Fighting Fires and Health Risks

By: Sina D’Amico

Firefighters are used to putting their lives on the line to save others. It’s a risky business, but so is eating like many firefighters do, as I found out during my three-week rotation with the dietitian for Montgomery County’s firefighters. After receiving a full run-down of what the dietitian does day in and day out, my partner and I were able to attend education sessions at various facilities, prepare meals for two stations, and create education materials and recipe books for the firefighters. 

A major focus in this population is their elevated risk for certain health problems such as heart disease and cancer that comes from their exposure to toxins when working active fires. The dinner meals that stations choose to make during shifts tend to increase their risk. The firefighters I spoke with shared with me the types of meals they liked to make at the station. Taste, they said, was their major concern. After all, their shifts can be physically and mentally exhausting and they need to recharge. The foods they tend to choose are more “comfort food” options, such as items wrapped in bacon, covered in cheese, or generally high in fat and cholesterol. The goal with this population is to still provide meals with lots of flavor but a lower fat and cholesterol content.  

Firefighters typically work 24-hour shifts – that means they must plan meals and snacks to bring with them to the station. Typically, dinner is prepared at the station and each shift member contributes a certain amount to cover grocery costs. Each station has an A, B and C shift; each shift also has their own refrigerator and storage space. However, space is usually limited and time is a major concern. There is no knowing when a call will actually come in; the members could get a call in the middle of eating their prepared station dinner. When this happens, all of the food is left exactly where it is until the members return. There is no one there to put things away to save for later. This makes it hard to prepare and eat full meals, especially around dinner time. 

One way I supported healthier eating by the firefighters was to create meal guides. These resources featured quick, healthy and affordable items that they could prepare at home or the station. Additionally, these items could be easily transported for a meal on the go. My partner, Caty, and I spent time researching different recipes that were healthy but did not compromise on flavor. The biggest thing this population was concerned about was how their meals tasted – which is understandable. With this in mind, we compiled a list of recipes that were healthy and budget-friendly, along with options to prepare a greater quantity if individuals were able to use a slow cooker at home.

The cover photo of one recipe book my partner and I created

An important component of this project was to get to know the firefighters so we could tailor the meal guides to their needs. Caty and I visited four different stations and talked with them about what they like to eat. Taking their answers into account helped us ultimately choose which recipes we included and which we left out of our final recipe book projects. Once the different stations found out about this project, they were excited and could not wait for the dietitian to share it. 

To really get the firefighters hooked on healthier eating, we decided they needed to taste one of the delicious meals in the guide. So next I cooked dinner at one of the stations to show the firefighters that a healthier dinner can taste good. I visited the station where I would be cooking prior to the night of the meal to see their cooking structure and one of their typical meals. On the menu that night was chicken stuffed with jalapeno poppers. The jalapeno popper stuffing consisted of cream cheese, shredded cheese, jalapenos and green onions. This was mixed together and stuffed inside the chicken breasts. Each chicken breast was then wrapped in two pieces of bacon and even more shredded cheese topped off each piece. While this might sound like a good meal, from a nutritional standpoint it was extremely high in fat and cholesterol, which increased these firefighter’s health risk even more.

Taking this typical meal into consideration, Caty and I decided to cook a Cajun chicken pasta. This recipe was from a book that included recipes developed by other current and previous University of Maryland dietetic interns. All of the prep for this meal was done in the station kitchen. Ingredients included chicken (made in the crockpot), kielbasa (cooked in a separate pan), whole wheat pasta, peppers, onions, chicken broth and tomato paste. The simplicity of this dish was that everything could be cooked in one pot, making cook time and clean up time even shorter for an already busy station.

All of the foods Caty and I prepared for our station meal

Preparing this meal taught me how to make something for a large group of individuals where everyone has a different food preference. Some shift members have allergies, some follow a specific diet, and others are picky eaters and don’t eat a wide variety of foods. Just like station members on cooking duty must do, I had to take this into account when planning the dinner. After the meal was served and all the station members were seated, they started complimenting the meal and giving very positive feedback. None of them noticed the difference in the use of whole wheat pasta versus regular pasta and they were excited to get the recipe to start making it on their own. 

This three-week rotation taught me a lot about being able to accommodate certain groups without having to completely change their way of eating. The health risks that come along with being a firefighter are severe, and making food that can lower these risks is extremely important. It was very satisfying getting the station members engaged and excited about cooking healthier meals.

