Chronical Illness and the Issue of Context in Dietary Counselling

In dietary counselling contextual food and eating issues are increasingly considered important when trying to promote dietary change. Besides transferring knowledge on healthy eating based on an assessment of the nutritional adequacy of clients diet priority is given to obtain the full dietary story including contextual issues concerning relationships, family values, culture, finances, and personal beliefs. The focus on contextual issues seems to reflect a holistic and empowering approach to the promotion of health. Also, the consideration of contextual issues can be seen as essential to 'learning to live with chronic illness' which is stated as a main goal in health policies and in clinical and behavioral management of chronic illness. However, the use of the notion of context is far from neutral but always socially and historically situated. In this study, it is explored how contextual food and eating issues are taken into account in dietary counselling and how this reflects broader epistemological and political issues related to the prevention and management of chronic illness. A concluding statement from the study is that in order to empower clients, the complexity and contextual nature of food and eating needs to be addressed in a more systematic and critical way than is usually the case in dietary counselling. A narrative approach informed by insights from qualitative research on food and eating is suggested as a more context sensitive approach.