The purposes of this study were 1) to compare the effectiveness of an interactive/reflective lifestyle education program with an instrumental program in changing nutrition behavior for the reduction of cardiovascular risk, and 2) to evaluate the effects of interactive/reflective nutrition education practice on patients' development of critical/creative thinking and problem-solving skills. Patients were stratified according to risk, and randomly assigned to the experimental (interactive/reflective) or control (instrumental) group. Measures of knowledge and nutrition behavior were administered prior to and immediately following the intervention, six weeks after program completion, and three months later to assess maintenance effects. Of 32 relatively well-educated patients completing the study, participants in interactive/reflective sessions demonstrated improvements in nutrition behavior relative to the control group that could not be attributed to gains in knowledge scores. Qualitative evaluation of the learning process suggested that the development of critical/creative thinking and problem-solving skills among experimental group participants may have contributed to behavior change.