Clinical therapy for hyperlipidemia and obesity mandates dietary changes. The rationale for modification of specific dietary components becomes more impressive with each decade, as research and epidemiologic studies continue. Treatment modalities should be based on lipid patterns and lipid aberrations. Intervention methods should become practical and behaviorally motivating for patients. The environment must be receptive, with sophisticated interaction between the physician and registered dietitian. Third party reimbursement trends should be considered, but should not deter nutrition care services essential for medical management of the individual with heart disease.