Experience at FNCE 2022

 Written by Andrew Ceballos; SLU Dietetic Intern

        Coming up to FNCE, I had no experience going to a professional conference of any sort. Being a dietetic intern, budgeting is important in our very busy lives. Once the news spread about a really good deal on a flight to Orlando, I knew it was time to book the flight. Every intern from our class that was attending FNCE in person was on the same flight, so we had plenty of time to bond. At the boarding gate I looked around and saw multiple laptops open, headphones in, and focused faces trying to complete assignments, rotation work, or even studying for exams before we depart from Missouri to the sunshine state. 

 

        Looking through the topics and sessions for FNCE, I was surprised to find so many topics that were interesting to me. Among these were Athletes with Eating Disorders, Optimizing Sleep for Better Health, and Nutrition Counseling for Individuals with Disabilities. On Day 1, I was able to attend sessions on athletes with eating disorders, the evolution of cystic fibrosis management, plant-based nutrition and chronic disease, and intermittent fasting in athletes.  

 

        Day 2 of FNCE had another wide array of topics. The first session I attended was on inflammation and metabolic disease. Next, I had the opportunity to listen to Ginger Kerrick speak about her life and accomplished career with NASA. I also attended nutrition counseling for individuals with disabilities which was my favorite topic because of my experience working with this population. The final session I attended was on cancer and exercise. I also was able to attend the poster sessions both days and learn about what others in the profession are doing while also getting to interact with businesses about their products and companies. 

 

        Knowing myself, I never thought I would I enjoy a conference as much as I was able to enjoy FNCE. I was able to advance my knowledge in a variety of topics, some that I know better than others, and consider these when returning to my classes and dietetic internship.   

TikTok of Experience

Nutritional Analysis of a Division III Baseball Player

 Written by: Sydney Beach; SLU Dietetic Intern

My name is Sydney and I am a dietetic intern at SLU! My passion lies with athletes and learning how to fuel them not only for their individual needs but their sports and competitions as well. Here is an athlete I worked with over the course of a season, it was a very rewarding and eye opening experience! I went over with him what his needs were as well as his increased energy needs during the season and came up with a meal plan that he would find not only appealing but realistic to his lifestyle. Here is my analysis report for how the whole experience went.

Nutritional Analysis of a Division III Baseball Player 

Sports Nutrition Research Paper 

Sydney Beach

Table of Contents 

Baseball: America’s Pastime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Interview with the Athlete . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Estimated Energy Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

MyDietAnalysis Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Meal Plan Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Baseball: America’s Pastime

        Baseball is a sport known to many as “America’s favorite pastime.” This game has

molded and changed since it first became popular back in the 50s. It is an interesting

sport because it has many components involved within it. There is sprinting, running,

jogging, throwing, tossing, catching, jumping, turning, diving, fielding, among many

other actions. There is more of emphasis on anaerobic energy sport in the actual game.

The aerobic energy system also plays a role but is not the main focus. Knowing that is

helpful when planning a diet for a baseball player because it is very unique from other

sports. The athlete that is my main focus is a baseball player whose main position is a

pitcher. He is 6’0 and 190 pounds. His diet, for three days, was analyzed by a program

called MyDietAnalysis and taken into consideration was his height, weight, age, and

activity level. Based off of the results I found from his previous diet and eating habits I

configured a two day meal examples for his competition days and also two day meal

examples for training days to help fulfill what he was missing from the analysis. I also

took into consideration his position and how much activity he was doing as well as his

fluid consumption as well. Based on the findings, I made many notes on what my

athlete needed to improve to help improve his performance and his overall mood. My

notes were as follows:

● Decrease calories from fat and sat fat

● Increase caloric needs

● Lower protein intake

● Increase carbs

● Increase fiber

● Lower Cholesterol intake

● Increase water intake

● Increase Vitamin A, all the B vitamins, Vitamin C, D, E, and Folate

● Increase Calcium, Magnesium, Phosphorus, Potassium, and Zinc

● Decrease Iron and Sodium

 Also to go along with his diet I wanted to include how much fluid he needed to drink
based on his physical activity. I determined his fluid needs by doing a simple calculation
during a sweat trial. I weighed him before and after a 50 minute weight lifting session. I
included all the fluids he took in and subtracted them from the weight gained. The
results showed that he gained 0.25 pounds. Meaning he needs to intake about 23.80
ounces per hour at the rate at which he was lifting weights that day, to get a more
accurate number this trial would be repeated to get a more fitted number to the athlete.
Drinking water and electrolytes to replenish the body is extremely important and I took
that into account as I designed my meal plans. My biggest tip to athletes is to always
carry a water bottle with you so you are always drinking fluids and staying hydrate.

