Lisa Haynes – UMCP Dietetic Intern

Have you ever wondered what it takes to feed thousands of hungry college students every single day? During my food service rotation, I got to find out. I had the opportunity to spend three weeks on-site with the University of Maryland’s Dining Services, where I saw firsthand what it takes to feed thousands of students, along with some faculty and staff, across just three dining halls. Many aspects of the food and service stood out to me during this experience.

Before this rotation, I had eaten in cafeterias at many different institutions, including elementary, middle, and high schools, universities, hospitals, and employer-run facilities. From that unofficial sampling of institutional food, I expected the usual: bland, quickly prepared dishes with hit-or-miss quality and presentation.

The dining halls at the University of Maryland exceeded my expectations. There are
three in total, each offering a wide variety of fresh, well-prepared, and flavorful food. It was especially heartwarming to see how many options allow students to get balanced nutrition at every meal. In addition to being tasty, the dining halls feature different types of cuisine every day, so there is almost always something that appeals to everybody.

Many of the dining halls’ current policies were developed to help reduce food insecurity on campus. Students who live on campus are required to have a meal plan. In addition, the dining halls are open from the beginning of breakfast to the end of dinner. Once inside, students can stay as long as they like and eat as much as they need. Students with a meal plan have unlimited daily access to the dining halls, and there are different meal plan options available to meet the needs of both commuter and resident students.

Nutritious meals are only helpful if students actually want to eat them. In addition to
variety, flavor, and preparation quality, it is essential to consider allergies and
intolerances. One of the dining halls, 251 North, maintains a Purple Zone, which is a
completely separate kitchen kept free of peanuts, tree nuts, eggs, milk, wheat, fish, shellfish, soy, and sesame. The other two halls also have allergen-free stations, but they are not in a separate kitchen.

Cultural and lifestyle choices are also carefully considered. All the halls clearly label halal foods, and 251 North even has an entirely halal section. Every hall includes vegan sections as well. Students can choose from Mongolian grills, pasta bars, pizza stations, delis, and salad bars. And breakfast foods are served all day. Each dining hall has its own unique setup based on the chef’s plans, so there is always something for just about everybody at every meal.

As you might imagine, it takes a large and dedicated team to bring this amount of food to the campus community every day. In addition to chefs, food preparers, and cleaning staff, there are: procurement specialists who arrange food ordering and delivery, staff who coordinate training, and others who manage the meal plans and Dining Dollars. The IT team oversees the food ordering system, while marketing, maintenance, and nutrition professionals all play a part in keeping everything running smoothly. Everyone works together to ensure that the campus community is fed well and safe.

It is truly a huge collaborative effort that has been noticed outside of the UMD
community! The National Association of College & University Food Services has
awarded Dining Services for its Innovative Nutrition Program and also highlighted the Purple Zone for its commitment to food safety.

The large variety and excellent quality provided by Dining Services at the University of Maryland give students the nutrition that helps nurture their learning experience on campus. Many people work to make sure that happens every day. It was refreshing to see the care and consideration given to feeding the campus. It will raise my level of expectation in future professional kitchens in institutions that I’ll encounter.

Before starting my rotation, I had no idea how much I would connect with my team and how rewarding serving my community felt. My experience working at Community Support Services (CSS) was truly unforgettable. Having worked in several food service settings before, I was familiar with meal prepping and production, but never in a setting that combined both nutrition and direct client interaction with individuals with autism and other disabilities. This rotation helped me to see how nutrition can powerfully influence health while giving me a better perspective on the entire process of procurement, cooking, packaging, and sanitation.

Before working at CSS, I had some familiarity with autism through family friends, but I had never prepared meals specifically tailored for this population. Many individuals with autism often prefer simple, familiar meals and are often hesitant to try new foods. During this rotation, I learned that supporting individuals with autism requires patience, creativity, and flexibility. You need to be open-minded and adaptable to your environment for things to flow smoothly. Many clients experience sensory sensitivities, meaning that certain textures, smells, or temperatures can be overwhelming.

Throughout the rotation, my intern partner and I followed guided recipes and even
created a few of our own. A popular dish we made was steak with roasted tomatoes and fried onions, served with yogurt or milk. Recipes had to include major food groups, mild and familiar flavors, and be simple enough for clients to follow. Each recipe was designed as a pictorial guide to help clients visualize each step and feel confident replicating it on their own. Because we cooked for about 60 individuals, we also had to consider dietary restrictions; a few clients did not eat pork or shellfish. This required careful cleaning, sanitization, and organization to avoid cross-contamination and maintain food safety. It was a great learning experience in planning, ordering, and preparing food. I typically like to follow recipes step by step, but we learned from our preceptor that sometimes improvising is necessary to cook more efficiently. We would then pack all components together and store them until pickup. In the end, all our meals turned out delicious and were well received.
Nutrition education at CSS was also a unique experience. Traditional counseling
approaches were not appropriate since the clients don’t learn in that way. Instead, we focused on meeting clients where they were and using innovative strategies such as introducing new foods, creating a positive food experience, and engaging them with fun hands-on activities.

