Monday, April 24, 2017

Food Insecurity in Montgomery County

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Over 42 million Americans suffer from food insecurity, which is over 13% of people in the U.S. People are considered food insecure if they do not have reliable access to a sufficient quantity of affordable, nutritious food. In other words, someone who is food insecure may not know where their next meal is going to come from or may fear that they will run out of food before they have money to buy more. In Montgomery County, Maryland, around 80,000 people are food insecure, including many children. This, along with other things I learned during my rotation at the Manna Food Center, has inspired me to write this blog post.

Food Insecurity in Montgomery County

According to Montgomery County Public Schools, over 30,000 elementary school students are eligible for Free and Reduced Meals (FARM), but only 11% of those are actively participating in the FARM program. Other programs aimed at reducing food insecurity are the Supplemental Nutrition Assistance Program (SNAP), the National School Lunch Program (NSLP), and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Unfortunately, some Americans don’t know about these programs or don’t know how to enroll in them. To help increase enrollment in these programs, some local organizations offer information, resources, and services to food-insecure members of the community. The Montgomery County Food Security Collaborative partners with other local organizations to address this issue. Their mission is to reduce hunger in Montgomery County by 2020 by redistributing fresh, perishable food and increasing collaboration among businesses, non-profits, food providers, and families in need for this purpose. Their partners include Manna Food Center, Women Who Care Ministries, GaithersburgHELP, Full Plate Ventures, and more. I also recently heard about Volunteer Income Tax Assistance (VITA), which helps low-income individuals prepare taxes free of charge. There are many dietitians who volunteer to help sign these individuals up for food assistance programs while they are waiting for their appointment.

Get Involved

If you’ve read this far and you would like to help reduce food insecurity in your community, one of the easiest ways to get involved is to volunteer your time to a local food bank. Other ways to get involved include donating money or food, organizing a fundraiser, or organizing a food drive. I volunteered at Manna Food Center by helping put together boxes of food for distribution. Each box consisted of fresh fruits and vegetables, non-perishable canned and boxed goods, a few pounds of protein foods, and bread. For most families, it was enough food to last two to three days. That may not sound like much, but it could be the difference between eating and going without until the next paycheck.  

Food Insecurity and Health

Good nutrition is one of the most important factors that affects a person’s health. People who suffer from food insecurity are also at risk for developing chronic illnesses, such as cardiovascular disease and diabetes. I want to continue to help these individuals by reducing food insecurity and promoting good nutritional health wherever and whenever I can. One way that I was able to do this during my rotation at Manna was to create educational inserts for the food boxes. These inserts accompanied boxes that were designated for special diets. For example, some of the inserts were related to diabetes. Each diabetes insert contained information about diabetes and how it relates to food and had a recipe using five or fewer ingredients so that clients could learn new ways to use the foods that are provided for them to create healthy meals. I’ve included an example below for you to see. This concept can continue to be expanded on so that every box that a client takes home has good, nutritious foods and information that will help make Montgomery County healthier and happier.

Diabetes Myths

Monday, April 17, 2017

Joint Class Day: Nutrition Taking A Frontline Role in the Military

The Walter Reed National Medical Center is one of the nation’s largest military medical centers, and it’s located right in Bethesda, MD! Earlier this spring, our class was able to attend a joint class day to gain a deeper insight on the role RDs play in nourishing the country’s military. Many dietitians influence the success of the US Military, whether they deal directly with the civilian or military population. The nutritional health of civilians determines how many civilians are eligible to become a part of the military. Once enlisted, soldiers are expected to maximize their health and performance, but this isn’t always happening. Currently, 5% of active duty soldiers are prescribed sleep medications, 5% fail their Army Physical Fitness Test (APFT) and 13% are clinically obese. The Performance Triad has been designed to address these issues.

The Performance Triad is a strategic initiative aimed at improving soldier performance by targeting the areas of sleep, physical activity and nutrition. Each of these categories have targets and goals that soldiers work toward in order to maximize their performance:

  • Get 8 hours of quality sleep per 24 hour period
  • Go caffeine free 6 hours before bedtime
Physical Activity
  • Aim for at least 10,000 steps per day, with the ideal goal of getting an additional 5,000 steps throughout the day
  • Include at least 2 days of resistance training per week, plus one day of agility training
  • Incorporate at least 150 minutes of moderate aerobic exercise, plus 75 minutes of vigorous intensity exercise per week
  • Eat at least 8 servings of fruits and vegetables per day
  • Re-fuel 30-60 minutes after strenuous exercise

Nutrition is now on the frontlines of improving military effectiveness. Accomplishing these nutritional targets and goals requires teamwork. It starts with meal planning so that the right nutrients are available. The diet developed to support the Performance Triad consists of 4,875 kcal and 155 g pro, strategically timed as follows:

