1 Food Talk: What your patients don’t tell you and why you need to ask Diane Stadler, PhD, RD, LD Associate Professor & Director Graduate Programs in Human Nutrition Bob & Charlee Moore Institute for Nutrition & Wellness Oregon Health & Science University Portland, OR OHSU
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Food Talk: What your patients OHSU · Food Talk: What your patients don’t tell you and why you need to ask Diane Stadler, PhD, RD, LD Associate Professor & Director Graduate Programs
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Food Talk: What your patients don’t tell you and why you need to ask
Diane Stadler, PhD, RD, LD
Associate Professor & Director
Graduate Programs in Human Nutrition
Bob & Charlee Moore Institute for
Nutrition & Wellness
Oregon Health & Science University
Portland, OR
OHSU
Conflicts of Interest/Disclosures
I have no conflicts of interest to disclose
Images obtained from Google Images with
designation of “noncommercial, reuse”
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Objectives
• Crucial conversations
– Ask about food preferences
– Identify collaborative
solutions
– Support success
• Summarize popular fad diets and
food trends and their nutritional
implications
• Review healthy dietary patterns
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Crucial conversations about Food and Nutrition
“What do you say when a patient asks
you for nutritional advice?”
“I change the subject!”
Conversation between Kent Thornburg, Director, OHSU Bob & Charlee Moore Institute and physician colleague
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Starting the conversation…“If you ask just one question…”
Precautionary guidance…
“Do you use a seat belt when you’re
driving?”
“What type of car seat do you use?
“When you ride a bike, do you wear a
helmet?”
“Are you planning to become pregnant in
the next year?”
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We need to use the same strategies to talk about diet...
“Tell me about the foods you usually eat?”
“Are there foods that you tend to avoid?”
“Where do you shop for food?”
“How many times a week do you eat foods that you didn’t prepare at home?”
“What are your favorite go-to meals?”
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Food Choices among Asian WIC Participants in Oregon
“We usually have noodles, like rice noodles, for
breakfast and rice for dinner.”
“We know brown rice is very healthy but the kids is
not liking it. Because the brown rice is very, very dry
and very hard. Not easy to eat.”
I don’t know how to cook tortillas. So I haven’t
bought them.”
“The canned fish we never buy, cause we want the
fresh one. I always like the fish is still swimming.”
Tsai, C. Influences on Food choices, Postpartum Traditions and Breastfeeding
Among Asian WIC Participants in Oregon. OHSU Master’s Thesis, 2018. OHSU
• Thiamin, niacin, riboflavin, and iron (1940, 1952)
• B-vitamins, folic acid, iron
• Calcium, Vitamin D
• Folic acid (1998)
• Folic acid (2016)
Dietary Reference Intakes: Guiding Principles for nutrition Labeling and Fortification.
National Academy of Sciences, 2003
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Marketing: simplicity, variety, choice & claims
“Focus on variety, nutrient density
and amount. To meet the nutrient
needs with caloric limits,
choosing a variety of nutrient
dense foods across and within all
food groups in recommended
amounts.”
“Atkins 40 is an easy low carb
diet plan based on portion
control and eating 40g net carbs
per day. If you have less than
40 pounds to lose, are pregnant
or breastfeeding, or want a
wider variety of food choices
from the first day of your diet,
Atkins 40 could be a great fit for
you.”
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First, do no harm…Find common ground…
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Low-Carb Eating fewer simple sugars
Paleo Eating more home cooking
Gluten-Free Eating more ancient grains
Raw-Foods Eating more nuts & seeds
Clean-Labels Eating less processed foods
Juicing Eating more fruits & veggies
Longevity Good at counting calories
“Tell me more about this…”
Adapted from a slide by Robyn Flipse, MS, RDN
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The Power of Active Listening and Empathy
“Obese…, he told me I was obese…and his
only advice was to each more celery and
carrots!”
“He didn’t ask what I thought contributed
to my weight gain.”
“And, he wants to see me back in 6
months…6 months, what good is that going
to do?”
“I don’t even like celery!”
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First Seek to Understand
“My husband is following a low-carb diet…He’s been doing this for 2 years. He says he feels great…I’m concerned…He won’t talk with his physician…I don’t know what to do.”
“Why did they contact you?”
“What do they think you’re going to do for them?”
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Paleo Diet (a.k.a., Caveman, Stone-age Diet)
“Eating like our prehistoric ancestors leads to weight loss & lower risk of developing diabetes, heart disease, cancer other health conditions”
Nutrients of concern: Calcium, B-vitamins, Iodine, Vitamin D