One of my most memorable experiences was working alongside clients during meal
prep and cleanup. Clients often joined us in the kitchen to help wherever they could,
and those moments built genuine rapport . Every Friday, we arrived early to thaw, chop, and prepare the day’s food. One client, Matthew, always volunteered to help marinate the food. Our preceptor would sing next to him as he worked, making sure he was engaged and enjoying himself. His joy was contagious. Once he got tired, we all paused for a snack break and went together. Although this was something small, it was a meaningful moment of connection.

Working at CSS strengthened my ability to communicate nutrition messages and work effectively in a foodservice environment. It also emphasized the importance of
teamwork, adherence to policies and procedures, and clear communication. Most
importantly, this experience reminded me that food is more than nourishment, it is a
bridge to connection, comfort, and independence.

By: Chelsei James

Imagine a world where everyone can access fresh, nutritious food, fueling growth, health, and strength. Community nutritionists and dietitians work to make this vision a reality by providing nutrition education, advocating for improved food access, and promoting chronic disease prevention on a broader scale. During my community rotation at the University of Maryland Extension, I learned how they support nutritional health in Queen Anne’s County.

A Quick History of UMD Extension

The Cooperative Extension Service was created through the Smith-Lever Act of 1914. As the designated land-grant institution for the state of Maryland, UMD provides informal education statewide through the University of Maryland Extension. This act mandates providing education to the public in agricultural and mechanical fields. At the local Queen Anne’s County location, UMD Extension offers programs in 4-H youth development, Family & Consumer Sciences, Environmental and Natural Resources, and Agriculture and Food Systems. As a dietetic intern, I learned how nutrition education is integrated into these programs, gaining insight into its role in community outreach and public health. 

The Petal Pot Activity 

One of the best ways to encourage children to eat more fruits and vegetables is by showing them how these foods are grown. This hands-on experience removes the mystery of where food comes from and sparks curiosity about plant growth and harvest. During my rotation, I assisted a 4-H educator with her youth pollinator series by creating a supplemental crafting activity. Students decorated their pots to resemble the flowers of the vegetable plants they would grow, making the experience both educational and fun. Students will learn how their bean or pea plants develop, plant their seeds at home, care for their plants, and, hopefully, enjoy their harvest.

Food Pantry Fun

Despite my previous experience as a SNAP-Ed educator, my time at UMD Extension introduced me to new approaches in community nutrition. I assisted their SNAP-Ed educator with a recipe tasting at a local church food pantry, where we prepared a green bean and corn salad using surplus pantry ingredients. To encourage participants to try the recipe at home, we provided reusable canvas bags filled with the recipe, ingredients, and a nutrition fact sheet. We also distributed colanders and educated customers on the importance of rinsing canned foods to reduce sodium intake. Additionally, we evaluated the pantry setup, identifying opportunities for improvement, such as implementing cold storage solutions during distributions and training volunteers to manage the tasting station. This experience deepened my appreciation for how nutrition education can be effectively tailored to a food pantry setting.

Final Thoughts

My experience at the University of Maryland Extension has deepened my understanding of how community nutrition shapes healthier communities. From engaging children in gardening activities to delivering nutrition education in food pantries, I’ve witnessed the impact of these initiatives in fostering better food choices and overall well-being. UMD Extension’s approach of meeting people where they are—whether through youth programs or supporting families in need—highlights the power of accessible, community-driven nutrition education. This rotation has reinforced my commitment to working at the community level to make lasting health improvements.

Every nutrition professional aspires to help their patients live healthier lives, but what happens when access to food is a barrier? No matter how sound your nutritional advice may be, it falls short if a family cannot afford groceries or lacks reliable access to food. During my rotation at Children’s National Hospital, I witnessed firsthand how the innovative Food Pharmacy program addressed food insecurity, transforming the lives of families in the process.

An Interdisciplinary Approach

One of the most memorable aspects of my experience at Children’s National Hospital was spending a day in their outpatient diabetes clinic, where they focused mainly on children with prediabetes and type 2 diabetes. This clinic took an innovative, interdisciplinary approach to patient care. The team was a well-oiled machine consisting of dietitians, doctors, nurses, diabetes educators, and psychologists. What made this model so effective was their collaboration. The entire team would meet in a central room to discuss each patient and then visit the patients, one after the other. After each patient consultation, the team would huddle to discuss their findings, build on one another’s insights, and brainstorm immediate solutions. This rapid-fire collaboration led to quick problem-solving and highlighted a level of advocacy you rarely see in traditional clinical settings.

