Question 3
When counseling a patient with NAFLD or NASH, what types of lifestyle change
(diet) would you recommend? What strategies would you use during a counseling
session to help them understand and initiate their lifestyle change? Ex. MyPlate, food models, etc.
posted by Jamie Smythe @ 10:16 AM
36 comments
36 Comments:
This comment has been removed by the author.
Based on the results from this article, the fact that a low carbohydrate and saturated fat diet with high amount of lean protein, fiber, and omega 3’s is beneficial I would want to teach label reading so that individuals know the amount of carbs and fat, etc they are consuming. I think teaching serving sizes possibly with the use of food models goes hand in hand with reading labels and of course good sources of all those foods.
I think I would recommend the DASH diet plan. The DASH diet plan has been proven to be beneficial for lowering blood pressure but it is a healthy diet for almost everyone. The diet would have to be tailored to stress reduced intake of alcohol, refined carbohydrates and simple sugars as well as more fiber found from whole grains, complex carbohydrates and vegetables. Strategies used to help understand and initiate their new lifestyle change would be dependent on the patient. Patients benefit from books, educational material, online health programs, online food records with feedback. I think this part of counseling depends on the patient and how they learn best. It is important to stress that slow steady changes are most successful in a lifestyle change. Making sure that your patient knows that you don’t expect immediate change but gradual overall change because this will ensure that they are more likely to be successful.
I would recommend a gradual weight loss of about 10% of their current body through diet and exercise. I think it is very important to stress the need for gradual weight loss and not drastic by being too restrict because we do not want patients losing their muscle mass. I think that a regular healthy diet low in saturated fats and trans fats, and high in fiber and omega 3 fatty acids would be a good diet to stress. I would definitely address portion sizes with food models in the counseling session because I feel that this is something all Americans struggle with. I also really like the new MyPlate as an excellent goal plate to work towards as we fill our plates at meals. If the patient seemed willing, I would suggest possibly beginning a food diary because it can be good to be accountable for what we eat by writing it down. I would also include any handouts on healthy eating, lowing saturated fats and increasing fiber intake.
This would depend on the patient and their level of readiness. I found while working with outpatients during my rotation that often starting directly at the basics was necessary and the plate method was usually the best was to go with that in mind. If the patient was ready or further down the line I would move more towards hands and healthy food choices that include low fat, lean protein and high fiber choices.
Molly, the DASH diet is a great idea. I think there would be some success with that in these patients.
Based on the results from this study the ed from care manager on a heart healthy diet would work pretty well. It encourages fruits and vegetables, whole grains, and lean meats. I like that the hand out lists foods that are recommended and foods not recommended. I like to set goals with pt when counseling and I would want to see them 1-2 a month and set goals and asses goals at each meeting to track progress.
Stephanie,
I think that teaching them portion sizes would be one of the best things to teach these pt's. If they are obese they probably have no idea what a serving actually is. I think that teaching someone serving sizes is a good way to show them how much they have been eating vs. how much they actually need.
Considering the researched macronutrient distribution, I feel the myplate information would be appropriate for promoting lean protein, fiber, and healthy fats. The method itself already helps one reduce calorie intake by controlling for portion sizes and better choices.
I am interested to see what the study defined as low carb as we know it has many definitions. Molly and Jordan provide both excellent methods for teaching pts on healthy, low-fat diet education.
Molly, I like your idea of using the DASH diet. I think this is a well-rounded diet that would be beneficial to most everyone! I would probably use food models to get the patient to really grasp the idea of portion sizes and portion distortion because this is something so many people are unaware of. I would definetly use a brainstorming session with the patient to talk about how they are going to fit these changes into their lives. For instance, if they're going out to eat what types of foods will they chooose and how will they avoid the foods they might be tempted to have. I would also talk to them about altering their own recipes to fit the diet, such as using brown rice instead of white. That said, every client is different and each counseling session should be tailored to their needs.
Amanda-
I agree that MyPlate is a great starting tool to get individuals to eat a healthier and more balanced meal. As long as we counsel on portion sizes and low-fat protein and dairy and whole grains as an addition I think it would be a simple method for the client to incorporate into their lives.
