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Table 1—

Comparison of traditional and empowerment viewpoints regarding diabetes medical nutrition therapy

Traditional viewpointPatient-centered viewpoint
Food choices affect physical health, including diabetes management. Food choices affect psychosocial quality of life as well as physical health. 
The professional is the expert in nutrition and is therefore in charge of developing a meal plan based on assessed needs. The professional is the expert in nutrition, and patients are the experts about themselves and their life circumstances. 
The focus is on metabolic goals, such as weight and blood glucose levels. The professional provides instruction on an appropriate meal plan and teaches clients how to follow it. Desired metabolic outcomes shape behavior change plans but are not in themselves behaviors that clients can control. The focus is on behavioral goals, i.e., specific action steps that clients can control. 
The professional feels effective and successful when clients follow nutrition recommendations. The professional teaches behavior change skills so clients can achieve their own nutritional goals. The professional feels effective and successful when clients become skilled at making informed choices and solving problems. 
Traditional viewpointPatient-centered viewpoint
Food choices affect physical health, including diabetes management. Food choices affect psychosocial quality of life as well as physical health. 
The professional is the expert in nutrition and is therefore in charge of developing a meal plan based on assessed needs. The professional is the expert in nutrition, and patients are the experts about themselves and their life circumstances. 
The focus is on metabolic goals, such as weight and blood glucose levels. The professional provides instruction on an appropriate meal plan and teaches clients how to follow it. Desired metabolic outcomes shape behavior change plans but are not in themselves behaviors that clients can control. The focus is on behavioral goals, i.e., specific action steps that clients can control. 
The professional feels effective and successful when clients follow nutrition recommendations. The professional teaches behavior change skills so clients can achieve their own nutritional goals. The professional feels effective and successful when clients become skilled at making informed choices and solving problems. 

From Maryniuk MD: Counseling and education strategies for improved adherence to nutrition therapy. In American Diabetes Association Guide to Medical Nutrition Therapy for Diabetes. Alexandria, VA, American Diabetes Association, 1999, p. 369

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