Breakfast (06:00)
Hot Line and Beverages
1,000 kcal/40 g protein

Morning Snack (09:00)
Complex carb, produce, protein source
500 kcal/10 g protein

Lunch (12:00)
Meal Ready-to- Eat (MRE)
1,345 kcal/45 g pro

Afternoon Snack (15:00)
Complex carb, produce, protein source
500 kcal/10 g protein

Dinner (18:00)
Hot Line with Beverages, Salad Bar and Dessert
1,200 kcal/45 g protein

Midnight Snack (23:00)
Complex carb, produce
350 kcal, 5 g pro

I am surprised to see how much higher, the recommendations are for the active duty military compared to those for the civilian population, but providing all those calories helps support the increased physical activity of active duty military members. This meal pattern is coupled with nutrition education that teaches the importance of different nutrients and promotes increased fruit and vegetable intake. To make it easier green, yellow and red labels are used to make healthier choices immediately identifiable with one glance. Green foods should be eaten often, yellow occasionally and red avoided.

The Performance Triad has shown to increase fruit and vegetable intake by 1.5 servings/day, as well as increase the frequency of refueling after exercise. Food is fuel and this program is the perfect example of the impact food choices have on overall health and performance!

Learning how the military is shifting its focus to nutrition was very encouraging to hear as a dietetic intern. Research has proven that proper nutrition improves performance and the military is listening! As the focus on nutrition continues, RDs will need to continue their advocacy and research to support and empower our country’s military.

Monday, April 10, 2017

Renal Nutrition Class Day

One of my favorite things about being an “almost dietitian” is that there are so many career options: clinical, community, communications, and food service to name a few. The possibilities seem endless! Along with fellow University of Maryland dietetic interns, I recently visited a DaVita Dialysis Center in Annapolis to learn about renal nutrition from several Registered Dietitians (RDs) and other experts.

Fellow intern, Julia, and me at our renal nutrition class day.

The day started out with a brief dialysis overview which touched on the different stages of Chronic Kidney Disease (CKD), including when dialysis is needed (stage IV and V), and what the dialyzer does and how it works. It really helped me understand the incredible filtering capability and limitations of the dialyzer, which will be helpful when I am counseling patients. The next speaker dove a little bit deeper into the stages of CKD by explaining how nutrition needs are different in each stage. She also discussed different options for dialysis home modalities. Before this day, I had no clue that doing dialysis at home was even an option! How cool – and convenient!

Next on the agenda was the renal nutrition lecture which covered calorie, protein, fluid, and mineral (specifically sodium, phosphorus, and calcium) requirements for patients receiving dialysis and their “lab value goals.”  I learned that no two patients are alike. It is important for RDs to tailor their care to fit each individual’s lifestyle and meet their specialized needs. As the disease progresses, patients’ needs will likely change, and dietitians can help them transition their diets.

The last speaker talked to us about the role of a renal dietitian at DaVita including their day-to-day responsibilities, their electronic medical record system, and what to expect when working with dialysis patients. This lecture was particularly valuable because it opened my eyes to what life would be like as a renal dietitian.

During the day, DaVita’s divisional vice president popped in to welcome us, share his experience working with DaVita, and answer our questions.  All of the speakers seemed very passionate about their work and were very knowledgeable. Overall, I learned a lot from this day and feel more prepared for my renal rotation. I am looking forward to learning even more during my renal rotation next month.

Monday, April 3, 2017

Celebrating National Nutrition Month at UMD

What better way to spend National Nutrition Month than promoting healthy lifestyles to the University of Maryland’s (UMD) students and staff? During my 3 week long rotation with UMD’s dining services, my internship partner and I created “Wellness Walls” with fun posters and infographics filled with tips about nutrition, exercise, cooking, and healthy recipes. Our artsy and creative sides were definitely put to work!

To encourage informed meal choices and variety, we focused on a different food group for each week of March. With fun colors, titles, and pictures, we encouraged our audience to live healthier lifestyles. It was a great time for us to promote healthy habits since the University advanced to “Any-time dining” halls, offering all-you-can-eat food. Some of our tips included: switching from regular to low-fat milk, looking for whole grain ingredients, and eating a variety of colorful fruits and vegetables. We even created some content in Spanish, in order to reach out to employees whose first language was Spanish. Although we were only there for 3 weeks, we were able to design ahead of time and create content for all 4 weeks of National Nutrition month:

Week 1: “Live a Legen-dairy Lifestyle” focused on choosing healthy dairy options, such as low-fat milk in order to reduce saturated fat intake, while still getting the same vitamins and minerals as whole milk!

