Dietary Issues in Primary Care


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Created for Dr. Lalita Kaul by KMG Consulting & Training. May 2007

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  • Dietary Issues in Primary Care

    1. 1. D IETARY I SSUES In Primary Care
    2. 2. A presentation by Dr. Lalita Kaul, PhD, RD, LDN Professor Dept. of Community and Family Medicine
    3. 3. What You Will Learn: <ul><li>Basic changes that will impact U.S. lives </li></ul><ul><li>An effective physician delivered nutritional counseling approach </li></ul>
    4. 4. Nutrition related diseases are the leading causes of morbidity and mortality in the US today? DID YOU KNOW. . .
    5. 5. Most Americans have a primary care physician whom they see on average at least once a year.
    6. 6. Non-Acute office visits include nutritional counseling only 30 – 42 % of the time.
    7. 7. It’s possible for primary care physicians to provide nutritional counseling with a few basic changes using simple time sensitive tools.
    8. 8. Use Nutritional Counseling tools like: Chronic Disease Vital Sign Stamp The A 5 Algorithm Approach
    9. 9. Estimates are that between 300,000 to 800,000 deaths per year could be prevented . . .
    10. 10. Obesity
    11. 11. Stroke
    12. 12. Hypertension
    13. 13. Healthy People 2010 & the U.S. Preventive Services Task Force have specific nutrition counseling recommendations.
    14. 14. How does their pyramid stack up? Fats Grains Vegetables and Fruits Meats
    15. 15. It’s Agreed . . . Nutrition interventions are generally safer than many pharmacologic or surgical approaches to disease treatment.
    16. 16. 72% of Primary Care Physicians consider it their responsibility to perform nutritional counseling.
    17. 17. However . . . Time is always a factor . . . It needs to be included in a visit normally lasting for 10 to 16 minutes.
    18. 18. BARRIERS to Effective Counseling
    19. 19. Uncertainty of the effectiveness of nutrition counseling
    20. 20. Inadequate skills in providing nutrition counseling
    21. 21. Lack of financial incentives
    22. 22. Lack of systematic, organized approach within the practice. What to ask the patient When to ask the patient How to ask the patient Who will ask the patient Where to ask the patient
    23. 23. Case Studies Show Results . . .
    24. 24. <ul><li>CASE #1 </li></ul><ul><li>The patient has: </li></ul><ul><li>Overweight with a normal LDL cholesterol level </li></ul><ul><li>Increased fasting glucose </li></ul><ul><li>Increased blood pressure </li></ul><ul><li>Increased waist circumference </li></ul><ul><li>Diagnosed with metabolic syndrome because: </li></ul><ul><li>Abdominal obesity (waist circumference > 40 inches in men; > 35 inches in women) </li></ul><ul><li>Blood pressure of 130/85 mm Hg or higher </li></ul><ul><li>Elevated fasting glucose level (> 100 mg/dL) </li></ul>
    25. 25. <ul><li>CASE #2 </li></ul><ul><li>The patient has: </li></ul><ul><li>Normal weight </li></ul><ul><li>Normal LDL cholesterol level </li></ul><ul><li>Elevated fasting triglycerides </li></ul><ul><li>Low HDL cholesterol level </li></ul><ul><li>Elevated blood pressure </li></ul><ul><li>Also diagnosed with metabolic syndrome </li></ul>Primary Target: The lipid profile and NOT body weight
    26. 26. <ul><li>CASE #3 </li></ul><ul><li>The patient has: </li></ul><ul><li>Elevated LDL cholesterol </li></ul><ul><li>Elevated Triglyceride levels </li></ul>Primary goal: Reduce saturated fat to reduce LDL cholesterol.
    27. 27. Nutrition Counseling Tools Make the Difference
    28. 28. Chronic Disease Vital Sign Stamp
    29. 29. Smoking
    30. 30. Chronic Disease Vital Sign Stamp Height Weight Waist Circumference Body Mass Index Blood Pressure Physical Activity Smoking Status
    31. 31. Rate Your Plate
    32. 32. Rate Your Plate Direct patients to record their eating patterns, and provide an assessment of the nutritional quality of the food choices.
    33. 33. The A 5 Algorithm Approach
    34. 34. A DDRESS the Agenda
    35. 35. A SSESS
    36. 36. A DVISE
    37. 37. A SSIST
    38. 38. A RRANGE Frequent Follow-up
    39. 39. How Do You Incorporate Nutrition Counseling Into Busy Practices ?
    40. 40. It’s difficult to fit effective counseling into an already overworked practice. HOWEVER . . .
    41. 41. Following the A 5 Approach can assist primary care physicians in providing important health benefits for their patients and the greater US population. A DDRESS SSESS DVISE SSIST RRANGE
    42. 42. <ul><li>Embrace: </li></ul><ul><li>Training </li></ul><ul><li>Effective Tools </li></ul><ul><li>Whole Staff Participation </li></ul><ul><li>Collaborate with and refer to qualified nutrition health professionals </li></ul>
    43. 43. Envisioning a healthier America through Innovative Primary Care Dietary Counseling.
    44. 44. About the Author Lalita Kaul, PhD, RD, LD, LN , is Professor of Nutrition in the Department of Community and Family Medicine, College of Medicine, Howard University (HU), Washington, DC. and the Director of the Bariatric Clinic. Dr. Kaul is the National Spokesperson for The American Dietetic Association and has published over 40 papers and two books - Multidisciplinary Approach to Obesity and the South Asian Diet Cookbook . She has worked in the White House Health Care Information Center and Presidential Correspondence Analysis.