Posts

, ,

National Nutrition Month

March is National Nutrition Month. The campaign promotes healthy eating habits and nutrition education, and it celebrates the people who promote these healthy habits. In 2018, the theme is “Go Further with Food”, highlighting that food decisions make an impact on your overall health.

Members of the American Society for Nutrition (ASN) are diverse. We study nutrition as a science, reporting on the physiological and biological aspects of foods and nutrients. We are also the nutrition educators and practitioners who get the latest nutrition science into the hands of those who need it: policymakers, dietitians, medical doctors, nurses and allied health professionals, and consumers. To celebrate National Nutrition Month and ASN’s impact on enhancing the knowledge of nutrition and quality of life, we will be highlighting some of our programs and activities that ultimately influence public health and how we can “go further with food.”

NUTRITION 2018 – American Society for Nutrition’s Annual Meeting

Nutrition 2018 LogoThis year ASN kicks off a new annual meeting that will focus on the multidisciplinary field of nutrition science. The meeting will bring together basic, translational, clinical, and population scientists and practitioners. The meeting will be held in Boston June 9-12 and registration is open now!

Some hot nutrition topics at the meeting:

  • Role of Anti-inflammatory Nutrition Strategies
  • Pediatric Nutrition
  • Nutrition and the Environment
  • Precision Nutrition
  • Science of Breastfeeding
  • Food Allergies

These are only a few topics that are included in the 4-day nutrition meeting. Our NUTRITION 2018 schedule is now open so please refer to it for the latest sessions.

Stay tuned for more news and a special membership offer for dietitians and nutritionists during National Nutrition Month.

, , , , , ,

How can we implement better health behaviors in cancer survivors?

Lifestyle interventions targeted at obtaining/maintaining a healthy body weight and/or incorporating physical activity and healthy eating habits have great potential in improving outcomes in cancer survivors. Cancer diagnosis is a “teachable moment” wherein many patients are highly motivated to make changes (1). Furthermore, a balanced diet and moderate exercise can improve prognosis, quality of life, physical function, and survival across the cancer continuum. As such, groups such as the Amercian Cancer Society, National Comprehensive Cancer Network and the American College of Sports Medicine have released lifestyle guidelines for cancer survivors.

However, implementing changes in individuals and healthcare systems is challenging, to say the least. This is a recent topic covered by Karen Basen-Engquist and a number of colleagues as part of a special Issue of Obesity (Transdisciplinary Research on Energetics and Cancer)(2). Their article provides a 6-point agenda for translating research into clinical and community action, as follows:

  1. Increase the availability of different types of activities for weight management, nutrition counseling, and physical activity. One size will never fit all when it comes to improving health. Individual goals/preference, resources, and logistics all come into play, and cancer-specific programs may be needed.
  2. Improve screening and referral to lifestyle interventions. A system for evaluating and triaging patients for health programs should be developed. Importantly, an individual’s physical status, health needs, and goals should be considered.
  3. Improve the health care provider’s ability to screen, assess, and refer survivors for lifestyle programs. Oncology providers have a powerful role in helping cancer survivors; however, they often do not feel confident in screening, giving advice, or administering recommendations for lifestyle-related constructs. Implementation of processes such as the 5As (Ask, Advise, Assess, Assist, Arrange), which has been successful in tobacco cessation (3) and obesity management (4) might prove beneficial.
  4. Expand the support of oncology-specific professional training and certification. Professional organizations of dietitians, exercise professionals, psychiatrists, and physical therapists have additional certification programs for oncology or are working on developing one for its members. However, professionals with specific expertise in oncology are still greatly needed to address the unique needs of this population.
  5. Expand dissemination and implementation research. Many research programs do not address how a program could be implemented in a real-world setting (external validity). Dissemination of research findings with consideration of the sustainability and generalizability of programs is essential for broader impact.
  6. Advocate for health care policies that support lifestyle services for cancer survivors. Coverage for health programs is highly variable and often has barriers such as large co-payments, no coverage in grandfathered plans, and cost sharing. A potential solution could be incentivizing nutrition and exercise services, although more research is needed to determine the effectiveness of such actions.

As the authors eloquently articulate, the time has come to enable research into action for optimal healthcare in all cancer survivors.

