Dietary Issues in Primary Care

Slide 1: DIETARY In Primary Care ISSUES

Slide 2: A presentation by Dr. Lalita Kaul, PhD, RD, LDN Professor Dept. of Community and Family Medicine

Slide 3: What You Will Learn: •Basic changes that will impact U.S. lives •An effective physician delivered nutritional counseling approach

Slide 4: DID YOU KNOW. . . Nutrition related diseases are the leading causes of morbidity and mortality in the US today?

Slide 5: Most Americans have a primary care physician whom they see on average at least once a year.

Slide 6: Non-Acute office visits include nutritional counseling only 30 – 42 % of the time. 120 100 No Counseling 80 60 Received Nutritional 40 Counseling 20 0 Non-Acute visits

Slide 7: It’s possible for primary care physicians to provide nutritional counseling with a few basic changes using simple time sensitive tools.

Slide 8: Use Nutritional Counseling tools like: Chronic Disease Vital Sign Stamp The A 5 Algorithm Approach

Slide 9: Estimates are that between 300,000 to 800,000 deaths per year could be prevented . . .

Slide 10: Obesity

Slide 11: Stroke

Slide 12: Hypertension

Slide 13: Healthy People 2010 & the U.S. Preventive Services Task Force have specific nutrition counseling recommendations.

Slide 14: Fats Meats Vegetables and Fruits Grains How does their pyramid stack up?

Slide 15: It’s Agreed . . . Nutrition interventions are generally safer than many pharmacologic or surgical approaches to disease treatment.

Slide 16: 72% of Primary Care Physicians consider it their responsibility to perform nutritional counseling.

Slide 17: However . . . Time is always a factor . . . It needs to be included in a visit normally lasting for 10 to 16 minutes.

Slide 18: BARRIERS to Effective Counseling

Slide 19: Uncertainty of the effectiveness of nutrition counseling

Slide 20: Inadequate skills in providing nutrition counseling

Slide 21: Lack of financial incentives

Slide 22: Lack of systematic, organized approach within the practice. When to ask the patient What to ask the patient Who will ask the patient How to ask the patient Where to ask the patient

Slide 23: Case Studies Show Results . . .

Slide 24: CASE #1 The patient has: •Overweight with a normal LDL cholesterol level •Increased fasting glucose •Increased blood pressure •Increased waist circumference Diagnosed with metabolic syndrome because: •Abdominal obesity (waist circumference > 40 inches in men; > 35 inches in women) •Blood pressure of 130/85 mm Hg or higher •Elevated fasting glucose level (> 100 mg/dL)

Slide 25: CASE #2 Primary Target: The patient has: The lipid profile and NOT body weight •Normal weight •Normal LDL cholesterol level •Elevated fasting triglycerides •Low HDL cholesterol level •Elevated blood pressure •Also diagnosed with metabolic syndrome

Slide 26: CASE #3 The patient has: •Elevated LDL cholesterol •Elevated Triglyceride levels Primary goal: Reduce saturated fat to reduce LDL cholesterol.

Slide 27: Nutrition Counseling Tools Make the Difference

Slide 28: Chronic Disease Vital Sign Stamp

Slide 29: Smoking

Slide 30: Chronic Height Weight Disease Waist Circumference Vital Body Mass Index Sign Blood Pressure Physical Activity Stamp Smoking Status

Slide 31: Rate Your Plate

Slide 32: Rate Your Plate Direct patients to record their eating patterns, and provide an assessment of the nutritional quality of the food choices.

Slide 33: The A5 Algorithm Approach

Slide 34: A DDRESS the Agenda

Slide 35: A SSESS

Slide 36: A DVISE

Slide 37: A SSIST

Slide 38: A RRANGE Frequent Follow-up

Slide 39: How Do You Incorporate Nutrition Counseling Into Busy Practices?

Slide 40: It’s difficult to fit effective counseling into an already overworked practice. HOWEVER . . .

Slide 41: Following the A5 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

Slide 42: Embrace: •Training •Effective Tools •Whole Staff Participation •Collaborate with and refer to qualified nutrition health professionals

Slide 43: Envisioning a healthier America through Innovative Primary Care Dietary Counseling.

Slide 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.