Many common ergogenic aids in the world of baseball are a creatine powder that is in
compliance with the NCAA or energy drinks, Monster for example is a very popular one.
The energy drinks I see athletes using are not my favorite thing to see because of all the
bad side effects that come from energy drinks, the two big ones being jitters and crash.
The pre-workout powder has positive effects on your body and has been proven to be
very effective for athletes to use and be safe.
        There is a big myth surrounding the sport of baseball, mostly in the pitching
world of baseball, that if you are using resistance training to improve your performance
it is considered taboo because players believe that they will lose mobility and speed on
their pitches. This is a big fat myth, of course! Resistance training doesn’t always have to
be rigorous and it can also be very light weight. It can be used to train the arms and to
train the muscles to act how you want them to when you need them.
        There is a lot of general knowledge about athletes and competition days that can
be applied to baseball players with pre and post game meals or snacks. Positions might
vary in what kind of macronutrient percentages they need because a first baseman is
going to be more active throughout the entire game than a pitcher that is not in the
hitting rotation. Being mindful of what position you are catering to will get you a more
precise and accurate measure of the exact kind of calories they should be consuming.
        Injuries are going to occur in any sport, it is inevitable because we are only
human. Typical baseball injuries include many shoulder injuries, hip injuries are also
very common. There are many during game problems that may come up like running
into a wall, going for a fly ball or foul ball, getting cleated by a runner, getting hit by the
ball either live off the bat or from the pitcher. Baseball also requires a lot of hand eye
coordination and quick reaction time. If a ball is hit and you cannot react quickly to it
you can seriously get hurt. All of this needs to be taken into consideration for all the
players’ safety and well being.

Interview with the Athlete

        Playing since he was very young, this pitcher has been playing the game for 17
years and counting. Currently, he is playing at a division three school in the Old
Dominion Athletic Conference. His training consists of six to seven days of field
practices, usually lasting somewhere between two and three hours, a 50 minute lift three
times a week, and because he is a pitcher he is required to do a lot of running outside of
practice, including short distance sprints, mid distance sprints, and long distance runs
as well. He is also required to throw six times a week, including games that they have an
bullpens he throws. This athlete does use an ergogenic that goes by the name of Spark.
This is an energy drink that is consumed every day before breakfast. This is said to aid in
energy and concentration levels and for the most part this has been working for this
particular athlete. Eating healthy has been shown to directly affect an athlete’s
performance and this athlete does know that, but he is very 50/50 on eating nutritious.
Before this report he never really thought much about what goes into the food that he
was eating. He would just crave certain things or just grab convenient things and not
think much of it. His coach doesn’t do any kind of check ups with what his athletes are
eating and the options he has on the road are not always the greatest. He does give a
brief general talk to the athletes here and there that they should be eating healthy to be a
better athlete, but my athlete doesn’t pay much attention to it because he really just
doesn’t think much of it. Vegetables are something that he has never really been a fan of,
and now with the exception of broccoli, carrots, green beans, and cucumbers, he does
not eat them. With no food allergies, I tried to expand this athlete’s diet to get the right
number of calories while he is getting all the minerals and vitamins that are essential.
Even knowing what to eat and being mindful of what you are putting in your body, it
still can be hard for athletes to find time in their day to sit down and have a good,
healthy, and filling meal. That is what my athlete says he runs into every day. He has a
very busy practice and game schedule that typically does not leave him enough time to
prepare his meals at home, and really only makes one to two meals at home, if any. He
has ten meal swipes at his cafeteria at school that he will take advantage of and use eight
or nine in one week. He does find himself skipping some meals at times because he
overslept in the morning or it is just more convenient because of a time crunch. Grocery
shopping is only available to him if there is time in his week to go and get groceries,
typically that is a quick trip once a week. There have been no injuries that have altered
his eating. He is very superstitious when it comes to preparing for competitions. Being
an athlete and being involved with baseball and on a team for so long has taught him
leadership and life skills that he says has been very valuable in his life every day. He has
also taken other life skills like responsibility, organization, being timely, and listening.
Another huge takeaway that my athlete has learned from this sport is the social aspect
and gaining new friends and meeting new people all along the way. He said he has
opened up more and has more of an open mind to try most anything because of it. On a
scale of one to ten, one being not interested at all, five being neither interested nor not
interested, and ten being extremely interested, my athlete is at about a seven wanting to
change his eating patterns if it will help him improve his sports performance. He says it
is just hard for him to completely commit to change his eating and diet because of the
time restrictions, it is hard to keep a consistent eating pattern with the kind of schedule
he has, and also commitment in general and keeping himself disciplined on his own is
difficult also.