Food Rx

However, one initiative stood out above all—the Food Pharmacy program. In partnership with the Capital Area Food Bank, Children’s National Hospital launched a pilot program to provide food for families facing food insecurity. Opting into the program was seamlessly integrated into the patient visit. After filling out a short questionnaire during intake, families who screened positive for food insecurity could receive free groceries at the end of their visit. This simple but impactful intervention made it easier for families to access nutritious food, directly addressing one of the root causes of poor health outcomes.

The dietitians played a key role in the program’s success. They managed the food inventory, placed orders for deliveries, and kept the kitchen consistently stocked with fresh and shelf-stable items. They packed up bags filled with nutritious food for the families every week. Patients could choose from a selection of proteins like fish, chicken, and eggs and were also given fresh produce such as garlic, ginger, onions, butternut squash, cabbage, and broccoli. The inventory also included pantry staples like dry beans, popcorn, spaghetti noodles, and canned vegetables.

One of the most thoughtful elements of the program was the consideration of transportation. Knowing that many families would need to carry their groceries home, the clinic provided carts to help transport the bags. This attention to detail ensured no family would be left without the needed support, regardless of their circumstances. Families left the clinic with bags in hand (or cart) and reported using the ingredients to make healthy meals and snacks. 

Final Thoughts

Witnessing this program in action was a powerful reminder of food access’ impact on health. It’s not just about providing advice on what to eat—it’s about ensuring that families have the resources to make healthier choices in the first place. Even in a clinical setting, there may be space to tackle social factors (food access, transportation, housing, etc.) if you are willing to be creative. By addressing food insecurity, Children’s National Hospital is not just treating diabetes; they’re creating a pathway to long-term health for children and their families. I am motivated to pursue opportunities in my future career that integrate both clinical and community nutrition to more effectively promote health changes.

Views expressed are my own. All opinions are own. The opinions expressed here belong solely to me and do not reflect the views of Children’s National Hospital.

This one is for those endlessly curious about the anatomy –

Have you ever seen a human stomach?

Do you know what color it is, what shape it is, where it sits in relation to the rest of our organs, how big it is, and whether it really moves on its own?

I had the unique opportunity to shadow a surgical procedure while interning under a bariatric dietitian. Though bariatrics and metabolic health may be a polarizing topic for dietetics, working with them and their clients was fascinating. Hearing my preceptor say that the surgeon allowed me to observe a procedure in the operating room was equally exciting. 

“He loves students,” she said. “He’ll be happy to have you.”

It never occurred to me that I hadn’t seen a surgery before. Of course, I hadn’t. It is easy to get lost in the false reality that you know for sure what human anatomy looks like after growing up with medical dramas like General Hospital, Grey’s Anatomy, or even House. There is nothing but movie magic behind those scenes (even if the rumors are true that they used bovine parts for some surgeries). Now that I had the chance, I jumped for my turn in the theater.

I want to emphasize that surgical intervention can be a necessary step for many people battling obesity. This facility met people at the end of their line after grasping for straws in the diet industry for years. They exercised, they dieted, they restricted, they used medications, all of it. No matter what they did, the weight always came back. In this particular clinic, bariatric dietitians know that their clients are not coming in for another dieting plan to shed one or one hundred pounds. Clients are coming to these dietitians to prepare for surgery and for the rest of their lives post-op. 

Casting and Rehearsal

Preparation for bariatric surgery is no walk in the park, either. Clients must complete a checklist of tasks to qualify through their insurance. This includes all sorts of screenings (cardiopulmonary, psychological, and endocrine), lab work, chest x-rays, and diet counseling. Some insurance companies require several months of physician-guided dieting to consider clients for bariatric surgery. If you miss an appointment, you have to start the process all over. 

Motivational interviewing goes a long way with bariatric clients. Most of them are at the change stage of their life, but some come in without full understanding that bariatric surgery isn’t a quick fix. To get to surgery, the following goals are made:

• Keep a daily food journal.
• Eat at regular intervals.
• Include a lean protein source at all meals. 
• Include a fiber source at all meals.
• Decrease or eliminate sugary and carbonated beverages.
• Meet fluid goals of 64 ounces per day.
• Decrease or eliminate sugary or refined carbohydrates.
• Try protein supplements to find the ones you like.
• Take a multivitamin/mineral supplements daily. 
• Work on healthy coping skills and identify triggers for unhealthy eating.
• Take time at meals and chew foods well.
• Get regular exercise and activity.

