resource management for low-income women

7 Eating competence is associated with lower prevalence of obesity and better insulin sensitivity in finnish adults with increased risk for type 2 diabetes: the StopDia study

8 Diet quality is related to eating competence in cross-sectional sample of low-income females surveyed in Pennsylvania