Estimated Energy Requirements

Mifflin St. Jeor Equation:

Athlete Statistics

Wt = 200 lbs or 90.10 kg

ht = 6’0” or 182.88 cm

age = 22 years

Men: RMR (kcal/day) = (9.99 x wt) + (6.25 x ht) – (5 x age) + 5

Where wt = weight (kg)

ht = height (cm)

age = age in years

Calculate Formula:

RMR (kcal/day) = (9.99 x 90.10) + (6.25 x 182.88) – (5 x 22) + 5

RMR (kcal/day) = (900.09) + (1,138.875) – (110) + 5

RMR (kcal/day) = 1,933.9

EER (kcal/day) = RMR x PAL

where RMR = resting metabolic rate

PAL = physical activity level

EER (kcal/day) = 1,933.9 x 1.9

EER (kcal/day) = 3,674.41

MyDietAnalysis Report

Meal Plan Recommendation

Training Day One -

Breakfast:

3 eggs over hard (1 egg= 70 cals, x3 210 cals)

shredded mozzarella cheese on top, 28 g (80 cals)

Whole grain bagel (340 cals)

Banana (105 cals) with yogurt, 6 oz (90 cals)

Orange Juice, 8 oz (110 cals)

Snack:

Granola protein balls, with peanut butter, chocolate chips, raisins, & crasins (350 cals)

Water, 16 oz

Lunch:

Double cheeseburger, with cheese,lettuce, ketchup, onions (552 cals)

Salad with lettuce, spinach, carrots, peppers, onions, sunflower seeds, shredded cheese,

chia seeds, tortilla strips, and lite ranch dressing (240 cals)

Water, 24 oz

Snack:

Gatorade, 12 oz

Peanut butter crackers (190 cals)

Apple (60 cals)

Dinner:

Grilled Chicken breast, 6 oz

Brown rice

Lettuce

Corn salsa (corn, onions, lemon juice, cilantro)

Shredded cheese

Sour cream

Whole grain tortilla chips

(1,235 cals)

Total Calories: 3,562

Training Day Two-

Breakfast:

Avocado Bacon Toast (380 cals)

2 Eggs over hard (1=70, X2 = 140 cals)

Hashed brown potatoes, 0.5 cups (59 cals)

Orange Juice, 8 ounces (110 cals)

Water, 8 ounces

Snack:

Banana (190 cals) with 2 tbsp of peanut butter (105 cals)

Fit crunch protein bar (190 cals)

Lunch:

Roasted Turkey and cheese sandwich with lettuce, tomato, and onion (420 cals)

Baked chips, 1 bag (120 cals)

Grapes, 1 cup (62 cals)

Water, 16 ounces

Snack:

3 turkey roll-up with lettuce and cheese (1= 44, X 3 = 132 cals)

3 hard boiled large eggs (1= 78 cals, X 3 = 234 cals)

Gatorade zero, 16 ounces

Dinner:

Grilled chicken breast, 6 oz (150 cals)

Steamed green beans, 2 cups (1= 35 cals, X 2 = 70 cals)

Mashed potatoes, 1 cup ( 268 cals)

Chocolate Milk, 8 ounces (208 cals)

Total Calories= 2,836 calories

Competition Day One

Breakfast:

Blueberry pancakes, 3 pancakes (260 cals)

Turkey sausage links, 2 links (70 cals)

Scrambled eggs, 0.5 cups (173 cals)

Water, 16 oz

Snack:

Greek yogurt with granola (230 cals)

Orange (62 cals)

Water, 8 oz

Lunch:

Ham and Turkey sub sandwiches with cheese, lettuce, tomatoes, onions (390 cals)

Pretzels, 1 oz (110 cals)

Water, 16 oz

Snack:

Peanut butter & jelly sandwich, 2 oz (210 cals)

Grapes, 1 cup (62 cals)

Gatorade zero, 16 oz

Dinner:

Spaghetti with meat sauce, 16 oz (8 oz= 351 cals, X 2 = 702 cals)

Steamed broccoli, 0.5 cups (17 cals)

Garlic Bread, 1 slice (138 cals)

Banana (190 cals)

Total Calories= 2,424

Competition Day Two:

Breakfast:

Omelette with cheese, spinach, peppers, onions, and turkey sausage (257 cals)

Hashed brown potatoes, 1 cup (116 cals)

Fruit cup, 1 cup (70 cals)

Water, 16 oz

Snack:

Whole grain bagel (340 cals)

Banana (190 cals) with 2 tbsp of peanut butter (105 cals)

Water, 8 oz

Lunch:

Grilled chicken wrap, with lettuce, tomatoes, and onions (360 cals)

Baked Chips (120 cals)

Macaroni Salad, 0.5 cups (280 cals)

Snack:

Fit crunch protein bar (190 cals)

Apple (80 cals)

Dinner:

Steak and Cheese panini (360 cals)

Steamed green beans, 2 cups (1= 35 cals, X 2 = 70 cals)

Mashed potatoes, 1 cup ( 268 cals)

Chocolate Milk, 8 ounces (208 cals)