Amanda-
I agree that MyPlate is a great starting tool to get individuals to eat a healthier and more balanced meal. As long as we counsel on portion sizes and low-fat protein and dairy and whole grains as an addition I think it would be a simple method for the client to incorporate into their lives.
Brooke-
A food diary is a wonderful way to get patients to be accountable for what they are eating. So often people have a little bite or snack here and there and don't really think about how everything adds up!
Because weight loss is so beneficial for NAFLD treatment, I would recommend calorie restriction at a level that will create weight loss of 1-2 lb/week for an overweight/obese individual. Recommending a patient consume a diet of low CHO and saturated fat, with high amounts of lean protein, fiber and omega-3's will both aid in their calorie restriction and intensify their disease treatment. Two strategies I might use would be goal-setting and menu planning.
Stephanie, I think it's a good point that educating a patient on label reading and serving sizes go hand in hand. Tiffany, I also agree that it would depend on the patient and their level of readiness. Educating them at a level they are comfortable with would be much more effective than overwhelming them with information.
I would go with what the article recommended with low carb, lean pro, high fiber and omega-3 foods. To do this I would recommend the diabetic exchange list for easy calculations of calories and carb control. I would teach them how to read labels to ensure proper fiber and fat type intake. I would also recommend an omega-3 supplement as well to ensure that they are receiving enough daily to be therapeutic.
Working at the Wellness Center I have really bought into the three step approach to weight loss, which is exactly what the "lifestyle" group in this study experienced. While I think the plate method and serving size are nice, this is a process and not a one-time, one-on-one diet counseling session. Once the patient was aware of this process I would discuss portions/portion control and provide tips to be more physically activity and address mindless and/or emotional eating. If my facility was fortunate to have counseling and exercise specialists associated with it I would refer the client to them, otherwise I would make a referral to outside professionals.
I would recommend using the DASH diet with NAFLD or NASH patients because they often display signs of metabolic syndrome including dyslipidemia, central obesity, hypertension, and insulin resistance. Excess body weight also seems to be a common factor as well. I would educate them about the importance of incorporating fruits, veggies, whole grains into this diet and how these foods can make a difference in their condition.
Stephanie-
I agree that educating patients about portion sizes is key. A new diet cannot be appropriately adopted unless individuals know what to eat and how much is appropriate.
I think a general, healthful diet that is lower in fat, especially saturated fat, would benefit NAFLD and NASH patients based on the evidence presented in the article. Some patients may have success with a Mediterranean diet. MyPlate and food models may be a good place to start when counseling to demonstrate portion sizes and to discuss incorporating lean protein, fruits, vegetables, and sources of omega 3 fatty acids into the diet. I also liked Brooke's idea of recommending the patient keep a food diary because this may help with long term weight loss goals.
I would discuss healthy weight loss and the importance of healthy gradual diet changes. I would make sure to use realisitc goal planning during the counseling session to make sure the client understands this is not a "diet" but a lifestyle change. I would also review label reading since a low cho and saturated fat diet and a high protein, fiber and omega 3 diet was shown to be beneficial.
Tiffany I agree with you that the patient's readiness for change really determines how the counseling session would develop. I agree that the plate method is a great visual for beginners for a healthy diet change!
The study claims that a diet low in CHO and saturated fat and higher in lean protein, fiber and omega 3’s is beneficial so I would want to discuss sources of these nutrients and help design some meal plans. I would want to discuss how to read food labels, how to record food diaries and how to operate MyPlate. Food logs and MyPlate are great ways for people to be aware of what they are consuming. I think that a calorie range and an activity plan should be personalized for the pt also.
This is sort of a restatement of an earlier post on another question but my focus would be to make it manageable for the patient. Start slow with a 25% caloric restriction and gradually work up to 35-40% restriction. I would try to focus on making healthy choices rather than on restrictions (no-foods) in the diet. For example, encourage eating whole grains and lean proteins instead of avoiding the cupcake. Psychologically, it is easier to focus on what the body needs to heal itself than on what you are forbidden from having. I would also start slow with an exercise routine that is appropriate for their abilities and work up to more rigorous exercise.