Week 2: “Lettuce Turnip the Beet” focused on the importance eating a variety of fruits and vegetables. According to CDC’s 2013 State Indicator Report on Fruits and Vegetables, an average of 37.6% of Maryland adults and adolescents reported eating less than 1 fruit per day and 30.9% reported eating less than 1 vegetable per day. Hopefully our wall encouraged UMD students and staff to reach for fruits and veggies more often!

Week 3: “Promote Health with Protein” introduced different protein sources and snack ideas to promote strong muscles. We made sure to include plant-based protein for those who don’t eat meat!

Week 4: “Use Your Brain, Choose Whole Grains” introduced a variety of whole grains and their benefits, such as a healthier GI tract!
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We had an "egg-cellent" time trying out some "punny" titles for our Wellness Walls! Aside from putting together these walls, we also participated in tabling events inside one of the diners, where we distributed handouts about a different food group each week. It was great seeing students eager to learn more about nutrition. In addition, we helped put together newsletters and wrote blogs for the campus’ student nutritionists.  Working on all of these unique projects during this rotation made me realize how much I love being creative.  

National Nutrition Month is a great time to focus on improving eating habits. Even though the month just ended, I hope the UMD students and staff will continue to put their best forks forward.

Monday, March 27, 2017

The Art of Mastering a Nutrition Education

It was 9 weeks ago but I remember it like it was yesterday. My hands were shaking and a glistening sheen of perspiration had appeared on my forehead. I was unable to create any coherent thoughts; I was about to give my first nutrition education to a patient. My first nutrition education was a weight loss education for a 500lb patient. I left this man’s room questioning the effectiveness of my education. Now that I am nearing the end of this clinical rotation, I like to think I’ve become more proficient in delivering nutrition education to patients. Here are a few things I’ve learned to help me in educating patients.
Meet People Where They Are
To put it simply, “meet people where they are” means inferring and understanding how likely they are to make dietary changes in their life. Most of the patients I educated did not seem interested in altering their diets. To meet them where they were, I usually tried and find one easy change they could make to their diet and have them focus their efforts there. In the case of the 500lb man, meeting him where he was involved understanding the difficulties that come with weight loss, his age, and his motivation to actually lose weight. This was a middle aged man who had been carrying extra weight his whole life and he had expressed several times his interest in an outpatient weight loss clinic. To meet this patient where he is, we decided that switching from regular soda to diet soda would be the easiest change to make that would promote weight loss.
Handouts can be a very useful tool when providing nutrition education. Some patients are in pain, half conscious, or uninterested in changing their diet, so they may not hear or retain dietary guidance when it is provided; this is where handouts come into play. Many professional organizations offer online nutrition education handouts. I prefer using handouts from the Nutrition Care Manual (NCM). The NCM is a product of the Academy of Nutrition and Dietetics and contains a section on client education with general information about nutrition and varying disease states. Each handout features the relation between nutrition and the disease, foods allowed and foods to avoid, and a sample 1-day menu that follows the prescribed diet, all formatted in a professional manner. The handouts are a great resource for dietetic interns or new dietitians, too, as they can be a prompt for important points to cover with patients.

A sneak peek at the NCM diet education page
Practice, Practice, Practice
As the old cliché goes, practice makes perfect. In my opinion, nothing prepares you for delivering nutrition educations more than practice. At my clinical site, we would receive a fair number of nutrition education consults which allowed for plenty of practice. On days where my floors lacked education consults, I would ask the dietitians on the other floors to send me any education consults they received. Being able to practice has helped me find a balance between simplifying the educations while giving enough detail to highlight what is most important nutritionally for each patient.

Although I am not yet an expert educator, I have learned a lot about providing sound, actionable nutrition education to patients.  I plan to use these three approaches to continue to hone my counselling skills.

Saturday, March 18, 2017

Food & Friends Joint Class Day: Building Community to Promote Health

Eating nutritious meals each day is essential for everyone to maintain a healthy body, especially those suffering from critical illnesses. On Monday, March 13, the University of Maryland (UMD) College Park Dietetic Interns joined interns from several other programs in the area for a joint class day at Food & Friends in NE, DC. We all worked together to prepare and package healthy meals for clients who require special meals because of their illness. It was a day filled with learning, collaborating, and volunteering to help those around the community who suffer from critical illnesses receive healthy food.

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The Food & Friends website states, “Food & Friends is the only home-visiting nutrition service that delivers hope by the meal -- specialized, fresh, delicious.” Food & Friends is a nonprofit that employs about 50 staff members and benefits from ~9,000 volunteers per year to “foster a community caring for men, women, and children living with HIV/AIDS, cancer, and other life-threatening illnesses by preparing and delivering specialized meals and groceries in conjunction with nutrition counseling.” On our day of volunteering, we were able to actively participate in the kitchen by expediting meals or helping to package groceries-to-go.