Total Calories= 3,014

If you have any questions or comments feel free to email me!

sydney.d.beach@slu.edu

References

Andrews, A., Wojcik, J. R., Boyd, J. M., & Bowers, C. J. (2016). Sports Nutrition

Knowledge among Mid-Major Division I University Student-Athletes. Journal of

Nutrition & Metabolism, 1–5. https://doi.org/10.1155/2016/3172460

Crotin, R. L., Forsythe, C. M., Bhan, S., & Karakolis, T. (2014). Changes in Physical Size

among Major League Baseball Players and Its Attribution to Elite Offensive

Performance. Journal of Strength & Conditioning Research (Lippincott Williams

& Wilkins), 28(10), 2705–2708.

https://doi.org/10.1519/JSC.0000000000000475 

Jorge L. Ortiz, @jorgelortiz, & USA TODAY Sports. (n.d.). Trying to get into game

shape. USA Today. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=J0E2994893

94814&site=ehost-live

Mandel, K. (2010). Play Ball! American Fitness, 28(3), 46–47. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=49804658&s

ite=ehost-live

Palumbo, C. M., & Clark, N. (2000). Case Problem: Nutrition concerns related to the

performance of a baseball team. Journal of the American Dietetic Association,

100(6), 704. https://doi.org/10.1016/S0002-8223(00)00205-4

Pawlak, R., Malinauskas, B., & Rivera, D. (2009). Predicting Intentions to Eat a

Healthful Diet by College Baseball Players: Applying the Theory of Planned

Behavior. Journal of Nutrition Education & Behavior, 41(5), 334–339.

https://doi.org/10.1016/j.jneb.2008.09.008

Rossi, F. E., Landreth, A., Beam, S., Jones, T., Norton, L., & Cholewa, J. M. (2017). The

Effects of a Sports Nutrition Education Intervention on Nutritional Status, Sport

Nutrition Knowledge, Body Composition, and Performance during Off Season

Training in NCAA Division I Baseball Players. Journal of Sports Science &

Medicine, 16(1), 60–68. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=121527720&s

ite=ehost-live

Sánchez-Hechavarría, M. E., Carrazana-Escalona, R., Planas-Rodríguez, M.,

Cala-Calviño, L., Barrios-Deler, R., Núñez-Bouron, A. I., & Ricardo-Ferro, B. T.

(2017). Assessment of the nutritional and vascular state in students and

high-performance baseball athletes. CorSalud, 9(2), 88–94. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=126462884&

site=ehost-live

Grocery Store Survival Guide: College Student Edition

 Written by: TaKeya Ball; SLU Dietetic Intern

    Do you have a meal plan? Whether you answered yes or no to that question, it is important for you to have food at home. What if it is late at night and you are cramming for an exam and you do not have the time to leave and grab something to eat. Having food at home will save you! Learning how to create a budget friendly grocery list each week will promote healthy eating, save you money, and reduce stress around planning for your meals. I am here to teach you how.

Before you grocery shop

Decide on a budget. Single family households typically spend around $59-$91 per week on groceries. Shopping for one full week at a time saves you money and reduces food waste.

Figure out your schedule for the week. As a college student your schedule fluctuates and some weeks are busier than others. Cooking simple meals that take a short time to prepare and cook gives you the motivation to cook and avoid eating out. 

Check your pantry and refrigerator before you create your grocery list. Checking your inventory before you create your list helps you to plan your meals based on what you already have and to grocery shop accordingly.

Decide on the foods you want to cook for the week. Create a grocery list of the ingredients you will need. Creating a grocery list allows you to not forget something while you’re shopping and keeps you focused to not spend additional money outside of your list.

Buy perishable foods in quantities you’ll use. Try to buy produce that you know you will eat within a week. Fresh produce expires fast. A good alternative is to buy frozen fruits and vegetables. They have a longer shelf life and it makes meals and snacks easily accessible.

Shop for non-perishable items online. Products like granola bars are ideally bought from retailers like Amazon. It saves you money and the shipping is typically free. Become an amazon prime member using your student email and you will receive a six-month free trial and have access to free shipping and exclusive deals. Check out https://www.amazon.com/Amazon-Student/b?ie=UTF8&node=668781011 for more information!

Look for deals and Coupons. Most grocery stores have an app that you can download on your phone and you will be the first to know of deals and sales of the week.

While Grocery Shopping:

Do NOT shop while hungry. You will end up buying more foods that are outside of your grocery list or you will forget items on your list because you are rushing to leave the store to go eat.

Tips:

Buy cereals and meat in bulk. Buying in bulk helps you to save money. Meat can be preserved for a long time by storing it in the freezer. It is important to remove the meat from the original package and store it in ziploc bags. That will limit air contact with the meat and prevent moisture loss. Check out https://www.britannica.com/technology/meat-processing/Preservation-and-storage for more information on preserving meat! Also, buying oatmeal in bulk costs less than buying the individual packs.