Discovering One Style Doesn’t Fit All

By Leslie MacManus

According to a recent survey by the National Survey of Student Engagement, on average, college freshmen write more than 90 pages during the school year and college seniors write more than 140 pages. If you do the math, that could be around 450 pages of papers during a full undergraduate career! Add that to the numerous projects and writing assignments in graduate school, and I can confidently say that I had done a lot of writing before my dietetic internship began. So, when I started the University of Maryland (UMD) College Park dietetic internship with a technology or nutrition informatics emphasis, I thought that I would breeze through all the writing requirements with ease. Little did I know, I was about to embark on a 10-month journey that incorporated a different style of writing almost every week! I have just about completed my fifth rotation in this program, so while I feel like I have learned multiple different styles of writing already, I think there will be even more in my future. Let me tell you about a few things I’ve learned in each rotation about writing.

Food Supplement Nutrition Education (FSNE)

First up: writing for a low-literacy audience. During my FSNE rotation, I was tasked with writing a blog post for the FSNE website on drinking water during the school day. I started writing right away, incorporating great vocabulary and detailed sentences that captured the ideas that I wanted to feature in my post. My preceptor then gave me a “readability score” resource I could use to check that my blog post qualified as a 6th grade reading level, which was a requirement for the blog post. I basically received a score equivalent to a failing grade at first. The resource my preceptor gave me had some tips listed to improve my readability score:

  • Use words with less than 12 letters, as long words are difficult to read and say.
  • Write sentences with less than 30 syllables, as long sentences are difficult to track.
  • Break down long sentences into simpler terms or multiple sentences.

With these tips in mind, I set out to write my next draft, breaking down words and sentences into more basic forms. It felt funny writing in a very simple manner, especially since I had just come from graduate school where I recently wrote very long papers, almost in the form of a thesis. This experience taught me that learning how to write in this style can only improve my skill set as a future registered dietitian (RD).

UMD Campus Dining Services and Sustainability

Examples of infographics I created during my UMD Campus Dining Services rotation.

Next on the list: informative writing for a large audience. The UMD Campus Dining and Sustainability rotations included the development of many educational materials for a large audience, including UMD students, faculty, staff and anyone else who may be on campus or visit the website. I had to learn how to take a certain topic and portray the main points to a large audience in multiple different ways: a blog post, a social media post, a poster, a table tent, and more. The fact that these educational materials often included pictures and graphics was an added challenge. I already knew how to create a simple infographic, but this rotation allowed me to strengthen this skill and create more detailed versions that were displayed across campus.

Snapshot of a farmers market brochure my internship partner and I developed at our sustainability rotation.

 

Clinical

Third writing style: concise writing. It may surprise you, but my clinical rotation actually taught me something about writing. After seeing a patient in the hospital, I had to write a short note in his or her chart. This note was a compilation of what the patient told me, what I observed and other relevant information from the patient’s chart. My first note seemed to be a bit of a disaster, as I included way too much information. Providing an extensive amount of patient information in the charted note seemed like a no-brainer to me. However, what I failed to realize was that the patient’s chart included notes from all professions – doctors, social workers, nurses, physical therapists, and more. The RD note was supposed to include only pertinent nutrition information that would be relevant to the next RD, doctor or nurse that visited the patient in the future. This was a difficult thing to learn, but by the end of my clinical rotation I felt like an expert on creating simple, more concise notes. I now know what information to include, what to omit, and how to write it in the most effective way possible.

Me at my clinical rotation practicing my mini case study presentation.

Abstracts

New concept in progress: writing with a strict word limit. At this point in the internship, we have started writing drafts of our abstracts to be considered for presentation at the student poster session of the DCMAND 2020 Annual Meeting. This has been one of the more difficult writing styles to learn, as there is a strict 250-word limit to each abstract. The only experience I have with writing limits has been in a page-limit format, where I am restricted to 5-, 10- or even 20-pages and there is plenty of space to include all the information I feel is pertinent. In this process, I have had to learn how to take my topic idea and compile it into 5 different sections while making every single word count – there is no room for “extra fluff” in the abstract, as it will not be accepted if it is even one word over the limit. If you think this sounds challenging, you are correct! Luckily, I am always up for a challenge, so I have been enjoying this experience so far.

