By Emily Kohler

“Honey, what is it that you’re doing over here? I’ve been so curious,” asked a gentle voice of an elderly woman, whose eyes revealed the persistence of a child. This question startled me as I poured strawberry-flavored water into tester cups at a community center, as part of my rotation with the Department of Aging. While collecting myself, I dreaded telling her that I was going to talk with the group about drinking more water, fearing I would be met with a pitiful, “oh that’s nice.” Instead, I was again startled when the woman responded with pure excitement. It was then that I had an epiphany: just because someone is elderly does not mean they lose all curiosity about improving their nutritional state.

If you’ve fought with your parents or grandparents about their health, then I know you’ll understand my presupposition – decades of habits can make someone stubborn! The real question is, have I misinterpreted stubbornness as a disinterest in health? During my rotation with Anne Arundel County’s Department of Aging I had the opportunity to visit group sites where Meals on Wheels provides congregate meals. During one visit, a group of women talked to me about the foods they eat and about their health conditions.

“I’ve seen a dietitian once for my diabetes. It was nice, but I didn’t want to tell her about the donuts I love to eat in the morning. Do you have any tips about diabetes?”

“My daughter’s visiting this weekend and I’m making her favorite pot roast recipe. And I know it’s bad, but we’re also going out for some ice cream.”

“I just got a slow cooker and I can’t figure out how to use it for the life of me. I saw a Giada recipe once I might try that. I wish I had it to show you.”

I could tell these ladies weren’t looking to completely change their lives. Sure, I could probably have found out many lifestyle changes that needed to be made, but for many, these foods are 60+ years of habits and comfort. They may not want to stop eating things that they used to make for their families or may love their sugar products, but they DO have an eagerness to understand nutrition!

The group’s enthusiasm continued throughout the presentation and I was pleasantly bombarded with questions and comments. Many group members were proud to share their current efforts or ideas that they might try out. Others just simply wanted to share their sister’s husband’s friend’s cousin’s interaction with the healthcare system. Whatever it was, there still remained a sense of ownership over health topics. No, the woman eating donuts daily may never stop, and I may not see any of them drinking 8 glasses of water, but I can continue to engage them with information and tips in hopes of additional habits forming. Seniors want to grow as people and sometimes it’s as simple as including them in the conversation about some flavored water.

By Emily Glass

On March 28th and 29th, the Consumer Federation of America hosted the 41st annual National Food Policy Conference in Washington, D.C. In the weeks leading up to the event, I read the program over and over again each time getting more excited. One of the things that drew me toward a career as a registered dietitian nutritionist (RDN) is that there are countless career paths I can take. I was eager to learn about yet another area where an RDN could play an important role.

This premiere event provided an opportunity to hear from the key players and policy makers in the food policy world. Over 300 people from across the country gathered for this unique forum to discuss and give insight on key issues related to consumers, the food industry and government. The diverse attendees were made up of consumer advocates, representatives from food industry, government, academics, RDNs, graduate students, and law students.

Throughout the two days I learned more than I could have ever imagined. I gained valuable insight on how the food policy world operates and what it takes to have a role in developing successful policy. Discussions included the importance of nutrition assistance programs such as Supplemental Nutrition Assistance Program, the farm bill, and the FDA’s new nutrition strategy. Among everything discussed, there were two themes that came up multiple times that stood out to me as a place where an RDN could have a major impact.

1. Transparency

If there was one main overarching theme of the conference, it would be transparency. Transparency on food labels, in food processing, from reporters and even from policy makers. Consumers want to know the details and are more than ever likely to ask questions. They want to know what is in their food and how their food is produced. By knowing these details, they are then able to make their own decisions on what they want to put in their bodies.

In one of the breakout sessions, a panel further discussed the consumers desire for transparency with the newly popular “clean label.” Although the definition is not regulated and allows each company to determine their own criteria, clean label generally means a product has simple, real ingredients. The panel was made up of three leaders in the nutrition industry: Lisa Lefferts (Senior Scientist at the Center for Science in the Public Interest), Katie Kriegshauser (Nutrition Manager at Panera Bread) and Catherine Adams Hutt (RdR Solutions).

 Panera Breads adaptation of clean label to all of their menu items

With this push for clean label products and transparency, an increasing number of companies are removing artificial flavoring, coloring, preservatives, and other chemicals from the foods they sell. But is it important to realize, just because a product is clean label, does not mean it is necessarily healthy. Clean label does not address the amount or types of fats or added sugars. The need and desire for transparency is an important topic for an RDN to be aware of and able to address. For a clinical RDN, just telling a patient what to eat may not be enough. Sometimes it is important to provide details and evidence to back up decisions and recommendations.

2. Science-based policy

During a time with news readily available at our fingertips, it is even more important that policy and reporting be solely based on science and fact. On the first day of the conference, a group of reporters discussed the many challenges in providing stories that are accurate, free from bias, and are based on science. As we begin to get closer to the new Dietary Guidelines for Americans coming out in 2020, this need is even more relevant.

Bruce Lee (Associate Professor of International Health at Johns Hopkins Bloomberg School of Public Health), Allison Steiber (Chief Science Officer at Academy of Nutrition and Dietetics), Dariush Mozaffarian (Dean of the School of Nutrition Science and Policy at Tufts University) and Betsy Booren (Senior Policy Advisor at Olsson Frank Weeda Terman Matz PC) gathered to discuss and offer valuable insight to the new guidelines. Among areas of discussion was the timeline of the guidelines. With new guidelines coming out every 5 years, it becomes very difficult to nearly impossible to have new research to back up possible changes. The panel considered the idea of changing the guideline to every 10 years with a small changes being address every 5 years. This would ensure that the guidelines have hard science to behind them.