Limit your purchases of frozen meals. Buying frozen meals costs more money than actually cooking the meal itself. Frozen dinners are also unhealthy and they’re high in sodium and saturated fats. Too much saturated fat in your diet can cause heart disease and other health problems. 

Buy fruits and vegetables that are in season. Purchasing seasonal produce is less expensive than buying that same fruit and vegetable during its off season. Check out https://www.seasonalfoodguide.org/ to review what produce is in season in your state!

Home Delivery Food Services:

There are tons of services that offer affordable meal kits to be delivered directly to your door. Online food services are great for people who have busy schedules and for those who have difficulty shopping for themselves. It is cost efficient and easy to access online or on your phone. You have the option to choose a variety of nutritious meals at a low cost. Services such as HelloFresh give you a 60% discount on your first box and it includes free shipping. https://www.hellofresh.com/. 

My Goal to become a Certified Diabetes Care and Education Specialist (CDCES)

Written by: Kai Wan, SLU Dietetic Intern

The story of my diabetes education

I was matched to the Dietetic Internship program at Saint Louis University in 2021; I will be finishing my internship this August. My short-term goal is to become a registered dietitian and a CDCES.

My first clinical rotation was about Diabetes back in August of last year. This rotation only lasted two weeks and I thought that would be all the time that I was going to spend on studying about diabetes. However, I was totally wrong. Soon after I went into my gastrointestinal rotation, I saw patients with GI issues and diabetes. In the renal rotation, I spend a lot of time educating my patients about how to manage their diabetes to decrease the risks of further kidney damage. I have also seen diabetes patients in the geriatric, pediatric, and almost every other rotation. What’s more, I was assigned the topic of “self-management on diabetes and hearing loss program” as my capstone project at the beginning of my internship, which was actually my second choice. It feels like it was fated when I’m looking back now.

What is CDCES and how do you become one?

Certified Diabetes Care and Education Specialists are a group of healthcare professionals who provide collaborative, integrated, and individualized care and education to people with diabetes and diabetes related conditions. They are the healthcare providers who have achieved a high level of knowledge and skills in the biological and social sciences, communication, counseling, and education and who have experience in the care of individuals with diabetes (ADCES, 2022).

Briefly, healthcare providers like nurses, dietitians, pharmacists, physicians, mental health professionals and others who choose to specialize in diabetes education are able to become a CDCES. Individuals who pursue the CDCES credential will need at least 2 years of professional experience, plus 1,000 hours of diabetes education over the previous four years, complete at least 15 hours of continuing education from a provider recognized by the Certification Board for Diabetes Care and Education (CBDCE) within two years of applying for the exam, and pass the CDCES examination.

What made me want to become a CDCES?

There were so many reasons that contributed to my decision to pursue becoming a CDCES.

Just as I mentioned before, I have interacted with a lot of diabetes patients in almost all of my rotations. Not only Have I learned a lot of new information about diabetes while I was preparing the interactions and educations, but also I have realized that there is a unique story behind every single patient with diabetes which has always triggered my curiosity to learn more about the relationship between lifestyle and diabetes.

I was so lucky to have more than one CDCES’s as my preceptors and mentors during my internship and graduate school. What inspired me the most is all of them are extremely passionate on diabetes educations. I could feel their passion from each patient interaction that I observed. I could feel their excitement when they see patients improved lab values. I could feel their happiness when a patient makes positive comments on the education they were given.

The prevalence of diabetes in the US has been increasing dramatically in the past decades, which means that there are more and more people that would benefit from receiving diabetes education. According to data from CDC, as of 2022 there are 37.3 million people that have diabetes in the U.S., which is 11.3% of the entire U.S. population (CDC, 2022). My grandmother passed away due to the complications of diabetes. I wish I knew more back then so I would be helpful to teach her on how to follow a consistent carbohydrate diet and switch lifestyle choices to improve her diabetes management. I believe that she would love to see that I am pursuing to become a CDCES and help more people with diabetes.

Sources:

https://www.diabeteseducator.org/practice/becoming-a-diabetes-care-and-education-specialist https://online.adelphi.edu/articles/certified-diabetes-educator/#:~:text=The%20professional%20practice%20experience%20requirement,of%20applying%20for%20the%20exam CDC, https://www.cdc.gov/diabetes/data/statistics-report/index.html

RDs as Lactation Consultants

Written by: Haley Pucel, SLU dietetic Intern

One of the many roles a Registered Dietitian (RD) can take on is a lactation consultant. Lactation consultants are a vital tool for new mothers to successfully initiate and maintain breastfeeding as a means to nourish their child. While a majority of lactation consultants are nurses, Registered Dietitians are eligible to follow this career path as well.

