Bright Spot: A New Leaf...Choices for Healthy Living

Photo by Nong Vang on Unsplash

This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.


Expected Outcomes

New Leaf has demonstrated effectiveness in reducing risk factors for heart disease and stroke. Results from randomized controlled trials show improvements in:

  1. Self reported diet and physical activity behaviors
  2. Objective diet and physical activity measures, and
  3. Physiologic outcomes

Cost Details

As of May 2014, the cost of this intervention is as follows:

  • Cost of reproducing notebooks and cookbooks
  • Cost of binders
  • Cost of stretch bands

For additional cost details, please contact the New Leaf program directly.

Key Steps for Implementation

The counseling process:

  • Diet and physical activity assessments to determine food and activity patterns and attitudes that are beneficial or contribute most to heart disease and stroke risk.
  • Goal setting to address diet and physical activity problem areas identified in the assessment
  • Diet and activity tips
  • Method of delivery and exposure to the intervention: depending on program objectives and available resources, several different strategies can be used to effectively implement the New Leaf intervention
    • Option # 1: One-on-one counseling - Three sessions per Individual/family; initial session should be in-person; other sessions can be by phone or in-person. About 45-60 minutes should be allocated for the initial counseling session since the risk assessments must be completed prior to goal selection and health counseling. Follow-up counseling sessions last 15 - 30 minutes each.
    • Option # 2: Combination approach - Two one-on-one counseling sessions and three or more group sessions typically lasting 90 minutes each plus brief, phone counseling contacts by peer counselors.
    • Option # 3: Group sessions - 12 group sessions, monthly newsletters, and quarterly reunions
    • Other delivery strategies can also be effective as long as providers offer sufficient exposure to the materials, time for counseling, and support for behavior change.

Other Key Requirements

Reproduction of the materials should maintain the number- and icon-coding to link the assessments with the tip sheets. This facilitates efficient counseling by Individual/families (professional and lay) who are not experts in nutrition or physical activity. For best results, complete the entire assessment at the first contact and use this to guide counseling in subsequent encounters. Give a copy of the assessment to the participant to take home and keep a copy for the clinic's records. Counseling can be streamlined by setting only a few goals at each visit and encouraging participants to review materials and make additional changes on their own as guided by the number- and icon-coded materials.

Special Infrastructure

Community health care centers, public health departments, community-based organizations (churches)

Participants should receive:

  • A looseleaf New Leaf binder with assessments and tip sheets a recipe book linked to tip sheets a stretch (resistance) band pedometer (optional)
  • Educational materials can be downloaded free of charge. The cost of reproducing the notebooks and cookbooks is the responsibility of the program provider. New Leaf notebook covers and spines can be downloaded for reproduction.
  • Binders (1' capacity, 3-ring) can be purchased from an office supply store.
  • Stretch bands can be purchased from a medical supply company. Individual/family stretch bands are cut from the roll; average length is 4 ft.


Health counselors need training to successfully implement the New Leaf intervention. Training should include interactive and 'hands-on' exercises such as role-plays that team up training participants as pairs of health counselors and clientsallowing them to practice a counseling session and to use the materials. Center TRT offers a web-based training on the implementation of the New Leaf intervention, including videos demonstrating a counseling session.

Types of Staff

A health counselor is needed to guide counseling and deliver the intervention. A wide variety of health care professionals and community leaders who may have limited training/experience in nutrition and exercise counseling can be trained to deliver the New Leaf intervention. In the past, the intervention has been delivered by physicians, nurses, health educators, nutritionists, and lay (community) health advisors.

Outcome Measures

  • Increased physical activity
  • Increased healthy eating behaviors
  • Tobacco cessation Improved blood pressure or hypertension control
  • Improved cholesterol or blood lipid profile
  • Healthy weight

Process Measures

  • Number of counseling sessions
  • Proper reproduction of materials
  • Assessment completion


Screen grab of Lifestyle Assessments
Lifestyle Assessments
Brought to you by Center TRT

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