Nutrition & Primary Care
Primary care is a realm of healthcare that promotes preventive medicine and health education through various means including routine screening, immunization, lifestyle management, and treatment of chronic illness. While the average young adult can go years without seeing a provider, it is imperative that infants, children, women, and older adults have access to primary care services for proper health management.
Primary care embodies specialties such as family medicine, women’s health, and pediatrics: all significant realms of medicine that often necessitate appropriate patient education on nutrition. I spoke with practicing providers, physician assistant students, and medical students who were able to elaborate on their own experience utilizing nutritional education in clinical practice.
Family Medicine
It is all too common for patients to read off a long list of conditions when asked about their past medical history. Hypertension, diabetes, and hyperlipidemia are a few of the most common risk factors for many acute complaints. These chronic conditions are often secondary to obesity, overnutrition, family history, and food insecurity. It is becoming more apparent that providers must not only counsel patients on the management of chronic conditions but also ask sensitive questions and assess their ability to carry out the treatment plans. Physician Assistant (PA) student, Vanessa Hernandez, explained how her program provides students with an overview of culturally-sensitive dietary recommendations and resources to better assist a diverse array of patients.
My own experience working alongside a family medicine PA at a federally qualified health center revealed the significant impact of nutritional education in treating patients with chronic conditions. I witnessed the PA implement dietary suggestions for patients with diabetes and collaborated with social work staff if patients were experiencing limited access to nutritious foods. He adapted to each person’s needs to ensure they had the tools to not only treat their disease states but also to support their quality of life. Those with diabetes often received guidance on how to decrease carbohydrates in their diet, while elderly patients at risk of developing sarcopenia may be recommended to increase protein intake.
Nutritional status is one of the more difficult components of health for providers to assess, as it is multifactorial and can be dependent on one’s socioeconomic status, individual habits, and even mental health. Anxiety and depression may often result in loss of appetite, undernutrition, and eating disorders. Brandon Rose, a third-year medical student who is simultaneously pursuing a master’s degree in public health, said his education has guided him in nutrition “as it relates to conditions such as anorexia nervosa, bulimia, bariatric surgery, and other gastrointestinal conditions”. Additionally, he has learned about the symptoms and pathophysiology of vitamin deficiencies and indications for ordering various diagnostic tests.
Women’s Health
Samira Soroudi, a physician assistant practicing women’s health, explained her “personal protocol” for evaluating patients in obstetrics. She always discusses the importance of healthy eating habits and exercise during initial visits with patients, especially for those with risk factors such as obesity, diabetes, and pregnancy-induced hypertension. Prenatal care and nutrition go hand-in-hand; women who go without this important service often face micronutrient deficiency and lack of gestational weight gain counseling. These deficiencies can result in poor maternal health, diminished neurodevelopment of the infant, future mental health issues, an impaired immune system, as well as many developmental barriers.
As displayed above, nutritional status during pregnancy is dependent on several factors, including socioeconomic status. Although Samira implements nutritional education and emphasizes the impact of a healthy diet, many patients are non-compliant due to limited access to healthy foods, an inability to carry out the treatment plan, or resistance to long-term lifestyle changes.
Pediatrics
Well-child visits are a staple within pediatric care and are imperative for tracking milestones within children and adolescents, ensuring their proper growth and development. One of the biggest problems faced in these settings is childhood obesity: a multifaceted and growing epidemic that stems from family beliefs, household routines, and decreased emphasis on physical activity due to technological advances.
Medical student Brandon Rose explains how he sees most pediatric providers counsel parents on lifestyle changes. Although they want their children to eat healthy, many parents continue to keep their house full of processed foods.
“It really takes commitment from the whole family to have healthy options at home and to stop buying fake food,” Rose says.
Some initiatives being implemented in prenatal and postpartum care to promote breastfeeding include the Starting Early child obesity prevention program. Fewer infants are being exclusively breastfed, leading to the early introduction of complementary foods and liquids. This is truly a “recipe” for disaster, as youth and infants are becoming physiologically programmed to overnutrition.
Additionally, solutions to childhood obesity include the implementation of health education for parents during well-child visits. Providers must seek to improve communication with parents while counseling on growth assessment and nutritional guidance, as many parents lack adequate understanding of these topics. Oftentimes, there is a disconnect between medical provider recommendations and at-home implementation. This is where educational reinforcement in schools, such as programs like KIN, can complement verbal recommendations by doctors.
Takeaway
We’ve all heard the old adage “An apple a day keeps the doctor away”, but continue to disregard the significant impact of nutrition on our health. This is mainly due to the prevalence of nutrient-deficient packaged foods, social influence, as well as limited access to nutritional guidance through primary care services. It is essential that providers promote nutritional guidance in clinical settings so their patients are able to make sustainable lifestyle choices and hold an active role in their health. Although providers advocate for proper nutrition, verbal recommendations only go so far. Promoting realistic change within lifestyle habits and food choice requires three strategies that work together simultaneously: patient education, food access, and school resources. Habits must be instilled at a young age to increase the probability of children carrying these healthy habits into adulthood. By supplementing preventive health services with school and community programs that promote nutritious food education and access, we can begin to shift the increasing prevalence of chronic disease in the nation.
KIN is taking a step in the right direction by addressing these missing components (nutrition education, food access, and parent resources) to supplement the gaps in healthcare services.
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