By: Emily Kohler

It doesn’t take a dietitian to tell you that America is overeating. There’s food everywhere and plenty of it, right? Actually, not everyone has the ability to indulge—1 in 8, or 41 million Americans experience food insecurity. The reality for those who are food insecure is that instead of overeating endless amounts of food, their access to food is very limited. Recently, as an intern, I’ve had the opportunity to work with this issue at the Manna Food Center of Montgomery County and also at the U.S. Department of Agriculture’s (USDA) Food and Nutrition Services (FNS). Exposure to food insecurity has provided me with a better understanding of my path in life: I’ve learned I want to be a part of the collective effort to break the hunger cycle, and in order to do this, I need to emulate the positive, empathetic, and ambitious attitudes of those that I’ve observed in places like Manna Food Center and FNS.

What is food insecurity?

The USDA defines food insecurity as “a lack of consistent access to enough food for an active, healthy life.” It isn’t just people experiencing homelessness who are food insecure; in fact, most food insecure individuals have homes and jobs. Entire families can be classified as food insecure and it is common to find seniors and disabled persons in this category. Feeding America, a network of food banks across America, describes their clients as having a median annual household income of $9,175. How would you make ends meet with such limited resources? According to the USDA’s Economic Research Service 2016 survey, 97% of households with very low food insecurity reported that an adult had to cut their meal size or skip a meal due to a lack of money for food and 88% of households reported this occuring in 3 or more months.

What is the result?

What happens when people don’t eat enough? How about when all they have to eat is highly processed foods? The answer is fatigue, malnutrition, and disease. As consequence, financial and productivity burdens accumulate, intensifying this cyclic effect. Policy, community, clinic, and hospital-based interventions are all needed to slow this cycle.

Breaking the cycle within a community

Manna Food Center distributes food to 40,000 clients each year from their warehouse to soup kitchens, food pantries, and emergency shelters within Montgomery County. At Manna, I worked in the warehouse for a day to create food packages for their clients. I was told to make sure that each package had as much food as possible inside since, for some clients, this was their main source of food for an entire week. That stuck with me. In addition to this, I noticed that my preceptor sifted tirelessly through items in order to create the perfect box for clients with diet restrictions. This shows the ambition and empathy necessary to normalize the eating experience for clients receiving a small, but impactful package of food.

Breaking the cycle at the federal level

My current rotation is at FNS, which has given me exposure to the policy side of food security. FNS is the hub of 15 nutrition assistance programs. Nutrition Education, Training, and Technical Assistance (NETTA) is a division of FNS and works to improve Child Nutrition Programs. Within NETTA is the branch that I work with called the Nutrition, Education, and Promotion Branch (NEPB), which supports programs by providing educational materials about healthy lifestyle choices based on the Dietary Guidelines for Americans and awards grants to states working to improve their program delivery. These resources are especially important for programs in food insecure regions, ultimately making strides towards slowing the perpetuation of the hunger cycle. As an intern, I’ve worked with the team to ensure materials are 100% perfect before they are distributed to the public. This requires an aptitude to understand the comprehension and needs of their target audience to ensure their readers will be able to readily utilize the information. In addition to this, like the staff at Manna, FNS team members remain positive and ready to dream big in their goals for the public, despite the obstacles that ensue.

The takeaway

Working to combat the heartbreaking cycle of food insecurity over the past several weeks has inspired me. As I attempt to emulate those who I have shadowed, I’ve reminded myself to celebrate the little wins and trust that my efforts are making an impact.  As I practice this, the barriers at hand seem more and more penetrable.

 

By: Danielle Ferguson

Some of the important things I learned during my foodservice rotation: 1) Homemade cornbread is amazing, 2) Singing loudly in my car helps long drives go by faster, and 3) the kitchen staff is incredible in their commitment and support to providing patients the appropriate nutrition recommended by the dietitians on the floors. I had the opportunity to complete my foodservice rotation at the same hospital where I am now completing my clinical rotation. Seeing it from both points of view has opened my eyes to how crucial the nutrition services kitchen staff is in aiding my patients in their healing and recovery process.

