2.3.2. Food Order Counseling
Participants in the carbohydrate-last (FO) group received additional carbohydrate-last food order counseling for 15 min by research assistants at baseline and weeks 4, 8, and 12. There were three graphs illustrating the results of previous food order intervention studies shown to participants to enhance their understanding of the influence of dietary intervention on blood glucose, insulin, and ghrelin responses in acute conditions. The food order counseling initially focused on the clear categorization of foods into the three categories of interest: vegetable, protein, and carbohydrate. This required recategorization of some traditional food types with a high carbohydrate content to be moved around within the traditional food category placements. For example: peas, corn, fruit, milk, and non-Greek yogurt were placed into the carbohydrate category whereas other dairy products such as cheeses, cottage cheese, and Greek yogurt were placed into the protein category (The second component of food order counseling focused on advising patients to consume their vegetables and protein portions before their carbohydrates at each meal. For meals where this was not feasible, such as when consuming a sandwich, patients were advised to start the meal with a salad or other non-starchy vegetables. Handouts were provided to patients outlining the carbohydrate-last food order intervention using the basic framework of USDA MyPlate and categorizing common foods into macronutrient groups (Additionally, the participants in the FO group were instructed to record after every meal consumed “yes” if they followed the food order for the meal and “no” if they did not follow the food order. Subjects were told to carry this out daily for the entirety of their study participation. These records, which were termed food order logs, were analyzed to determine adherence to and the feasibility of the carbohydrate-last food order intervention.A study exit questionnaire was administered to the participants in the FO group at the end of 16 weeks to assess the overall feasibility of the intervention (