At this point in my internship, I have learned about several new writing styles that I will carry with me into my future career as an RD. I appreciate that I am learning and strengthening my writing skills on a daily basis. I look forward to seeing what writing style I will learn or work on at my next rotation!

Weight Loss Surgery – Not the quick fix people may think

By: David Cover

When most people think of weight loss surgery, they assume that it is taking the easy way out. What they don’t realize is that many of the patients who decide on getting weight loss surgery are the opposite of lazy. They have tried multiple different weight loss programs throughout their lifetime. I know this first hand from my previous work with Medifast where most clients have been on more diets than you can imagine. Currently, the prevalence of obesity in Americans is estimated  to be roughly 39.8% and rising. Obesity is a multifactorial disease, which is influenced by lifestyle, cultural, and genetic factors. All those factors make it exceedingly difficult for people to both lose and maintain their weight loss. It became apparent during my rotation with Inova Bariatric Surgery that surgery wasn’t an easy way out; it provided patients with a tool to help them lose weight and keep it off.

There are various surgical options to treat obesity, however the sleeve gastrectomy and Roux-en-Y gastric bypass procedure are the two most commonly performed. During this rotation, I learned that the surgery selection depends on the severity of obesity, patient medical history, and other factors. Additionally, research has shown that multifaceted preoperative preparation greatly improves long term success rates after weight loss surgery. The staff at Inova understand this and utilize a multidisciplinary approach to weight loss. In addition to the bariatric surgeons, Inova employs dietitians, exercise specialists, behavioral specialists, and certified bariatric nurses to counsel the patient on all stages of their weight loss journey. For example, during a diet education patients would frequently bring up topics such as exercise type and duration. Fortunately, we had a certified exercise specialist in the next office to answer all of their questions. Additionally, bariatric patients may have a propensity for certain addictions, and having a behavioral health specialist available was very helpful for our patients. It was a great experience to see firsthand how all the specialists in their respective field work together to improve their patients’ health.

During this rotation I worked alongside a dietitian who provided weight loss counseling and diet prescriptions to patients through all phases of their weight loss journey. When a patient is planning to have bariatric surgery, there are multiple diet phases they must undergo in order to prepare their body for surgery. In addition to this, a patient must prove they are able to maintain, if not lose weight, prior to surgery in order for insurance to cover the procedure cost. This is where the dietitian is crucial in ensuring patient success. Before this rotation, I was not fully aware of the diet progression patients must undergo. For example, for two weeks prior to surgery, patients can consume only clear liquids in addition to two protein shakes per day. The reason for this isn’t only weight loss, the low carbohydrate and fat nature of this diet are used to exhaust liver glycogen and lipid stores, thereby shrinking the liver. This helps make the surgery easier for the surgeon to perform and decreases the risk of complications. After surgery, the patient remains on a clear liquid diet for two weeks and progresses towards thicker foods overtime, which allows the stomach to heal properly.

After observing a few of the dietitian’s consults, I was allowed to speak with the patients regarding their diet progression and vitamin and mineral supplementation instructions. Many patients who undergo bariatric surgery are unable to properly absorb the micronutrients from food. Therefore, it is very important for them to get routine lab work for the dietitian to review and provide supplementation as needed. I was also able to conduct a pre-bariatric diet education session to a group of roughly 15 patients using a large auditorium in our building. I gave a powerpoint presentation on how they can properly prepare themselves for bariatric surgery and how to structure their diet both pre and post operatively. Following the presentation, I held a brief Q&A session for patients to ask me specific diet related questions. This was also a great experience as I have never held group classes before. The physicians are also allowing me to observe one of their surgeries and I am very grateful for that opportunity. Working oneonone counseling patients was similar to my previous work experience. However, this area of dietetics involved a patient population with more specific needs. This made my rotation at Inova a great learning experience, while also strengthening my existing skill set.

I enjoyed interning at Inova Bariatric Surgery. The staff are extremely professional and it was very apparent how much they care about the lifelong health of their patients. I hope to have the opportunity to work in this area again because I found this clinical rotation the most rewarding. Interning at Inova reinforced that bariatric surgery isn’t a quick fix it only provides a tool for weight loss. It takes a lot of courage to tackle obesity through weight loss surgery. Surgery itself would not work if the patients were not both motivated and dedicated to a total lifestyle change, and I can tell you from experience that many of them are.

