“What did you have for dinner last night?” Nutrition and the healthcare system

Nov. 9, 2015 / By Steve Delaronde

While we often hear about the role of good nutrition in promoting health, it is not typically discussed in the context of the Triple Aim – better outcomes, lower cost and improved patient satisfaction. What are the opportunities in health care to promote good nutrition and improve healthcare outcomes? Good nutrition means different things to different people, but is generally accepted as a diet that consists primarily of plant sources such as whole grains, beans, fruit, and vegetables, and limits or eliminates animal sources such as red and processed meat, refined carbohydrates, saturated and trans fats. The good news uncovered by Wang and colleagues and published in the November 2015 issue of Health Affairs is that the U.S. diet has been improving since 1999 and has contributed to lower disease burden. The bad news is that these improvements are less pronounced in low socio-economic groups and the overall quality of the U.S. diet remains poor. There is plenty of opportunity for improvement.

The U.S. medical model has not historically incorporated nutrition education into its patient care model. Rather, the focus has been on providing and coordinating medical treatment, and ignoring the most basic building block of health – good nutrition. When healthcare professionals counsel a patient with a chronic disease such as Type II diabetes, they are often confronting a lifetime of poor eating habits that are difficult to change. While primary care may be important in the overall treatment and care coordination for chronic conditions, primary care physicians have not been at the forefront of delivering nutrition counseling or providing behavioral treatment of obesity for patients as reported by Wadden and colleagues in November 2014 in JAMA.

Changing eating habits of Americans is not easy. Changing nutritional behaviors which are most likely to contribute to disease and poor health outcomes is bigger than the healthcare system. Achieving good population nutrition not only involves individual interventions, but also includes policy changes that impact agriculture, food production, labeling, advertising, food safety, public assistance and special interests.

Healthcare providers, and primary care providers in particular, have an opportunity to engage patients in a conversation about their nutritional habits and its impact on their health. Before any medication is prescribed, procedure is performed, or a medical referral is made, patients can be reminded that they have an opportunity to impact their current and future health state simply by making good decisions about what they eat. There are a variety of nutrition screening approaches, behavior change methods, education programs, cooking classes and licensed nutrition professionals that are available to a primary care provider. Each of these have strengths and weaknesses in promoting behavior change and all require ongoing reinforcement. Perhaps the best place to start with every healthcare visit is to ask the patient, “What did you have for dinner last night?”

Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.

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