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Introduction: Expert Insights is an ongoing medical education podcast. The Carle division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please click on the link and complete the episodes post-test This podcast forum is brought to you to share expertise and insights within our integrated delivery system. To help us improve the health of the people we serve and achieve world-class accessible care. This is Expert Insights. Here's your host, Melanie Cole.

Melanie Cole: Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole and I invite you to listen in, as we discuss obesity and nutrition updates. Joining me is Kristina Adams Smith. She's a Dietician with the Carle Foundation Hospital. Kristina, I'm so glad to have you with us. And this is such an important topic today. Give us some of the latest updates that you know of between the relationship of obesity and nutrition. What are you seeing in the trends these days?

Kristina Adams Smith: A lot of what we're seeing is focusing on more nutrient composition of what is being taken in as far as calorie counts. So it's leaning a little bit away from overall calorie based diets or kind of extreme dieting and certain examples like a fasting or liquid dieting. Those haven't been as popular lately, more just looking at how the food components can be balanced a little bit better and be able to manage it more lifelong as far as a lifestyle change.

Host: So interesting because it's taken so many layers these days, Kristina, when we talk about this growing epidemic school and recess for our kids gym and the built environment, all of these things that we now factor in, when we're talking about nutrition, do you feel that the diet industry has played a role in this picture and indeed the food industry as well, trying to make us want foods that maybe we might not have eaten naturally or even urban deserts things where there aren't availability of quality, nutrition and nutrient dense foods?

Kristina Adams Smith: Yes. I guess if I had to answer one way, there's a lot that has changed over the years and I believe media advertising, product development, there's a lot that goes into that. And a lot of times that's product specific or some of the naming or descriptions have been a little bit more leading and making a lot of consumers think that things are healthier than something else. And that may not be always the case. And a lot of times we're also looking at fad dieting. That's evolved over the years and what's worked for one may not work for someone else. So there's always the one size doesn't fit all. So I think that's played a part of what's changed over the years and also just technology in general of how it's evolved and access to food and our lifestyle being so much different than it was 20, 30 years ago and eating away from home versus cooking at home. So there's just so many layers that go into that, but definitely there's been a big shift

Host: There certainly has. And are we still calories in calories out, as you mentioned, fad diets and how they come and go and there's ones of no carbs. And then there's ones ketogenic. There's all these different diets now. And some are good Mediterranean. Some are really balanced. Some are not. Are we still basically calories in calories out or has that changed as well?

Kristina Adams Smith: There has been a little bit of change with that. It still is a calorie composition is more of the focus versus a calorie count, if that makes any kind of sense, but we're looking at the composition of the food as far as the big macro nutrients, the carbs, the protein, the fats, and more layers under that of where are they coming from? Are they whole grain? Are they refined carbohydrates? Is it healthy fats looking at more specific to some of those nutrient intake so that if you are really fine tuning that then the overall calorie number itself can be much more manageable and healthier at the same time, so that you're not just consuming empty calories or unhealthy high fat refined sugary foods. So it definitely can make a difference when we are looking at where are those calories coming from more importantly.

Host: Well, that makes a lot of sense. So when we're talking about weight loss and for other providers that are counseling their patients on obesity and the comorbid conditions that come along with it and weight loss, tell us about some of your best ways, whether it's medically supervised weight loss programs and really what that means or in the extreme circumstances, bariatric surgery, or some of the diets that you do? Tell us a little bit about what you do and what you want other providers to know about how they can work with their patients as well?

Kristina Adams Smith: Sure. A lot of what I focus on is meeting the patient where they are, what sounds good on paper, or maybe in a research article may not fit the patient's sitting in my office. So I do try to customize to patients in what they have access to, whether it's financial and trying to see how they can eat healthier based on their finances, or if it's a limited grocery store access of where they go to shop. So trying to figure out that first and then go from there instead of just saying here, try this. So I do try to customize it for that patient and meet them where they are and looking at also back to that nutrient composition. So trying to educate what are protein foods, what are healthy fats, what are carbohydrates, and the difference between them. I think carbohydrates have gotten a really bad rap over the last probably 20 years. I think it's been awhile, but because of the different types of carbohydrates that fall under that are very challenging.

I think for patients because of the media and the mainstream information and fad dieting has been around trying to really figure out is it truly healthy for me or not? And that can vary too based the patient's health status. So if they are concerned with diabetes, then we have to look at fruits and vegetables need to be managed differently than someone who is trying to lose weight and is consuming more fruits and vegetables let's say because they're low calorie because of the blood sugar concerns with someone with diabetes, same thing where someone has heart disease, they're wanting to look more at healthy cooking techniques, also and healthy fat intake to help promote healthy fats in the diet that can help lower risk of heart disease and also looking at what kind of carbohydrates. So it's definitely more specific to the patient based on not only their access to certain foods or limitations and also what their health status is. So I try not to just say, go try X program or Y program. It's more about what they have access to, what they're comfortable trying.

Also, I do have patients that are interested in some kind of planned program that they can follow that will just take the guesswork out of it. And that's perfectly fine. I try to educate on finding something that is going to be there for them in the long-term, meaning that it's not only going to help them get the weight off, but it's going to help them keep the weight off long-term, because that's where I tend to see a lot of patients. I did this diet, but I gained all my weight back. What happened in their interim? Where did they not stay with it? Was there no long-term support to help them with managing the weight loss part of it? And keeping the maintenance going? And also there are those patients that are just ready for surgery. They've tried multiple diets. They may have a genetic predisposition where there just has been a lifelong battle for them. And they just haven't been able to make any headway in getting towards healthy weight goals and being able to stabilize them for any long-term. So sometimes surgery is a goal in mind.