Two weeks leading up to surgery, clients receive more goals: the liver-shrinking diet. Two weeks of a highly restricted diet with protein shakes, a serving of dairy, a serving of fruit, and a single meal of three to six ounces of lean protein, soft-cooked vegetables, and a quarter-cup of starch. This diet is meant to reduce the chance of surgical complications related to the liver’s proximity to the stomach. 

Showtime!

I understand why they call it surgical theater. Everyone has a part to play, stage left, right, and center. Stand in the wrong place, and you interrupt everyone’s unspoken language. I arrived at the end of the first of three procedures and observed with my back to the wall. The nursing team disposed of materials and cleaned the room spotless in less than forty minutes. The scrub nurse prepared the surgical instruments, medications, and solutions. The anesthesiologist waved me over and asked me to identify the vocal cords for intubation once the patient arrived (I didn’t see them, but I saw the bronchial rings!). 

They would perform a laparoscopic robotic sleeve gastrectomy, also known as the gastric sleeve, the most common bariatric surgery in the United States [1]. Contrary to what I believed, the ‘sleeve’ is not some external mesh that compresses the stomach to restrict its volume. The surgeon showed me the tools he uses: the blades, robot, and laparoscope. He drew out the surgery for me and handed me the Sharpie afterward. “This is how big the stomach is after extraction,” he said before scrubbing in. Then, they took their time out and agreed on the patient’s identity, the procedure to be performed, and the medical necessity of it.

To say that my jaw was on the floor the entire time is an understatement. The laparoscope transmitted to massive screens throughout the room to show us the abdominal cavity in minute detail. Some of me thought the abdomen was a fluid-filled cavity, but it was rather hollow. The surgeon pointed out gross anatomy to me. There’s the splenic artery. That soft mass that looks like popcorn is the pancreas. The heart is beating just on the other side of the diaphragm. The dark organ there, lifted by a piece of metal (it makes me cringe thinking about it), that’s the liver. The nurses and surgeons pointed out the fatty deposits and the cirrhosis present despite the patient’s compliance with the liver-shrinking diet. 

There’s no way a YouTube video of this surgery could beat front-row seats. 

The first assistant walked me through the procedure, and I asked everything I could think of. I watched as the surgeon maneuvered the robotic arms to lift the stomach and separate the adipose tissue from the muscle. He cauterized vessels as he went to minimize bleeding. Then came a sound I couldn’t comprehend – the sound of the stapling tool used to separate the stomach from the remaining sleeve. Watching the excised stomach grow greyer and greyer felt strange as the surgeon sutured the sleeve around the staple line. It was equally strange to see them remove it from the incisions and place it in a specimen cup smaller than a cereal bowl. 

There it was. Less than an hour later.

Intermission

To minimize the risk of blood clots, patients are up and out of bed within six hours post-op. They’re on a clear liquid diet for two days in the hospital, then discharged home with the instructions to walk every hour and begin a full liquid diet of high-protein fluids like yogurt and protein shakes. Sipping on even a capful of water at every opportunity is necessary to prevent dehydration. After a few weeks, they can begin reintroducing one-quarter cup (total) of solid pureed foods at meals, then move up in texture until regular food is tolerated. Meal sizes increase over time; it can take twelve to eighteen months to eat a full cup of food thrice daily. 

Yes. One cup. The stomach is reduced to the size of a highlighter pen. Not much can fit in that space, and the risk of ripping stitches is real if a client overeats. This is why dietitians encourage practicing regular, small meals throughout the day prior to surgery. Habits cannot change overnight in most cases.

Final

All of this work and restriction ultimately leads to weight loss, though. The final goal. Clients can expect 60-70% of their excess weight (actual body weight at surgery – ideal body weight) to fall off in the next eighteen months. With work and consistency, it can stay off. I met two individuals for their annual checkups several years post-op to see an ideal case of bariatric surgery. Both were doing exceptionally well in their lives, had healthy relationships with food, and could maintain their nadir weight (or lowest weight after surgery). 

Unfortunately, not everyone will have this success, as there are some side effects of the surgery. Dumping syndrome, novel lactose intolerance, dehydration, protein malnutrition, and weight regain are a few potential risks of bariatric surgery. Even with these risks, I have heard clients express their excitement for the procedure. I met people who struggled with their weight for the majority of their lives – some citing issues stemming from early childhood. Speaking with them and learning about how weight affects their lives made obesity more than a descriptor of body composition. It ultimately taught me that obesity truly is a chronic disease driven by evolutionary biology gone wrong that deserves compassion, kindness, and relief.

References:

1. Howard R, Chao GF, Yang J, et al. Comparative Safety of Sleeve Gastrectomy and Gastric Bypass Up to 5 Years After Surgery in Patients With Severe Obesity. JAMA Surgery. 2021;156(12):1160-1169. doi:10.1001/jamasurg.2021.4981