References:

  1. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 2005;23:5814–30.
  2. Basen-Engquist K, Alfano CM, Maitin-Shepard M, Thomas CA, Schmitz KH, Pinto BM, et al. Agenda for Translating Physical Activity, Nutrition,and Weight Management Interventions for Cancer Survivors into Clinical and Community Practice. Obesity 2017; 25, S9-S22.
  3. Siu AL, Force USPST. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015;163:622-634.
  4. Rueda-Clausen CF, Benterud E, Bond T, Olszowka R, Vallis MT, Sharma AM. Effect of implementing the 5As of Obesity Management framework on provider-patient interactions in primary care. Clin Obes 2013; 4, 39-44.

 

,

My Clinical Nutrition Internship Experience

By Seth Morrison

My name is Seth Morrison, a final year medical student at the Medical School for International Health in Israel. I would like to share with you a taste of my experiences in the ASN’s unique Clinical Nutrition Internship.

Clinical nutrition was never really on my radar as something I might become interested in until halfway through medical school. It was then that I attended the International Congress of Nutrition held in Granada, Spain, where I met some members of the ASN. Like most medical students, the nutrition content in my courses was only enough to whet my appetite. I never had a chance to really delve into nutrition in-depth so that I would feel comfortable counselling patients or speaking intelligently about it with colleagues. The ICN conference opened my eyes to the many different research branches of the nutrition sciences as well as public health nutrition. The global trends in the “double burden” of malnutrition (undernutrition and overnutrition) in developing countries began to worry me, and I started learning about the many efforts that are underway to intervene. All of this made me want to find an opportunity to supplement my nascent interest in nutrition, and see which career avenues exist. I would like to incorporate nutrition into my medical practice and possibly conduct public health nutrition interventions in resource-limited settings worldwide. That is when I discovered this clinical nutrition internship.

I think my internship was an unparalleled opportunity for a medical student to get an insider’s look into the fascinating world of clinical nutrition and nutrition science. The variety of opportunities I had at the University of Colorado and Children’s Hospital Colorado working with Dr. Nancy Krebs as my mentor gave me the ability to look at the role of nutrition in health from many different angles. I saw how important clinical nutrition is in the weekly outpatient clinics at Children’s Hospital. There were two separate clinics for kids with either growth faltering or obesity. These clinics are where I spent a great deal of my time. Throughout that time, I gradually gleaned the beauty in which skilled nutrition practitioners were able to make a real difference in outcomes as a team. Other physicians in these clinics, along with the amazing nutritionists, nurses, and a clinical psychologist, each contributed to my education in unique ways. They taught me the decision-making process of how to decipher clues to the causes of very different clinical nutrition problems (i.e. overweight vs. underweight), whether they be organic, lifestyle-related, or sometimes, in the case of young children, family food-related behaviors. This created the immensely enjoyable opportunity to decipher solutions to these myriad problems with clinical judgement and a creativity that respects the patient’s/family’s abilities and interests. I like to say today that in order to provide effective dietary counselling to patients, each doctor should have a little bit of a nutritionist inside them. This skill is one of the greatest gifts that the internship provided me for my own toolbox of clinical skills.

A sampling of the other components of my internship that made it very well-rounded were a research project, visits to WIC clinics, family eating well classes, several journal clubs and special nutrition lectures every week, and even a few nutrition-related Grand Rounds on Friday afternoons. I also completed a research project, which was a small metabolomics study on the relative serum levels of acylcarnitines and branched-chain amino acids in lean vs. obese groups of pregnant Guatemalan women.

This research component of the internship added an essential ingredient to the overall experience. Not only did I get to work with a fantastic and knowledgeable basic science researcher on a project in a burgeoning field of nutrition science (metabolomics), I also gained new skills and refined others that are needed in any research project I may become involved with in the future. This academic component reinforced the ever-present need for an army of researchers to inform the nutritional counsel given to patients in clinical medicine.

Inpatient care in the University of Colorado Hospital especially gave me the chance to see how crucial proper nutrition is for pre- and post-operative patients, burn unit patients, and of course in critical care. The nutrition support physician and the knowledgeable dietitians there broadened my knowledge of TPN and other topics in critical care nutrition research. In doing so, the truth was ingrained in me that nutrition is dynamic and can, in different circumstances, be prevention, treatment, or even both. Whether a patient is acutely ill or on a path of long term lifestyle change to reach a healthy weight, nutrition is likely to play an important role in their success!

