* Will they be able to follow this diet for the rest of their lives? If not, it may be healthier and more realistic to carry around the extra 15 to 20 pounds rather than losing it 15 times.

* Is the diet individualized for the person? If not, it is doomed to fail.

Back to basics

With the abundance of diets on the market, and new technology, data and research evolving at a fast pace, it's easy to get off track. Nutrition has made a quantum leap in the last two decades. It has advanced well beyond the old four basic food groups to a new frontier of neurotransmitters, phytochemicals (600 found so far) and anti-oxidants (powerful chemicals in food that affect brain function and the ability to fight disease).

It is a challenge to translate the latest scientific and nutritional data into comprehensible advice, so that consumers can understand, digest and assimilate the information. The United States Department of Agriculture (USDA) and other governmental agencies, composed of scientists and nutritional experts, have taken on this task. They, along with the American Cancer Society and the American Heart Association, have published several guidelines and recommendations to help people understand the best diet to ensure good health.

The diet on which most experts agree is one that is relatively low in fat and high in fruits, vegetables and grains. This diet does not only help to prevent disease, but it works to ensure adequate nutritional intake of all essential nutrients. To emphasize these points, the USDA published the fourth edition of the U.S. Dietary Guidelines in 1996. Some recommendations follow:

Eat a variety of foods. A variety of foods doesn't mean one pill from the green bottle and one from the red. It means choosing different foods from each food group daily, with an emphasis on fresh fruits and vegetables.

Balance the foods you eat with physical activity to maintain or improve your weight. If weight rises above a certain range per height and weight, or if body mass index (BMI) is greater than 25, a weight-loss program may be indicated (see Table 2).

Choose a diet low in fat, saturated fat and cholesterol. Obtain most of the fat you eat in the form of unsaturated fats, such as liquid vegetable oils. Include fish at least twice a week for omega-3 fatty acids.

Choose a diet with plenty of grain products, vegetables and fruits. Daily recommendations include at least three servings of vegetables, two servings of fruits and at least six servings of grain products.

Choose a diet moderate in sugars. Don't avoid it obsessively, but go easy on refined sugars such as corn syrup, table sugar, jellies, jams, molasses, honey and syrup, and pies, cakes and cookies.

Choose a diet moderate in salt and sodium. Especially if you have, or are at risk for, developing high blood pressure, 2 to 4 grams of sodium per day is reasonable (the typical American diet has 5 to 10 grams). One teaspoon of salt has 2 grams of sodium.

If you drink alcoholic beverages, do so in moderation. A limit of one or two drinks a day is fine. And if you're not a drinker, there's no need to start.

Another publication that gives guidelines and recommendations for a healthy diet and lifestyle is The Food Guide Pyramid (also published by the USDA). It is a simple chart with specific recommendations for the quantity and type of foods to eat from five major food groups -- grains, fruits, vegetables, milk and meat -- based on calorie needs (see Figure 1).

According to Dr. Audrey Splindler, professor and director of the Didactic Program in Dietetics, department of exercise and nutritional sciences at San Diego State University, San Diego, Calif., "The anti-cancer diet with additional soy products is one of the best for health. Eat plenty of fruits, vegetables, legumes and whole grains, but limit both the quantity and type of animal products in the diet. Tofu may have replaced liver as American's most disliked food; nevertheless, I encourage women of any age to acquire a taste for soy products because of the phyto-estrogens and other beneficial compounds."

The missing link: The emotional component

Knowing what to eat doesn't always translate into eating what is healthy. What about the client who has tried every kind of diet without success? Or the client who eats out of loneliness, boredom or frustration? The Food Guide Pyramid or another weight-loss scheme isn't going to cut it in these situations. Nor will one more pill, fix or fad diet.

Diet and fitness are only one part of the picture, albeit an important part. Other pieces of the puzzle -- the cognitive, mental, emotional and spiritual levels of a person -- usually aren't touched upon in weight-loss programs. And yet, these areas can be the driving forces behind overeating, lack of a fitness program and depression. If they are not addressed, a person will not lose weight.

If weight has been an ongoing, chronic problem, it's time to look beyond external solutions (diet and exercise), and look at internal solutions to an internal problem. The root causes of why people are overeating need to be addressed. It is ludicrous to go on diet after diet, while the emotional drive that causes overeating is still operating at full speed.

Trish Stanley, a psychotherapist specializing in women's issues and a therapist for the Solution Program (a weight program) in San Diego, Calif., states, "Often what is needed is a diet rich in such vital nutrients as self-respect, dear friends, passionate interests and activities to help regain a sense of competence and the ability to comfort oneself emotionally. The best diet in the world is to feed ourselves emotionally."

Laurel Mellin, associate clinical professor of family and community medicine and pediatrics, University of California at San Francisco, and author of The Diet-Free Solution (Harper Collins) states, "In some sense it doesn't matter what the healthy ranges of diet are. Unless you develop two simple skills missed from childhood, effective limit-setting and strong nurturing, you won't stick to any diet program. The good news is, you can learn these at any age and when you do, the drive to overeat turns off and naturally eating in a healthier way sets in -- for good." In her book, she discusses the powerful mind-body forces that drive overeating and inactivity. Her theory is, if the causes of overeating are cured, then the drives that fuel overeating and inactivity stop.

Sometimes this type of clientele slips through the cracks in the fitness and nutritional arenas. If your clients fall into this category, you can help by asking such questions as, "Do you go on diet after diet without success?" "Do you find yourself eating when you're not hungry?" "Do your eating habits interfere with your lifestyle?" If they answer yes to any of these questions, they probably have a bigger problem than any diet or club membership can resolve. Refer them to a registered dietitian or therapist in their area (see Table 1).

Carol Ross, owner of Personally Fit, Rancho Santa Fe, Calif., states, "I only get to see a client about four to five hours per week, maximum. My job as a trainer is to help increase fitness levels and provide health education. Being a good listener is really important. I have to pull out information from them that is pertinent and, if necessary, refer them out. I can't do it all."

You can't be all things to all people, but you have done much for your clients if you have gone this far. Support them on the road to change and they will know you as someone who listened and helped on many levels.

Putting it all together

Whatever condition your clients are in, all health and fitness goals need to be realistic and fit into their lifestyles. For most clients, it is better to focus on meal plans that improve overall health rather than weight loss. Give them the facts and then let them decide what route to take. Following are some guidelines.

* Help clients determine what they're willing to do and then show them how. Renee Nowak McFarr, owner and operator of L'Physique, advises to first "analyze what the person is doing and what their eating pattern is. Do an assessment. The diet plan should be dependent on goals."

* Encourage one to two small changes at a time. Make sure clients are comfortable before you add more.

* Be flexible about getting a balanced diet over several days.

* Each body type is different. Teach clients to honor their own specific body type through body acceptance.

* Stay away from the "good/bad food" mentality. Deprivation is equated with stress. What people eat over a lifetime is more important than an occasional "bad" food.

Take-home message

Eating is one of life's greatest pleasures. Because of the emotional meanings attached to food (to celebrate, to comfort, to relieve boredom or stress, or to stave off loneliness), changes are always difficult. Knowledge is required to ease the burden of change, along with an attitude adjustment and skills necessary to implement change. Healthcare providers can help clients make positive changes one step at a time.

Remember, there is no right or wrong way. What works for one client may not work for another. Everyone needs to find a pattern of eating that is nutritionally, physically, emotionally and spiritually satisfying. A diet plan and fitness program that includes these components are a good start on the path to success.

Cindy Maynard is a health and medical writer and registered dietitian living in San Diego, Calif.