Host: It certainly is. And it's a great tool in the toolbox that we have nowadays to help people that are obese. And I can appreciate that you spoke about carbs because as you say, they've gotten a bad rap and they are not all created equal by any means. Can you, in the last few minutes here provide for us some balanced, nutrient dense food ideas to support that healthy lifestyle. And as we heard that you don't give specific programs all the time, that's changed and evolved over the years. How do you work with people as far as recipes? And because people don't always know what to do with some of those healthy foods or maybe salads are a pain to make. So they don't always want to do that. How can we look to food dense, nutrient dense foods to really make a difference here?

Kristina Adams Smith: Yes. Excellent. A lot of what I use, I do give materials for the patients to leave with. So a lot of it is broken down for them and patient instructions. So I specifically go over maybe some goals to meet daily as far as a nutrient intake, a certain 50 to 70 grams of protein in a day, maybe even upwards of 90, depending on what they're doing and versus if they're a man or a woman, and then we go over what types of proteins there are. So I may give them examples of cottage cheese, or eggs, or maybe a balanced snack of healthy nuts with some grapes to snack on, trying to give them examples of what could be a healthy snack, as well as lean protein or lean meat that they could be eating. Also, we focus on the carbohydrate piece of it, more specifically dividing up starchy versus non starchy when it comes to vegetables and go through what those entail and help them to see that it is beyond salad. There's a lot more out there that can be consumed in the non starchy vegetable category and identify that basically, if it's not potato, pea, or corn, it's considered non starchy.

So that kind of opens up the door a little bit more. And this is where some of the misinformation I think that I find from patients has come from is they feel like some of those non starchy vegetables, such as maybe a carrot or a onion, they've gotten bad raps because they're considered high sugar. So we go over the fiber content and the, how the body breaks things down. So I do take it into a little bit more detail to help them understand that carrots and onions can be much healthier than eating a potato, corn, and pea at every meal. So we've talked a little bit about how the meal plan, using some of those tools, the healthy fats, as far as cooking with olive oil, pan sprays, maybe some healthy nuts that they can include it, breakfast, lunch, and dinner. They could put a slivered almonds in yogurts or cereals to help boost the healthy fat and a little bit of protein. They could sprinkle sunflower seeds on salad at lunch, and then they could easily use those healthy oils when cooking, if they're at home for dinner, cooking a meal. So just trying to give examples, and then the carbohydrate being the bigger group, we talk more about complex carbs, the whole grain factor.

And we look at limiting refined carbs, and I always call snacky foods that are the empty calorie things and trying to make those snacks once again, more meaningful. So if they want crackers set aside a certain number of the serving size, and then pair that up with maybe some cheese on each Cracker to have that balance of a carb with a protein food. So you don't have too many empty calories coming from a larger carbohydrate content food. And then once again with the fruit, same thing, just trying to balance some of the fruits when they're eaten with something that's a non carbohydrate food as well. So once again, it could be cheese and strawberries together as a snack. So meal planning, using a little bit breakdown of those three areas of healthy fats proteins and those carb foods. And then also looking at where those carbs are coming from, and maybe looking at if they're interested in using some kind of app that would track their food record so they can see the nutrient breakdown, or if they want to do it old school and just write it down and keep track that way too.

A lot of times I recommend patients come back to see me say three to six months down the road, possibly bring food records so we can see how the progress is going. Obviously, I, they have access to be able to check progress if they need it along the way, or they can always come back sooner. So it is up to the patient as far as how much accountability they would like from me in helping with this. And I do provide different websites as far recipes that can be found. There's Pinterest has always been a popular spot for most, and most people are aware of that. So there's always a lot of information there. You mentioned Mediterranean diet earlier. That's a popular one. That's gotten a good review year after year being the number one healthy way to eat in general, just for weight loss or any kind of health concern, Dash Diet comes in as well. So those are two that are very similar plans that mimic a lot of what I educate patients on, but just in a different way. But if someone does say they would like X number of diet to follow, I might recommend something like that. Or if they wouldn't do something more commercial, then we can look at what's available where they live.

Host: And as we wrap up, do you have any final thoughts for other providers on when you'd like them to refer to your department for patients in getting help with obesity and nutrition?

Kristina Adams Smith: Well, I think the biggest thing is the sooner, the better I tend to see patients sometimes and they've been diagnosed for years and they're just now seeing a dietician period. Maybe what's their second time seeing a dietician as long as they've been diagnosed with whatever health concern. So I think earlier on the better, the newly diagnosed patients with heart disease, cholesterol, triglycerides, blood pressure, the prediabetics trying to be able to manage their blood sugar sooner and earlier and helping prevent that diabetes diagnosis. A lot of, I get a lot of food allergies and food intolerances too. And a lot of times we can work with patients and helping them to manage their food intake better and not have to be on a lot of medication to help with tolerances. So I think sometimes nutrition is a lot more than just what and how to eat. There's more layers to it as far as specific combinations of foods and additives and colorings and the nutrient breakdown. So a lot more of a science, I think, than some providers may realize that we can help with

Host: Absolutely true. And that's really great advice. Thank you so much, Kristina, for joining us today and sharing your expertise because this is such an important topic. Thank you again. And that concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle provider's and to view, Carle sponsored educational activities, please visit our website at carleconnect.com, for more information. We hope the information gained will be applicable to your work and life. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. I'm Melanie Cole.