Breastfeeding is important because it provides milk specialized to the infants needs as they develop. Breastfeeding provides numerous benefits to both babies and mothers. Some of these benefits for breastfed babies include having stronger immune systems, fewer cases of necrotizing enterocolitis (NEC), fewer colds and respiratory illnesses, fewer ear infections, lower rates of infant mortality, and lower rates of sudden infant death syndrome (SIDS). These babies are also less likely to develop allergies, asthma, and eczema, and have a lower risk of type 1 and type 2 diabetes. Breastfeeding is beneficial for mom by stimulating the uterus to contract and return to normal size, less postpartum bleeding, fewer urinary tract infections, and less risk of postpartum depression. Breastfeeding can also assist mom with bonding with the baby and feeling confident learning her baby’s cues.

During my most recent rotation at Cardinal Glennon Children’s Hospital, I had the opportunity to shadow a lactation consultant. The lactation consultant was a gold mine of information. During my time shadowing, I was able to see lactation issues addressed including overproduction of milk, worries over making enough milk, and latching. One component of the lactation consultant job that I was unaware of before shadowing was how much of the role was empathizing and counseling mothers in their ability to provide breastmilk for their child. The lactation consultant emphasized that her role really is to build relationships with the mothers so that they feel comfortable discussing their barriers to breastfeeding. Breastfeeding is both a physical act but also an emotional one as mothers learn to bond with their baby. I also was able to see where the hospital stores mothers’ breast milk and even was able to assist with putting away donor breast milk from The Milk Bank. This experience validated my interest in lactation, and the lactation consultant encouraged me to pursue this career path.

Why do Registered Dietitians make valuable lactation consultants?

Registered Dietitians possess the knowledge of the nutritional benefits of breastmilk, and thus promote sustained breastfeeding for at least the first 6 months of an infant’s life. RDs know the nutrients and amount of breast milk an infant needs for proper growth and development and can work with mothers to make sure the infant is intaking all the nutrients needed to be healthy. RDs can address both the nutrition intake of the mother and infant to problem solve issues relating to milk adequacy. RDs can counsel the mother on barriers to breastfeeding to ensure its continuation.

Where can a Registered Dietitian work as a lactation consultant?

Lactation consultants work in a variety of settings. Many work in hospitals and others work in private practice or clinics. Pediatric dietitians are an essential tool for troubleshooting breastfeeding in the neonatal or pediatric intensive unit because these children might need modified feedings to meet their needs and mothers may need assistance with expressing breast milk and establishing a breastfeeding relationship with their child.  Another place lactation consultants work is at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) because WIC is known for their strong promotion of breastfeeding.

How do I become credentialed as a lactation consultant?

Despite lactation consultant credentials not being required by federal or state law, credentialing shows expertise and may provide career opportunities. Certification can be provided through the International Board of Lactation Consultant Examiners (IBLCE), which is the only lactation consultant certification program fully accredited by the National Commission for Certifying Agencies. There are multiple pathways to meet eligibility to sit for the exam but it is designed for the lactation consultants to have a health sciences background, minimum of 95 hours lactation specific education, and relevant clinical experience. For more information, visit the IBLCE website (https://iblce.org).

Breastfeeding is a proven health benefit to both infants and mothers. Registered Dietitians can be breastfeeding advocates by educating on the immense benefits of breastmilk and assist mothers with lactation. For those who are passionate about breastfeeding, consider becoming a lactation consultant because it will assure sustained breastfeeding which is vital for the health and future of infants and mothers.

 

References:

https://my.clevelandclinic.org/health/articles/15274-the-benefits-of-breastfeeding-for-baby--for-mom

https://iblce.org/

https://www.themilkbank.org/

Diamond, Lynnell. Lactation Consulting. Is it for you? American Dietetic Association. https://doi.org/10.1016/S0002-8223(97)00152-1

Connecting with My Roots: Cambodian Recipe Post

 Written by: Selena Oum, SLU dietetic intern

Throughout my life I had never fully embraced my culture, especially the food. During the end of my undergraduate, I noticed that there was not much cultural diversity within the dietetics field. Moving to Saint Louis University to start my internship, was the first time that I have moved out of my parent’s house. After living on my own and away from my own cultural roots, I realized how much I missed some comfort from home. Therefore, I started to learn how to cook Cambodian food. 

Growing up as a Cambodian-American, one of my favorite Cambodian dish is Salaw machu, also called Sour Soup. Salaw Machu is a popular soup base dish in Cambodia, located in Southeast Asia, that can be served for breakfast, lunch, or dinner. My family typically makes this dish during family gatherings. For me, it’s associated with a memory of getting to laugh with my cousins and playing games with them all night. A popular ingredient that Is used for Salaw Machu and in almost every Cambodian dish is Koreung. This gives the soup its sour umami flavor.

