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March 20, 2023

How Do Nutrition Services and Primary Care Combine to Make a Great Recipe for Health?

Nutrition plays a major role in our health. What we eat can impact everything from chronic conditions – such as diabetes and heart disease – to our overall wellness – such as our energy levels and immune system function. A healthy, balanced diet can also help prevent certain health problems from ever occurring.

That’s why Avance Care offers Nutrition Services as an integral part of primary care. Registered dietitians, or RDs, are health professionals who are trained to provide evidence-based nutrition education, counseling and therapy. By offerings appointments with registered dietitians on site, Avance Care ensures that our patients have access to the highest quality nutrition services and support.

Christina Dauer, MPH, RDN, LDN, CDCES, Director of Nutrition Services, tells us about what patients can expect from Avance Care’s registered dietitians. She also shares how she and her team work with patients to provide personalized care that helps patients reach their health goals.

How do registered dietitians work within a primary care practice?

We partner with primary care providers and with patients, so we’re all working together as a team to help prevent and manage nutrition-related chronic disease. Registered dietitians have a lot of training and specialized skills in the area of food and nutrition. We can really go deep with patients on that, spend time with them and support them in making changes. It’s a really crucial partnership: it helps patients improve their health and it helps providers? because we’re all working together toward healthier patient outcomes.

Why is good nutrition core to our health?

I really don’t like to use the word “good” when we’re talking about nutrition. When we use the words “good” versus “bad,” it has a lot of value judgment behind it, and there’s so much with nutrition that people feel judged on.

I think of nutrition more as a balance. We do want our body to get all the nutrients that it needs to work at its best. But there’s still room for those foods that do have less nutritional value, but hold meaning in other ways for people, which could be social, cultural or religious. And sometimes we do cope with food and eat a food that makes us feel good, but doesn’t have a lot of nutritional value, and that’s okay. If it’s happening too much, causing distress and impacting health, it’s a concern we can discuss. But what we most need is a healthy balance of nutrients to function and to prevent chronic disease, or to prevent complications from chronic disease. And food helps us do that.

What are the most common reasons patients see a registered dietitian?

Many people want to lose weight. Often, they want to lose weight to help them with another health condition, such as hypertension (high blood pressure), prediabetes, Type 2 diabetes, heart disease. We also get a lot of referrals for gastrointestinal issues, such as irritable bowel syndrome (IBS).

We have drastically increased the amount of eating disorder patients that we’re seeing. Since COVID, disordered eating has become a significantly greater issue, and there’s a lack of community resources for that. When there are higher levels of anxiety, stress or isolation, patients who may have had an eating disorder can start back with those behaviors that they’ve relied on in the past for coping.. We primarily see anorexia, bulimia, and binge eating disorder.

What can patients expect during their first appointment with a registered dietitian?

We spend the first session almost entirely getting to know them. We want to know what’s important for them about their health. What resources and strengths do they bring to this journey? We want to know what their goals are, and what their current nutrition and lifestyle behaviors are. We also want to know what foods culturally are important to you, and what has your relationship with food been throughout your life? How was it as a child with food for you? Because those habits are often sustained over time. Then we partner with them to make an education and a coaching plan.

How often do patients meet with their registered dietitian?

It’s important for patients to know that you can’t see a dietitian once and get the outcomes that you want. The research shows that most patients need at least 4-6 sessions, working with a dietitian to see and sustain positive outcomes. For weight loss, which is a common reason that people want to meet with us, the recommendation is at least 14 sessions over a 6-month period. And then having some monthly follow-ups really helps to sustain the changes. We’re looking to partner with them on a longer journey. That’s where we get the really amazing outcomes with patients.

Does insurance cover Nutrition Services?

Thankfully, most insurance in North Carolina covers nutrition counseling, so most patients would have coverage for this.

How do you help people with IBS?

A diet that can be really helpful for people with IBS is a low FODMAP diet. Basically, it removes certain types of carbohydrates from the diet that the bacteria in your gut feed on, which causes a lot of excess gas. People with IBS may have more trouble getting rid of gas because of problems with how the nerves or muscles work, or they may be more sensitive to gas in the intestine. So somebody without IBS might eat the same foods and have the same amount of gas, but not feel the pain from it. With IBS, we want to help them cut back on those foods that cause gas through an elimination diet. If they get symptom remission from that, over the course of about 6-8 weeks, then we would help them reintroduce things in a systematic fashion. That way we can identify the exact foods or the exact categories of foods that bother them. It really helps to work with a professional while you’re doing that, so you make sure your diet is still well balanced and that you’re supported.

IBS is also an area where we collaborate with behavioral providers. Stress exacerbates GI issues, so working on stress management can help with symptom management.

Nutrition, exercise and managing stress are all things that can influence weight. Is sleep also important?

Sleep is foundational for health. I have had patients sacrificing sleep for exercise, which I don’t recommend. When we don’t sleep enough, we have higher levels of certain hunger hormones. Our blood sugar can be higher. We have more cortisol, the stress hormone, when we don’t sleep enough. We talk about sleep with patients a lot. It’s something that we need to prioritize.

Do you think that Nutrition Services is sometimes overlooked? Maybe people don’t necessarily realize that there is help and support out there for them for eating or food-related issues?

Nutrition Services is significantly underutilized. A lot of patients don’t know that it’s covered by their insurance. So that’s a huge surprise when they realize they could get it covered.

I do think people feel like they can get a lot of information online. Which is true, you can. But it’s almost too much information, and it’s often conflicting, and it doesn’t really give you a personalized plan for what will actually fit into your life.

We tailor a plan that is for you. We want to learn your schedule. When you can cook and when you can’t. When you can be active. How you can manage your time to be to reach your health goals. Then we will help with recipes and meal planning.

Do you need a referral from a physician to see a registered dietitian?

Medicare requires a referral, but most insurances don’t. Anybody can self-refer.

Do you find that some people are too hard on themselves regarding weight and what they eat?

I don’t know if it’s social media or the narrative around weight, but it tends to be very black and white, all or nothing messaging. It’s cut out carbs, or try this diet, or don’t eat this or that. That sounds like it would be the easy fix for people, but it’s not. Then when you try something and you fail, it’s hard not to be hard on yourself.

But you’re not the one who’s the problem. Our team has dietitians who focus on non-diet approaches to health, and we do not over-focus on numbers or the scale. Because health is more than that. You can’t sum up somebody’s health based on a couple of numbers.  We might look at it holistically, but we can’t look at a number on the scale and really know anything about somebody.

Nutrition Services

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