The ASN Clinical Nutrition Internship satiated a special hunger for this nutrition niche in my medical education. I could not be more grateful and proud to have been awarded this unique opportunity, and the memories from it will linger with me for the rest of my career. As a soon-to-be physician, I’ve now learned that nutrition is a bit like music. It’s nice to listen to, but to really appreciate it, you must also learn to play some of your own notes.

 

,

ACCN15: Motivational Interviewing Techniques to Encourage Lifestyle Changes/Weight Loss

By Celez Suratos, MS, RD, ACCN15 Blogger

Motivational interviewing (MI) is a technique used to incite positive behavior change. It is directive and client/patient-centered. Healthcare providers (including registered nurses and dietitians) use MI to direct self-motivational statements from the patient. Hence, allowing patients to be in charge of setting and meeting their own goals. Dr. Kathryn I. Pollack from the Duke University School of Medicine facilitated an interactive workshop on MI at this year’s Advances and Controversies in Clinical Nutrition Conference (ACCN). The main focus was to inform healthcare providers of the “spirit” of MI, as well as putting MI techniques into practice through role-playing.

Most of us are familiar with the phrase, “it’s not what you say, it’s how you say it.” But did you know that communication is approximately 90 percent body language? MI is more than a methodological counseling approach. It also causes a healthcare provider be more present and aware of how he/she is communicating to the patient. According to Dr. Pollack, the “spirit” of MI embodies four key principles to elaborate on such a concept; Partnership, Acceptance, Evocation, and Compassion.

A healthcare provider may have the tendency to dominate the conversation by supplying the patient with numerous facts about the status of his/her health, likely telling the patient what he/she “must” do in order to prevent the “worst-case scenario” from happening to them. However, in MI, a provider should focus on building a partnership-like relationship rather than one that is hierarchical. One can do this by initially asking permission before sharing information and giving advice. This allows patients a choice to discuss their health based on their own readiness to handle the information you want to give them. Alternatively, a provider can ask the patient what concerns he/she may have in order to allow the patient to set the agenda, giving the patient the power to discuss what he/she may already be thinking about improving.

Acceptance goes beyond the concept of non-judgment. This means the healthcare provider accepts the patient’s motivation, commitment, and choices in totality. This relates back to non-verbal communication. If you are feeling judgment, you are also likely exhibiting judgment, which then means your patient can see your judgment. Think about it – do you ever cross your arms or furrow your brow when you disagree with a statement? Letting go of judgment will not only improve your skills as a practitioner, but can be freeing as well.

A healthcare provider may be able to provide a patient with beneficial reasons to improve his/her health status. However, evocation is the idea that people are motivated by their own reasons. In MI, the provider facilitates a conversation that allows the patient to find his or her own motivation for adopting positive change. One way to help patients find their motivation is to prompt them with questions to discuss their readiness to change. Such questions may include asking patients to rank their readiness to change (i.e., on a scale of 1 to 7 –with 1 being least ready to change and 7 being most ready for change, for example), then asking why they chose that particular number on the scale, what it would take for them to rank their readiness for change even higher (if not already ranked as a priority), and when will they be ready to implement their plan. Evocation extracts information from the patient, such as reasons to change, identifies barriers to change, and eventually a self-actualized plan to get patients to reach their goal(s).

Dr. Pollack also mentioned ‘compassion’ as a novel principle to the spirit of MI, particularly in the provider-patient relationship. It comes from the idea that providers should use open-ended questions, reflective statements, and summarize the conversation when they interact with their patients. This demonstrates active listening, versus a series of agreeable head-nods or dismissive “uh huh” verbal responses. Compassion also calls on providers to give patients affirmation with each step they take to reach their goal(s), even during times of perceived setbacks.

Dr. Pollack summarized that only the patient can make change happen for him or herself. The patient is the one who needs to put in the work to see results. Motivational interviewing is not only a tool healthcare providers can use as a catalyst for positive change, but is also a specific skill that takes practice and time to perfect.