 

 

During my foodservice rotation, I played a role in many of the kitchen operations, such as catering, raw vegetable prep, the nourishment prep station, the tray line, and the patient ordering process. Participating in these operations prepared me well for starting my clinical rotation; I now understand how hospital nutrition services processes work from several aspects, so I know what it takes to get patients meals tailored to their needs. Now that I am in my clinical rotation, I get to learn about the processes required to assess patients’ nutritional requirements and recommend or prescribe the best diet options for each patient.

 

While working the clinical side of this rotation, I determine appropriate snacks and supplements for patients, decide what diets are appropriate, and analyze the nutrients the patient is receiving. Working in the foodservice department before moving on to the clinical nutrition department has helped my communications and rapport with the foodservice department.These are two very different departments that need to work together for a common goal, so I think having this connection has really been a plus. Seeing both sides has allowed me to adapt very quickly to the protocols of the hospital, have a clear understanding of what nutrition we can offer, and be more efficient by understanding the entire foodservice process of this hospital. This has encouraged my faith that we, nutrition services as a whole, are providing the best comprehensive care possible to our patients.

I know every time I order a snack, supplement, or specific diet, the people on the receiving and production end of that order are as committed to these patients as I am, and for this I am grateful. This experience has grown my appreciation for those who do the work that at times may be under-appreciated, and allowed me to grow tremendously in my role of a clinical dietetic intern!

By Emily Glass, UMD Dietetic Intern

“An apple a day will keep the dietitian happy,” could be heard throughout the day at the Maryland Academy of Nutrition and Dietetics (MAND) Annual State Legislative Interactive Workshop. Distinguished MAND members looked to RD’s and dietetic interns to play a crucial role in advocating important nutrition bills to their state legislators.

Maryland State Senator Brian J. Feldman (15th Legislative District) began the day with important tips on how to approach legislators. Then our team got to work discussing the bills that MAND strongly supports:

 

HB0086/SB0656 – Health Insurance Coverage for Elevated or Impaired Blood Glucose Levels and Prediabetes Treatment

Currently, insurance covers individuals with Type 1, Type 2, and Gestational Diabetes. This bill supports insurance coverage for individuals that fall into the “Prediabetes” category. This diagnosis is given to individuals with elevated blood glucose levels that are not yet high enough to be classified as diabetes. Without lifestyle changes, people with prediabetes have a significant risk of progressing to Type 2 diabetes. This bills provides individuals with preventative care so that they may be able to lower their blood glucose levels and never develop diabetes.

HB0490/SB0163 – Public Health – Community Health Workers – Advisory Committee and Certification

Community Health Workers (CHW) play a vital role in bridging the gap between medical doctors and people in the community. A task force found that these CHWs often have varying degrees of education with differing backgrounds, therefore an advisory committee was made to educate CHWs and aid them in supporting the community. Currently, there is no Registered Dietitian (RD) on this committee. This bills supports adding an RD to the committee to ensure that nutrition concerns and problems can be properly addressed.

HB0806 – Education – Summer Meals Expansion Grant Pilot Program

Many families rely on school lunch programs throughout the school year to ensure their children have access to meals. When school ends for the summer, these children still require nutrition support. This bills will further expand the Summer Meals program, making it easier for children with limited income and transportation to get a healthy, nutritious meal throughout the summer months.

HB1113 – Maryland Medical Assistance Program – Services for Children with Prader-Willi Syndrome

Prader-Willi Syndrome is a rare genetic condition that occurs in 1 out of every 15,000 births. With this disorder, children have impaired cognition, low IQs, insatiable hunger leading to obesity, and a strong likelihood of developing other chronic diseases. These children require lifelong support, and currently this responsibility falls on families. This bill will help these people gain access to family trainings, treatment services, and various specialized support services.

I had the pleasure of advocating for these bills with six others, including RD’s and dietetic interns. Legislators were happy and open to hearing our opinions on these bills. To my surprise, many legislators were already strong supporters of the bills and valued the importance of an RD. In addition to advocating for legislation, we invited delegates and senators to participate in the “Apple Crunch Challenge.” By taking a bite of an apple, legislators and MAND members joined together to show support for healthy eating and nutrition.

MAND members and dietetic interns join with Senator Nathan-Pulliam for the Apple Crunch Challenge

The opportunity and ability to practice nutrition should not and cannot be taken for granted. This workshop helped me understand the magnitude of work that must be done at state government levels to ensure the success of dietitians. As someone just beginning my dietetics career, I think it is my responsibility to work with policy makers to advocate for sound nutrition policies. By advocating and building relationships with state legislators, we can have a positive impact on both the health of our communities and the future of our profession.

