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Nutritional counseling to the rescue
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To get the job done, Delaney herself may accompany clients to the supermarket on food-shopping trips or even go to their homes to help put meals together. "At times," she says, "I literally go through the aisles with them to fill their pantries."

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The 12-week lifestyle intervention program that Manby and her nutritionist run at LifeBalance includes field trips to a local market to learn how to read labels, as well as to restaurants.

"We go to a restaurant and look at menus to see how to eat out and still eat healthy," Manby says. "It's about balance. What's the serving size? The idea is not a diet change but a lifelong change in eating habits."

What's eating you is what you eat
Food safety issues are also important, says Ruth Frechman, a Los Angeles-based registered dietitian and spokewoman for the American Dietetic Association.

"A lot of people don't know how to store products so they don't get sick," Frechman says. "They will keep food out on a table overnight before eating it, or they won't cook it enough."

Registered dietician Jeannie Moloo, an ADA spokeswoman practicing in Sacramento, Calif., says in addition to counseling individuals and families, she tries to mitigate the overwhelming influences on children's eating habits outside the home. She has worked with food vendors at schools to reformulate their snack bars and frequently provides classroom education on nutrition.

"Once they're out of the house, going for the after-sports snack and so on, it can be very difficult for a parent to regulate what their children eat," says Moloo. "I talk to children's sports teams, coaches and parents about what makes a healthy snack."

Bad eating habits are a common disorder among clients of all ages, Delaney says. "We don't always eat based on how hungry we are," she says. "The clock tells us it's time for lunch, so we eat whether we're hungry or not. Then there's situational eating, such as popcorn at the movies and peanuts at the baseball game."

The length of treatment, like the counseling itself, depends on the individual. "It could be just one hour or multiple hours at different times," Moloo says.

"Some come once," says Frechman, "and others who need accountability could be coming for years."

At Manby's Arizona center, patients are monitored over several months, not only for weight change or maintenance, but also for metabolic changes. Their education can include watching "Super Size Me," a movie that uses a personal, life-threatening approach to show how the nation's obsession with fast-food consumption can impact an individual's health.

Whatever the particulars, the ideal, Delaney says, is to teach a client how to make food choices that are appropriate to his or her own body's needs.

"Once they get it," she says, "it becomes very doable, no matter what they eat."

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