- The document discusses the importance of nutrition counseling in primary care and barriers to its implementation. It provides an effective 5 step approach ("A5 Algorithm") for physicians to provide brief but effective nutritional counseling. - Case studies demonstrate how the approach can be used to address different patient nutritional issues like metabolic syndrome, lipid levels, and weight management. - Effective nutrition counseling in primary care has potential to improve health outcomes and prevent deaths from diseases like obesity, hypertension and stroke. Tools and a team approach are needed to successfully incorporate it into short patient visits.

1. D IETARY I SSUES In Primary Care

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

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

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

6. Non-Acute office visits include nutritional counseling only 30 – 42 % of the time.

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

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

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

10. Obesity

11. Stroke

12. Hypertension

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

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

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

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

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

18. BARRIERS to Effective Counseling

19. Uncertainty of the effectiveness of nutrition counseling

20. Inadequate skills in providing nutrition counseling

21. Lack of financial incentives

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. Case Studies Show Results . . .

27. Nutrition Counseling Tools Make the Difference

28. Chronic Disease Vital Sign Stamp

29. Smoking

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

31. Rate Your Plate

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

33. The A 5 Algorithm Approach

34. A DDRESS the Agenda

35. A SSESS

36. A DVISE

37. A SSIST

38. A RRANGE Frequent Follow-up

39. How Do You Incorporate Nutrition Counseling Into Busy Practices ?

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

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

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

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.