Increasing the Effectiveness of the National Cholesterol Education Program: Dietary and Behavioral Interventions for Clinical Settings

The National Cholesterol Education Program (NCEP) is the cornerstone of primary care efforts to treat hypercholesterolemia. It provides diagnostic criteria and an outline of appropriate assessment and treatment protocols. The initial treatment emphasis is on the Step 1, low-cholesterol, low-fat diet. A review of these guidelines from a behavioral perspective suggests that there may be several areas of concern. These include: (a) the absence of attention given to developing sufficient motivation for behavior change; (b) the limited efficacy of routine dietary education for promoting dietary changes; (c) the apparent need for diets more rigorous than the Step 1 and Step 2 guidelines to substantially lower cholesterol in some individuals; (d) the extensive support such dietary interventions must have from established behavioral change strategies; and (e) the lack of enthusiasm and experience many physicians and other medical personnel have for nutrition interventions. It is suggested that more conceptually-based behavioral assessment procedures, such as those based upon the stages of change model, could broaden the impact of the NCEP. In addition, data are presented which suggest that the NCEP could have greater effectiveness if more exacting behavioral strategies are followed. Interactive, multimedia systems are discussed as one means to facilitate dietary interventions in primary care settings. Finally, the importance of integrating measures designed to enhance long-term maintenance of dietary modifications is emphasized along with the need for more ongoing research within the NCEP.