Bringing Healthy Food to Schools Through Competition

By: David Cover

When you think back about your childhood, what do you remember most about the food served in the school cafeteria? For me personally, I remember lots of greasy pizza, french fries, and sloppy joes. I am not sure if I ever ate fresh fruit or vegetables. Over the years I have heard about how schools have been trying to implement healthy meals including fresh fruits and vegetables. I always believed that most children would prefer greasy, fried foods over fresh, plant based options if they had a choice. I know that my 10 year old self would choose the french fries over broccoli any day of the week. However, after my rotation with Montgomery County Public Schools (MCPS), my beliefs on this subject radically changed.

The dietitians at MCPS have been working tirelessly to offer a variety of fresh fruits, vegetables, and low sodium meals at a very low cost to children and their families. The staff at MCPS understand that many children may be reluctant to try foods such as whole grains, soy based products, green vegetables, etc, so they have devised clever ways of introducing these important foods into the menu. For example, all of the pizzas served now use 100% whole grain crust, and they have somehow been able to produce vegetable chicken nuggets that taste like the real thing! Believe it or not, the children are actually enjoying these healthy food options. I couldn’t believe my eyes when I saw students choose the chicken salad over a steak and cheese sandwich. During this rotation I learned that dietitians have a two fold goal for introducing these healthy ingredients. Successfully introducing these healthier menu items is not only important for children’s health in the here and now; over time children will become more accustomed to the flavors of these healthy ingredients, making them more likely to eat well later in life.The dietitians and chefs at MCPS have really done a great job at providing healthy, nutritious meals that satisfy the students’ tastes, all for a very low price.

In addition to providing nutritious and tasty meals for the students of Montgomery County, MCPS has even encouraged children countywide to come up with their own healthy recipes. MCPS has partnered with Real Food for Kids (RFFK), whose mission is to promote nutrition and health literacy to children of all ages. Just this year RFFK held a culinary challenge for more than 100 students from five local school districts with the goal of creating a nutritious dish that would be featured on the school lunch menu next year in Fairfax, Prince William, Arlington, Loudoun, and Montgomery County schools. Takoma Park Middle School students won this challenge with their “Kale Power Bowl.” During my rotation at MCPS, my internship partner and I were able to assist in preparing this recipe in our test kitchen to ensure a smooth rollout in the schools.

This “Power Bowl” consisted of kale, roasted squash, shredded chicken, quinoa, apple slices, raisins, and a chipotle salad dressing. It was hard to believe that middle school students came up with this recipe; I don’t think I have ever made a salad that fancy! It was a great experience working with a chef at MCPS to determine the best way to instruct kitchens to prepare the salad. I was able to learn about the various restraints large food service organizations have to work within in order to roll out recipes to large populations. The MCPS cafeteria staff gets extremely busy preparing meals throughout the day so it was important for us to determine the most efficient way to prepare the salad in order for it to be easily prepared at all the schools countywide.

In the end, we had to use a rice/quinoa blend to cut costs and craisins because MCPS already places large orders for craisins and had them on hand. I also learned that if we blanched the kale instead of serving it raw, it would take away some of the bitterness and make it look more appealing to the students by brightening the color. Hopefully our modifications worked to both increase student interest in the salad and make it easier for the kitchen staff to prepare. Other school districts might have to modify the recipe in other ways, but our recipe turned out great and I look forward to hearing students’ reactions in the coming school year.

It was a great experience interning at MCPS division of food services, the staff there really cares about school nutrition and work very hard to ensure students are receiving great tasting and nutritious meals at a reasonable price. Public school nutrition was an area of food service management that I really enjoyed, and I hope to have the opportunity to work in this area again. Until then, I look forward to preparing this “Power Bowl” at home for myself to enjoy.

The Role of Graphic Design in Dietetics

By: Alexis Mateer

Me with my poster on sustainable farming practices

Do you want to be an entrepreneur in the nutrition field? Do you ever want to own your own business, go into private practice, or even just develop more visually appealing education materials for your patients? If so then you need graphic design in your life! Graphic design is necessary for marketing purposes in a variety of fields. Within nutrition and dietetics, it’s necessary for disseminating nutrition information through creation of images that, for example, demonstrate serving sizes or nutrition facts. Now I am no graphic design expert; I am simply a dietetic intern who, through her internship, has discovered the benefits of embracing graphic design!