Koreung can be used in other soups, marinated with meats, or stir fried with other ingredients. Koreung a mixture of lemongrass, ginger, turmeric, and kaffir lime leaves that is pounded into a paste using a clay or wood mortar and pestle, which can be seen being used in other cultures such as Hispanic cultures. Each ingredient brings in many different health benefits.

Typically, salaw machu is made with beef and water spinach, but these ingredients can be swapped out for healthier options such as fish or chicken instead of beef and adding in more vegetables such as carrots, green beans, and Chinese eggplant. The dish is versatile, and I have had them in many different varieties.

I hope that future dietetic interns/students won’t be afraid to embraces their own culture and not to be afraid to eat what you grew up eating just because it doesn’t fit into the typical diet normality.  Your culture is what brings the uniqueness to the dietetics field.

My greatest takeaway from this program is that there is always so much to learn about other people’s culture and the foods that are connected to it. Always be open minded to listening to what other people’s favorite meals or recipes are that their parents or grandparents passed on down to them.

Approaching the Topic of Weight in a Sensitive Manner

written by: Jessica Mueller

The culture here in the United States is obsessed with the topic of weight. How often do you hear your family members and friends commenting on “how good” someone looks during your holiday gatherings because they shaved off a few pounds? Vice versa, how often do you hear gossip about an old acquaintance of yours that has gained a noticeable amount of weight? These comments are often seen as “normal” topics of conversation, and, in the case of weight loss, complimentary, the subject of weight may seem completely harmless.

The emphasis and lack of sensitivity towards weight continues in the healthcare setting. Earlier this year at one of my clinical rotations at a residential eating disorder clinic, one of the clients was sent out to a cardiology appointment due to heart complications related to prolonged, severe restriction of food intake. Per usual eating disorder (ED) protocol, the patient was weighed backwards so they did not see their weight. When meeting with the doctor, he told his patient that they did not need to gain any more weight or be at an eating disorder clinic because while their BMI was on the lower side, it fell within the normal range. This patient returned to the residential eating disorder clinic extremely confused. They had been restricting food for so long that their heart did not work properly and other complications were present; however, her doctor just told her that her weight was normal and not to worry. The eating disorder clinic RD explained that even though their doctor told them that their weight appeared fine on paper, the phycological strain her ED was putting on her in addition to the physical complications of prolonged, severe food restriction called for their body to be at a higher weight. What was supposed to be a cardiology appointment that lead towards a safe and successful recovery of an ED, turned into an additional road block and source of confusion for this patient.

Stories like the previous one are not uncommon. Whether intended or unintended, many healthcare professionals (and Americans in general) show weight bias. Weight bias is when a person has negative, prejudiced attitudes towards an individual perceived to have an excess amount of weight. These attitudes often manifest into weight stigma and/or discrimination (Puhl and Brownwell, 2001; Dennet, 2019).

Weight bias leads to many people in bigger bodies to have decreased quality of healthcare for a myriad of reasons. Healthcare practitioners spend 28% less time with patients who are obese than patients at a normal body weight (Phelan et al, 2015) and 40% of these professionals are reported to have negative reactions to patients with obesity (Fruh et al, 016). Additionally, healthcare providers are more likely to suggest weight loss and “lifestyle changes” to people in larger bodies as a treatment option while choosing to delay diagnostic testing and/or treatment for symptoms (Phelan et al, 2015). Both direct and indirect weight bias from healthcare professionals contributes to anxiety, depression, disordered eating, medical non-adherence, antisocial behavior, reduced patient satisfaction, and reduced self-esteem in patients who have fallen victum to weight bias and discrimination (Dennett, 2019; Papadopoulos and Brennan 2015; Phelan et al, 2105). These negative interactions related to weight status in the healthcare setting sometimes cause people to delay or avoid seeking treatment for illness or preventative care (Fruh et al, 2016).

Discussing weight status with patients and peers is difficult. After all, ample evidence connects obesity with cancer development, insulin resistance, and high blood pressure, and more. What’s an effective and sensitive way to portray this information to patients and peers? When is the correct time to bring up the conversation of weight? During my clinical rotations, my weight-inclusive preceptors have shared their own strategies on tackling this difficult topic. I have also received resources from the Health at Every Size approach to healthcare, the Obesity Action Coalition, weight- inclusive articles on the Harvard Health and Cleveland Clinic websites, as well as listened to many personal testimonies from the creators, Aubrey Gordan and Michael Hobbes, and the fans of my favorite podcast, Maintenance Phase. Below are some ways to approach weight in a sensitive manner as a healthcare professional and peer.

How to discuss weight with patients as a healthcare professionals:

Treat the patient.

