Adding Nutrition to my medical practice

When I first started as a PA, I was at times dubious about how I could realistically incorporate nutrition into my practice. There were many times I felt I had to compartmentalize while in PA school, and I felt a bit weary about how I would be able to make this happen. Though as I settled into my job, the self-doubt lessened and I felt far more confident.

Before jumping into the ways I integrate nutrition into my practice, I first want to review a few things that come before all of these visits:

  1. Asking consent. Food and nutrition are incredibly invasive topics, and I want to ensure a patient wants to talk about these things before just jumping in.
  2. Gauging motivation for change. It’s also important to gauge motivation for change before lecturing a patient how food/nutrition. I made a LOT of mistakes as a new grad. The biggest being trying to change *everything* at once and leading with my own philosophy and agenda rather than meeting a patient where they’re at. It’s important to know how a patient feels about the plan of care and to create a plan together, rather than simply notifying them what your proposed plan is. I also think it’s super important to emphasize the importance of slow, small changes over long periods of time. This way, behavior change is sustainable, and it doesn’t advocate for unrealistic and toxic diet fads.
  3. Asking about accessibility to certain foods. Lots of folks don’t have regular access to nutrient dense foods. Prior to discussing certain foods/food groups, it’s incredibly important to first ask what someone has access to.
  4. Providing culturally competent care. It’s incredibly important to acknowledge what foods/food practices are important for the patient’s culture prior to making recommendations.

When discussing nutrition with patients, I do so in a variety of different ways – in dedicated nutrition visits, in physicals, in problem based visits where nutrition is relevant, and in group visits.

Since I have my master’s in nutrition, I often speak to patients that other providers in the office refer to me. We also have an amazing dietetics team who work with patients, though my role specifically combines nutrition with medicine. We’ll talk about a wide range of things, from relationship with food to pace of eating to the hunger/fullness scale to lifestyle factors (stress, sleep, medications, alcohol use, physical activity), etc. I am so very lucky to work in a clinic who views my role as a dovetail between nutrition and PA. This was something I talked about a lot in my interview process.

When not in a dedicated nutrition visit, I’ll discuss nutrition, access to nutrient dense foods, and behaviors that impact nutrition choices (ie sleep, stress management) in both physicals and problem based visits.

In physicals, we discuss the above, and/or review prior labs that are impacted by nutrition/lifestyle, ie blood pressure, A1c, cholesterol screening, elevated liver enzymes, etc.

Within the problem based visits, the questions will vary based on presenting concern. Ie for GI symptoms, we’ll talk about dietary triggers, pace of eating, stress surrounding meal times, relationship with food, stress management, mental health, etc. Whereas for a mental health visit (ie anxiety/depression), we’ll touch upon regularity of meal times, blood sugar balancing nutrition, appetite, alcohol/caffeine intake, sleep, stress (and so much more). It’s entirely dependent the patient’s chief concern for that visit.

I also talk about nutrition in my group visits! This is an 8-week curriculum where we start with mindfulness based movement, discuss nutrition in a broad strokes way, learn about intuitive eating, and utilize the collective wisdom of the group to making health promoting behavior changes. We discuss nutrition as it relates to blood sugar irregularities (pre-diabetes, diabetes), hyperlipidemia, hypertension, mental health, as well as intuitive eating and ways to improve sleep, relationship with physical activity, and stress management.

When I first started as PA, I spent a lot of time discussing the ‘what’, ie specific foods, timing of meals, macronutrient composition, etc. While I absolutely acknowledge those things are important, I now spend far more time talking about relationship with food, breaking longstanding history of dieting, behaviors surrounding mealtimes/nutrition, and how stress/sleep impact food choices.

Underlying all of the above is the ideology and framework of decentralizing weight from these visits. Setting goals outside of weight can be far less harmful and help break the cycle of toxic diet culture. We aim to use other quantifiable biomarker (ie A1c, lipid panel, blood pressure) rather than weight alone. Taking this size inclusivity approach has been incredibly impactful to my overall practice.

This seemed unmanageable and overwhelming as a PA student, though has been relatively seamless as a practicing PA. It’s a wonderful career where there’s a lot of independence to add your passion into your practice.

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