I got matched to University of Maryland (UMD) College Park Dietetic Internship, and I can confidently say that I am glad I did. I knew from the beginning that the internship has a technology focus; I just did not realize that the tech focus encompasses elements of graphic design.

How I got my Feet Wet with Graphic Design

My third rotation of this internship was in UMD’s campus dining services department. My intern partner, Abby, and I walked in on the first day and were welcomed with a packet of projects. The site has had interns before, so they were well prepared for us and knew how they wanted to use us. The rotation was three weeks, and it was demanding. Essentially, we were tasked with marketing the Cool Foods Movement to the student body, as well as creating educational nutrition infographics. The Cool Foods Movement is about elevating sustainable practices to help reduce greenhouse gas emissions. UMD was the first university to sign the Cool Foods Pledge—reducing food-related greenhouse gas emissions by 25% by 2030. Both marketing the Cool Foods Movement and creating nutrition infographics required that we design visual educational materials. 

Table Tents, Articles, Posters Oh My!

Abby and I were each tasked with making 3 table tents, one poster, and two nutrition article fact sheets. We had three weeks. They all had to be on the Cool Foods theme. For all of our graphics we used Canva. Canva is a website that allows users to easily make infographics, flyers, posters, magazine covers, etc. Throughout this rotation I got better and better at using Canva to create what I wanted. At the end of the rotation, our preceptor told us that our graphics were some of the best she had seen! I’d never before thought of myself as being very tech savvy or a design natural, so I was pretty proud.

Wellness Walls

Wellness Wall week one

Each week of the internship Abby and I also created a Wellness Wall. This is a bulletin board that contains one nutrition tip, cooking tip, healthy recipe, and exercise tip. The bulletin boards and infographics needed to have a united theme. The theme Abby and I chose was, “It’s Spooky Season, but Healthy Habits don’t have to be Scary.” We also had to replicate each bulletin board in Spanish. 

Why I think Graphic Design is Relevant for Dietitians

So why is this important for dietitians, or future Registered Dietitians (RDs) like me?

  1. Health Literacy

It’s simple: images can be easier to understand than words. For some, language and literacy are barriers to healthcare and medical advice. Abby and I came to this realization when creating an infographic for UMD’s dish room staff. The infographic used both words and images to detail the safe use of the chemical Scale Away. Since the diverse staff included individuals that speak different languages, we realized that making a highly visual graphic utilizing common safety symbols was best.

  1. Different Styles of Learning 

Not all people learn the same ways. Personally, I learn best by seeing and then doing. Not everyone is going to be able to read a document or educational material and understand it or be able to act on it. We can’t expect clients or patients to be able to do the same with nutrition advice. Having the ability to give patients verbal, written, and visual instruction or education will enhance their comprehension and create lasting, powerful messages. Infographics are powerful tools that incorporate both written and visual messaging. 

  1. Branding and Marketing

If you are trying to build a personal brand or are working in private practice, graphic design is going to help you build your client base. Private practice entrepreneurs and/or anyone developing a personal brand must be able to reach their target audience. This is done through marketing, and is most effective when done with a set of specific messages and expectations about that brand. Logos, handouts, and materials that are easy to understand and that showcase personality, knowledge, and trust are necessary.

  1. Making Yourself Stand Out

If you feel that there is a need for some type of graphic or educational material at your facility or worksite, then you have the power to fix that! And people don’t necessarily know what they are missing until they see it. Be the person to create that missing piece or educational element and bring it to your facility’s attention. It’s going to make you stand out as an employee, and seem like a worthy candidate when looking for that promotion.

A Few Design Tips I’ve learned:

  • Simple Message – Overall message should be direct, clear, and specific.
  • Color – Colors should be pleasing to the eye, set the mood, and lead the eyes to important content.
  • Font Size – Consider your audience. Older adults will need larger font size. Text that is easiest to read will be dark on a lighter background.
  • White Space – Don’t overcrowd graphics. White space is essential, and if lacking, can make content unappealing.

Wrapping it all up…

Learning how to make graphics can be time consuming at first, but definitely becomes easier with practice, trust me. Start practicing now! Think about creative ways that you could enhance your work. Despite being so busy with all my projects in school dining, the rotation remains one of my favorites. I really did enjoy making all the nutrition-related graphics; it was kind of relaxing! I liked having a physical, final product of my labors and it feels great getting commended for my creations. Graphics are necessary materials in the field of nutrition messaging. How can you play a part in their creation and use?