If a patient arrives to an appointment complaining of ear pain, treat the ear infection. It does not make sense to bring up their weight in an appointment unrelated to their weight. Always ask yourself if weight status if relevant to the conversation you are having with your patient.

Provide the same care for all patients.

This recommendation should seem like a no-brainer, but according to the evidence stated above, patients in larger bodies often have decreased quality of healthcare because of their weight status. Spend the same amount of time with patients with obesity as you would with patients at a normal body weight. Order the same tests and procedures as you would for a patient at a normal body weight at the same point in treatment as you would for a person at a normal body weight.

Keep numbers out of the conversation surrounding weight and weight status.

Using numbers and categories can be really triggering for a person with an eating disorder or disordered eating. Stay away from mentioning numbers in order to prevent avoidable triggers that can lead to or worsen eating disorders. As a side note, make sure to scour a chart for previous evidence or note of disordered eating before discussing weight.

Build rapport.

Before discussing weight with your patient, you want to build rapport. Trust is essential for discussing weight in a sensitive manner.

Focus on the mental health of a patient.

Eating disorders, disordered eating, and obesity all have phycological components. Before congratulating a patient on their weight loss or condemning a patient for weight gain address their mental health status. Ask questions in a sensitive manner and search for patterns of disordered eating such as fad dieting, restrictive eating practices,  fear of gaining weight, negative attitude towards weight gain or people in larger bodies, bingeing, depression, anxiety, or other conditions related to altered patterns in diet. Treating the root cause of weight gain or loss can help healthcare professional more effectively treat the whole patient at one time.

Refer patients looking for nutrition advice to Registered Dietitians- they are the experts!

Registered Dietitians complete a 4 year undergraduate degree in nutrition as well as an internship with 1200 supervised clinical, food service, and community nutrition hours. All of the training and education dietitians go through make them the experts on food and nutrition. If a patient is seeking medical nutrition advice related to their weight status or simply wants more information on eating healthy, a Registered Dietitian can provide personalized information and counseling that benefits the patient and can be extremely effective to their overall health.

How to Discuss weight with your peers and family members:

Don’t.

Discussing weight often encourages people to want to lose weight. It is important to remember that a weight loss technique that might have worked for you, or your cousin, or your cousin’s hairdresser’s, next-door-neighbor might not be the tactic that works for everyone. Vice versa, if you comment on “how good” a person looks since you last saw them, you could be unintentionally encouraging disordered eating habbits. When complimenting or critiquing another person, it’s best to stick to the “5 Minute Rule”. Unless a person change some the aspect you are commenting on in 5 or less minutes, do not comment on it.

But what if they bring it up?

Weight loss, dieting, and nutrition are common hot topics and themes of gossip sessions. If someone brings up their recent weight loss efforts or unexpected weight gain, change the subject or refer them to healthcare professionals trained to teach on the subject area. Adding to weight-related gossip fuels Weight Bias and Weight Stigma.

    But what if I’m really concerned about someone and their weight status?

    If you have a rapport with a person you feel needs an intervention related to their weight status, go about it in an extremely sensitive manner. Focus on their mental health and make observations about their attitudes and behaviors instead of their appearances. Always encourage them to get help from a trained professional if you believe their habits and emotional state are harmful to themselves.

   By approaching weight in a sensitive manner in the healthcare setting and with our friends and family, we can create a more inclusive environment for people of all body types. Improving attitudes around weight and reducing weight stigma, patients can have improved satisfaction in their appointments and procedures, healthcare professionals can improve their quality of care, and patients and healthcare professionals can have better, more meaningful relationships with one another.

 Resources:

 Implicit weight bias test: https://implicit.harvard.edu/implicit/selectatest.html

Health at Every Size: https://haescommunity.com and https://www.sizediversityandhealth.org/health-at-every-size-haes-approach/

Maintenance Phase Podcast: https://www.maintenancephase.com

Discussing Weight in the Healthcare Setting:

https://health.clevelandclinic.org/weight-bias-in-healthcare-can-it-be-prevented/

https://www.health.harvard.edu/blog/addressing-weight-bias-in-medicine-2019040316319

https://www.obesityaction.org

 

Citations:

Dennett, C. (2019, May). Weight Bias in Dietetics Education. Today's Dietitian, 21(3), 36. 

Fruh, S. M., Nadglowski, J., Hall, H. R., Davis, S. L., Crook, E. D., & Zlomke, K. (2016). Obesity stigma and Bias. The Journal for Nurse Practitioners, 12(7), 425–432. https://doi.org/10.1016/j.nurpra.2016.05.013 

Papadopoulos, S., & Brennan, L. (2015). Correlates of weight stigma in adults with overweight and obesity: A systematic literature review. Obesity, 23(9), 1743–1760. https://doi.org/10.1002/oby.21187 

Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319–326. https://doi.org/10.1111/obr.12266