I was waiting for this article to say something about fructose but it never did. Current research is showing that high levels of fructose consumption is a major contributing factor in the development of NAFLD. I would definitely educate my clients to read labels and avoid corn syrups when possible, along with a general sugar restriction. For anyone interested: http://onlinelibrary.wiley.com/doi/10.1002/hep.23535/full
I would want to keep the intervention and education as simple as possible. The disease itself is so complicated, these patients are likely already overwhelmed. I would tell them to focus on whole foods, namely fresh fruits and vegetables. Limit refined products, especially sugars and oils. Perhaps visiting a grocery store together would be helpful, if time allowed. I would give them a calorie range to stick to (probably more generous than that discussed in question one) and help them develop an exercise regimen. I would direct them to MyPlate to make their nutrition intervention more independent. Being able to look up a food in a database and see exactly how it measures up empowers the patient.
Tiffany,
You are absolutely right about everyone being at a different place. What works for one patient may not work for the other. I also like how you mentioned that you would use different education tools throughout your experience with the patient. I think this is important. It is great to use multiple tools, but the key is to not use them all at once so the patient isn't overwhelmed, and to introduce them at appropriate times.
As many have commented, the approach to take when counseling a patient with NAFLD or NASH would be dependent upon the individual patient and their level of knowledge and motivation. I think the DASH diet would be helpful in meeting the recommended nutrient goals, and MyPlate is a simple reference for the patient to use when building their meals. It is likely that the changes patients need to make will be drastic to the way they are used to eating. I would look to the patient to choose incremental goals they feel are achievable.
Technology can be a great tool for those who are savvy. There are an abundance of smart phone apps that serve as a diet record and activity log. Their interactive nature can assist patients in making wise decisions by allowing them to see the nutrient content foods, track physical activity, and set and monitor goals.
I think that a gradual weight loss diet would be beneficial to patients with these diseases. Meeting with them and discussing important "healthy eating" topics would be the first step to helping them change their lifestyle. I would also recommend becoming more active throughout their day and exercising throughout the week. Food models would definitely be helpful with these patients because portion sizes are so large that most people simply don't know how much they should be eating. Also, a food record would help patients to see what they are consuming and what they might need to change about their dietary habits.
Molly, I agree with the DASH diet idea. This does seem to be a successful plan for those who follow it and it also seems fairly easy to stick to as well.
I would follow the articles findings and suggest diet-induced weight loss, promote physical activity, and an overall diet that is low in carbohydrates, low in saturated fat, and higher in lean protein, fiber, and omega 3 fatty acids. I would provide the patient with information on good sources of lean protein, fiber, and especially omega 3 fatty acids so they can make a smooth transition of these foods into their diet. Also, like others have said it would be important to help the patient learn about nutrition labeling in order to follow the advised diet. The severity of each individual’s disease will affect how intense the diet and weight loss strategy will be.
Amy, thanks for sharing the information about fructose. I read the abstract for the article you posted and it was very interesting. Good find!
Molly,
I really liked your idea for the DASH diet. I feel it is so versatile and promotes a generally healthy diet. I also couldn’t agree with you more about how the changes need to be slow and steady. It is hard for people to drastically change their lifestyle but if the changes are gradual the patients are more likely to stick to them.
Molly-
I think using the DASH diet would be a great idea. It is a great way to help emphasize portion sizes, eating a variety of foods and getting the right amount of nutrients, along with improving health and lowering blood pressure. This would be a good option for anyone, especially those with NAFLD.
Stephanie, Brooke, Ali, et al. who mentioned food models. I agree that given the weight status of these individual there is probably a bit of 'portion distortion'. Food models would be a good tool to use to demonstrate appropriate portion sizes.
Taylor,
I agree with your point of directing patients to whole foods would simplify food choices as they begin to learn a new way of eating. Even though I know how to read food labels, sometimes I think it's easier to grab an apple and some peanut butter than spend 5 minutes deciphering the nutrient content and ingredients of snack foods. As the print I just hung in my kitchen says... "Eat Real Food".
Angela,
I agree with the idea to use technology for those who are savvy. My father currently uses an app on his smart phone that helps him track calories he is taking it. He isn't that savvy but he really enjoys being more conscious of what he is consuming. I think depending on the reliability of the app and the information they provide this could be a great tool to help the public stick to a healthy diet. At Health Promotion and Wellness we are doing a livehealthy challenge that requires tracking your physical activity and diet. I have notice that it has helped me realize what I am eating and how much activity I am getting so I can thoroughly access my progress to reach my goals.
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