Alleviating hypertension: Grocery-store based nutrition education can improve eating habits

11 Feb 2019 --- Grocery store-based nutrition counseling is effective in changing the dietary habits of patients being treated for hypertension, a study published in the Journal of Nutrition Education and Behaviour has found. The researchers note that the location of the counseling may help to reinforce dietary changes as it is an environment where food decisions are made. Hypertension affects over 60 million adults in the US, yet less than half have their condition under control.

“Primary care providers face multiple barriers when delivering nutrition information to patients, including a lack of training on how to provide lifestyle behavior counseling combined with a lack of time to interact with the patient,” says lead author Rosanna P. Watowicz, Ph.D., Department of Nutrition, Case Western Reserve University, US. 

“This study aimed to evaluate the effectiveness of a nutrition counseling program provided by a registered dietitian in the familiar setting of a grocery store,” she adds.

The study included patients from three primary care offices that were part of an urban academic medical center. Thirty adults aged 18-60 years diagnosed with hypertension participated. Study participants represented a diverse demographic in regard to sex, race, education and employment.

Participants received individual counseling at one of three local grocery stores from two registered dietitians trained to provide lifestyle modification information based on the DASH (Dietary Approaches to Stop Hypertension) diet. Three counseling sessions provided free to the patients occurred over 12 weeks. The first visit was 60 minutes long, followed by two 30 to 45-minute sessions. Following each meeting, a recap of the visit and patient’s progress towards their health goals were provided to the primary care provider to be included in the patient’s records.

Diet quality was assessed using the Healthy Eating Index-2010, a measure of overall diet quality compared to the Dietary Guidelines for Americans. Patients completed a food frequency questionnaire, documenting food and beverages consumed at least once during the previous three months, before beginning the study and at the end of the study. Blood pressure measurements were also taken.

Following the education, patients’ eating habits significantly improved regarding the total consumption of fruit, whole fruit, greens and beans, whole grains, fatty acids, refined grains and empty calories. Sodium, saturated fat, discretionary solid fat and total fat intake also decreased significantly. Intake of added sugar also decreased although not to the same extent as the other categories.

Blood pressure measurements also decreased during the study, but due to the small number of participants, the differences were not statistically significant. Additionally, patients reported a high level of compliance in taking their hypertension medication as prescribed during the study.

“Providing education at the grocery store offers a convenient location on a schedule with more flexibility than a primary care office and reinforces dietary changes in the environment where food decisions are made,” says Dr. Watowicz. “This strategy should be researched with other health conditions.”

A further grocery-store focused study found that moving the location of fruit and vegetables in stores can lead to a 15 percent sales increase. The University of Warwick, UK, study found that sales increased without any further messaging or marketing when the placement of fruit and vegetables changed, suggesting a simple “nudge” can lead to healthier diets for young adults. The findings, published in BMC Public Health, were based on data collected between 2012 and 2017 in a real University campus grocery store.