Additionally, on our joint class day we had the opportunity to meet two Registered Dietitians (RDs), Priscilla Dhas, Nutrition Services Manager, and Anna Kinard, Community Dietitian. They explained that the dietitians at Food & Friends provide personalized nutrition counseling, develop 11 specific meal plans for each diet need, perform nutrient analyses, instruct cooking classes, create educational handouts, ensure quality control, and participate on various committees.

Our class day at Food & Friends was great because we were able to collaborate with interns from other programs, actively participate in the preparation of food for the clients, and learn from several lectures given by RDs. Joint class days are nice because interns have the opportunity to see other interns, but today was extra fun because we actually got to work side by side with people we didn’t know. At the beginning of the day, everyone was assigned to one of two groups, which prevented us from sticking with our usual partners. The groups took turns volunteering in the kitchen and learning from the lectures. We were also provided a delicious lunch!

Prior to volunteering at Food & Friends, I didn’t know an organization like this existed. However, I do think organizations like Food & Friends are necessary, especially for those who need special diets and have serious nutrition needs or considerations due to their medical therapies! Moreover, this experience was very insightful as I learned that Food & Friends has no requirements for income.  It serves those with life threatening diseases, compromised nutritional status and a limited ability to prepare their own meals. A lot of people don't have a caretaker who can prepare and deliver meals everyday and this area is where Food & Friends really helps. Caretakers typically have to juggle their job, house, and family in addition to now helping their loved ones or in some cases their neighbor or friend go to appointments and receive adequate food. Food and Friends is making a tremendous difference in the lives of both those living with a serious illness and those who are taking care of the patient. Finally, this experience showed me another work option for RDs!

Tuesday, March 14, 2017

MAND State Legislative Interactive Workshop

On February 8th, 2017, the University of Maryland interns joined forces with members of the Maryland Academy of Nutrition and Dietetics (MAND) in Annapolis to rally for nutrition-related bills. Teams spoke with Maryland Senators, Delegates, and their staff to encourage approval of bills that, if passed, will benefit nutrition professionals and residents alike. Each team leader was equipped with a list of bills to discuss along with related talking points.

My team and me with Maryland Delegate, Alonzo Washington

The bills that we promoted include:
  • Health Care Practitioners-Cost Estimate A huge barrier to effective healthcare is the cost. This bill will, in theory, would provide the public with estimated costs of services prior treatment. Unfortunately, sometimes the number of treatments or exactly what insurance will pay (or not pay) is not known in advance as it may change depending on later testing results, insurance reimbursement changes, etc. For this reason, MAND supported the concept, but opposed the bill based on its approach, i.e. its “language”.
  • Update of Advisory Board & Councils on Health & Wellness
    With the help of MAND testimony given in January, a bill was approved which allows dietitians to serve on the Council on Health & Wellness. During our visit we thanked legislators for supporting the bill.
  • Workgroup on Health in All Policies
    We asked that dietitians have the ability to join this workgroup, as dietitians have a unique perspective on health, wellness, and community that can strengthen the group. The mission of this group is to collaborate to improve health and healthcare accessibility in both the private and public sectors.
  • Maryland Farms & Families Act
    With this bill, food-insecure Maryland residents will have double the financial support to buy fresh fruit and vegetables at farmers markets. Although this bill will be financially cumbersome for the state, it will help SNAP and WIC participants by allowing for double the purchasing power and will also help local farmers thrive by promoting farmers markets.

What I took away from the workshop:
Before this interactive workshop, I had minimal interest in state legislation. I now have a new respect for lobbyist and the legislation process at the state level. Each representative that my team spoke to was kind and welcoming. I was impressed by the attention that was given to our quick speech. What I appreciated the most, however, was that each conversation was approached with logic and a touch of empathy--the very combination that drove me to a career in nutrition.

The week before this workshop, I attended a committee meeting as part of my rotation with the Agency on Aging. This committee is dedicated to increasing accessibility of healthcare in the “Health Enterprise Zone,” an area of Maryland that is a healthcare desert. Before the meeting, I knew nothing about the situation but immediately felt a calling to do something. Little did I know that a week later, I would be promoting the “Workgroup on Health in All Policies”  bill, which could help that very situation. My team met with state senator, Joanne C. Benson, who shared our passion for the “Workgroup on Health in All Policies.” She spoke to us about how, if enacted, this bill will improve access to healthcare, especially for those in the Health Enterprise Zone.

This workshop has inspired me to stay informed and active on similar state and local-level nutrition-related bills. It is inspiring to know that I don’t need to a have a career in politics to make a difference.