Re the suggestion of just asking people to make a couple small, meaningless changes:
I'm firmly in Dr Esselstyn's camp, when it comes to the belief that the most ethical thing to do, is to give a person ALL the information about their condition. And then, let them determine their level of compliance.
The thing about small changes is that they yield small (and unsatisfying) improvements. If I tell a person to just cut back their soda consumption by one can per day, them maybe they drop five pounds over the course of a couple months. Kinda hard to excited about those kinds of results!
When someone knows that they are capable of dropping their full amount of excess weight, or getting entirely into remission for their illness, and that there is a well-laid-out protocol that'll get them there, well THAT seems worthwhile. Now, some people really do love their donuts more than their health, but others just have never been given the correct protocol. They've never had anyone believe in their ability to be completely free of their disease, or of their excess weight, or of their substance abuse (in the case of coffee, cigarettes, whatever). So, i'd really encourage you to BE that, for the people who are willing to pick the path of complete remission and drastic results.
Keep in mind that dozens and dozens of us here, are here because Jeff Novick, and Drs. Fuhrman and McDougall and Goldhamer and Klaper and Esselstyn, GAVE us that path.
I would've been pissed off if all of the above said, "Traci, maybe you can get from 135 to 130, but people aren't really capable of great changes, and you'd be foolish to try to get yourself completely off of oils and fats." No, man. Screw that!
So, baby steps are fine for people who wish to implement great change, one step at a time, but if the entire protocol is, "Just reduce your cola consumption a teeny bit", then you are offering them crappy bits of improvement, when they are capable of so much more.
I'd say, at least OFFER them the path of compelte health. Be sure that they know, "YOU CAN COMPLETELY TURN YOUR HEART DISEASE AROUND" and I can show you how. Be sure that they know, "You can be in complete remission from your joint pain" and I can help you get there. Be sure that they KNOW.
Now, of course, you can't say "complete" remission, because I know that some conditions do not heal 100%, and some joint damage remains in people, and some level of artery blockage is still there after eating SAD for 40 years. But y'know -- do not act like you don't have the tools to help them heal, when you DO!
So, yes, if people choose to do what it takes to heal as completely as possible, they should know that they can take things one change at a time, and turn into a butterfly (so to speak) over the course of many, many months, or they can just clean out their kitchen and learn a new way of living, all at once. But setting the bar low for people is, in my opinion, an act of betrayal.
You are their doctor. It costs you nothing to offer them a full-court-press plan of excellent behavioral health (nutrition, exercise, etc.), and you can ALWAYS feel good about yourself if you present them with five different paths, and they choose a path of only moderate nutritional modifications.
But I believe that people need those who will offer to support them medically if they wish to get into remission, get off their meds, and transform their health. People are LONGING for this (y'know -- SOME people), and for those who are interested, you can really help them to believe that THEY TOO can turn their health around.
Anyways, those are my thoughts! Hope that is of some use.