By Alexandra Long

The story of two sisters was being projected on the screen in front of me. Both were born with the same disease; however, one was able to live a normal life while the other suffered severe damage to her brain and nervous system. The difference in their outcomes came down to one thing: diet. “This is where the RD is the rock star,” said our presenter, Danielle Starin, of the Rare Disease Institute of Children’s National Medical Center (CNMC).

For one of UMD’s dietetic internship joint class days, I had the honor to attend the CNMC Pediatric Nutrition Symposium. Having never worked with children, part of me was questioning if I would find the subject matter intriguing. Aware of this, I made sure to enter the symposium with the positive mindset of learning something new and remaining open to the world of pediatrics.

Another part of me knew, however, that I would like everything about the symposium. That’s my hang up. Throughout the course of the internship, I’ve liked everything that I’ve come across in rotations ranging from clinical work in a hospital to community work at a food bank. This may sound like an ideal scenario, but for me I felt like I was becoming lost in the world of dietetics. In what direction should I go? Where do I focus my network? The profession of dietetics may be small, but the opportunities are endless.

  *UMD Dietetic Interns at CNMC Symposium

It’s always been in my nature to plan: plan my day, my week, the next five years, and even into retirement. Without having a clear goal and vision of what my dream job in dietetics would be, plans for my future seemed to be at a standstill. Being in a dietetic internship is a wonderful opportunity because interns are exposed to so many types of dietetics jobs. The goal of my job as an intern is to gain experience, learn as much as I can about these jobs, and to grow as a dietitian. Recently, however, I have started to think about my career after the internship. I couldn’t be happier with the profession I chose, but I was starting to worry that I would “just end up somewhere” in the profession without finding my true passion.

The symposium started off well. Maybe I could work with kids after all. The key role that dietitians played at CNMC was evident; the speakers worked in an array of specializations including pediatric nutrition support, diabetes, weight management, cystic fibrosis, the NICU, and gastrointestinal disease. As always, I found myself interested in every topic. I could see myself working in any of these areas. Did that mean I would be on the right track if I followed clinical dietetics in general? Is pediatrics what I should try? I normally have a strong gut feeling when I make important decisions, so being left with such ambiguous thoughts to decide my career path didn’t sit too well with me.

We were nearing the end of the day, and there was one presentation left. This was a breakout session, and we could choose between the options of two lectures to attend. The first choice was to go down the hall in a separate auditorium for a lecture on eating disorders, and the second option was to stay put and attend the lecture on inborn errors of metabolism. I perked up at the mention of this second option. In my undergraduate program, these rare diseases were maybe covered in one lecture in my medical nutrition therapy courses. I didn’t realize that that you could specialize in their study, and that there were jobs available for dietitians to work solely with these patients.

A lightbulb moment occurred only one slide into the presentation. Illustrated was the genetic defect in a disease commonly called PKU. In PKU, the enzyme which breaks down a specific protein, phenylalanine, malfunctions. This can lead to a buildup of phenylalanine that can eventually cause neurological problems, as in the case of the two sisters. The younger sister was diagnosed with PKU at birth, whereas the genetic testing was not in place when the older sister born. The difference? The younger sister was placed on a strict, low phenylalanine diet and was able to develop normally without the same neurological problems as her older sister.

Of course! My two favorite courses in school were clinical biochemistry and microbiology where we studied genetics and their resulting biochemistry. Dietitians working with inborn errors of metabolism directly apply genetics and biochemistry to develop treatment plans to give patients a better quality of life. My vision of working in this field was strong, so much so that I felt the need to explore this field further. This was the gut feeling I was waiting for.

The symposium was just a week ago, yet I’ve already started my planning. The questions I am asking myself now are more targeted, such as, “Do I get my MBA to start my own practice or a Master’s in Human Genetics?” and, “Should I expand my study to nutrigenomics?” It’s as if that one lecture renewed my excitement to plan for my future career in dietetics. My experience is a testament to being open to new opportunities that come your way. Having a focus area to explore adds to this exciting time in my career, and I look forward to what future opportunities await.