Panelists discussing their opinions and raising concerns for the 2020 dietary guidelines.

In addition, many of the panelists agreed that the guidelines may be too broad for the general population or for a practicing nutrition professional to use. For example, Dr. Mozaffarian hopes to see a shift from just giving a recommendation on the amount of fat to breaking it down further to discuss healthy vs. unhealthy sources of fat. Another panelist pointed out that policy makers are not the one using the guidelines everyday in practice making it difficult to know what is practical and what is not. The RDN is the expert who is translating the recommendations from the dietary guidelines into information the general public can understand. It necessary that the RDN discusses their concerns with the dietary guidelines to ensure key concerns are address and the information can easily be used in practice.

When I walked into the conference, I had no idea what to expect. As distinguished food policy leaders gave their presentations and sparked discussion, I gained valuable insight on the direction that food and nutrition are headed in the future. The diverse backgrounds of the speakers and attendees allowed for well-rounded discussions on science, food, consumers, the Farm Bill, food assistance programs, and technology. Through my intellectual conversations with policy writers, academic professors and food lawyers, I saw how important an RDN is in advocating for sound food policy. Whether in food service, community, clinical or policy, the RDN is the nutrition expert. With policy makers shifting their attention to address nutrition concerns, RDNs have the ability to speak up and provide valuable insight. As I left the conference, I felt empowered with yet another possible career path to explore as an RDN.

Imagine a busy weekday: maybe you’re running late and quickly grab something out of the fridge for breakfast. You go to the cafeteria for lunch and pick out the chef’s special, chips, and an orange juice. On the way home, you make a last-minute stop at your favorite fast food restaurant since you have soccer practice and will be short on time.

Now imagine you have type I diabetes. Do you know how many grams of carbohydrate were in each of your meals, and would you be able to figure it out before you ate them? How many servings were in that bottle of orange juice? What is a carb, anyway? Would you be able to check your blood sugar 4+ times per day, and give insulin accordingly? These are the questions I began asking myself during my recent rotation in the Children’s National Medical Center (CNMC) Endocrinology and Diabetes Clinic. Would I be able to perform the same tasks that we were asking of children and their families?

This past month, I had the opportunity to work for two weeks alongside the endocrine and diabetes pediatric outpatient dietitian at CNMC. Most patients that I saw had type I diabetes, and self-management is a 24/7 job with both nutrition and insulin. Patients and their families undergo a crash course in type I diabetes and how they can manage it at home.

Think back to the scenario of a busy week day. Imagine all the changes you would need to make in your day to be successful and make sure that you’re eating the correct amount of carbohydrates at each meal, and that you have your meals at the right times. After working with the children and their families at CNMC, I learned that these skills are part of the everyday job of managing type I diabetes. Imagine, too, that you were newly diagnosed.

Trying to learn all this new information, especially if you don’t work in either nutrition or the healthcare field, is considerably overwhelming. During my rotation, I learned how a dietitian can counsel a child and family to help them manage diabetes factoring their own lifestyles, needs, and wants. Some families were ready to count carbohydrates and look at blood sugar trends, while others may prefer focusing on food groups and portion sizes. This was demonstrated by two families that I saw. The first family was a new diagnosis at the age of 8, and the second family was for a follow-up with a 15-year-old. The first family wanted to learn everything they could to count carbs, time meals, and manage blood sugar levels during exercise. The second family was experiencing “diabetes fatigue” after having been diagnosed 11 years ago. Their fatigue came from managing diabetes on a daily basis for so long, and so the instruction was simpler to help get them back on track for success. The big take-away for me was that I need to meet my patients where they are so that I can assist them in creating achievable goals.

Before starting this rotation, my goal was to gain clinical knowledge in pediatrics. I achieved this goal and so much more. I also acquired valuable counseling skills, which are needed for meaningful visits with patients and their families. Just calculating patients’ nutrient needs and telling them what they need to do isn’t enough. To really have a strong impact, I will need to use those counseling skills to clarify what patients are telling me, gather important information from them, provide them with information on their conditions, and train them so that they can make positive lifestyle changes and adhere to their treatments’ protocols.

Not all families are ready to count carbohydrates down to the gram in the foods they’re eating. At times, the better approach is to give simpler instruction on portion sizes and following the “MyPlate method.” Families need to feel successful in their management and slowly build more skills from there. An important part of counseling is meeting a patient where they are and tailoring your nutrition advice to what fits their life and needs.

Pediatrics adds another level to counseling as often not only are you counseling the child, but you are counseling their caregiver as well. Understanding the different obstacles between age groups of children is important too. Counseling a six-year-old will look very different from counseling a sixteen-year-old. The teen years add new obstacles as children look to gain independence and are no longer under the full care of their parents.

This was my first experience working in an outpatient setting to understand the interaction between a dietitian and their patients using counseling and education. The skills I gained from this rotation are applicable anywhere I go in clinical dietetics. It is always important to listen to your patient and be able to judge at which level they are ready to receive information. It’s important that the goals a patient makes are achievable, and it’s the small steps along the way that can add to big changes.