Question 1
What are some strategies that you might use to help a
patient who consumes a large quantity of SSBs?
posted by Unknown @ 8:33 PM
16 comments
ISU Dietetic Internship Journal Club
Objective: To become familiar with current scientific literature on a variety of nutrition topics and to gain experience in gathering, organizing, critically evaluating, presenting and facilitating group discussion of the literature and the implications to practice.
16 Comments:
I would first understand why the patient enjoy these SSBs so much, is it the taste, the carbonation, the sweetness, or convenience? Then I can incorporate the reasons why they frequently consume SSBs to find other alternatives. Perhaps the patient does not like to drink water because they don't like the taste of it. Then I would suggest them to try adding real fruits (e.g. lemon wedges, berries, orange wedge, etc.) to give it a sweetened taste and something different without all the calories.
Essentially, I would work with my patient to find out what alternatives work for them to help decrease their consumption of SSBs. I would also suggest slowly weaning them off SSBs since suddenly cutting all SSBs out may make the patient feel deprived or frustrated. We can work slowly towards reducing their intake and finding healthier, lower-calorie alternatives (preferably water!).
I actually encountered a consumer at the Hy-Vee store during my rotation whom was asking the RD to find alternatives to help her give up her diet coke because her family insisted on it. She sounded very shaken, frustrated, and close to tears as she described her addiction. After observing and interacting with the customer, it helped me understand how difficult it could be for individuals to give up their favorite drinks even if they are blasted with calories and sugar.
One of my biggest approaches to reduce SSB consumption would be based on the environment in which the SSBs were consumed. If SSBs are readily available in the home, I would encourage the client to purchase alternative beverages to have ready access to. This limit in availability and accessibility would likely decrease SSB consumption and increase consumption of more healthful alternatives. As always, I would encourage the client to have a water bottle with them at all times to sip on as needed - By always having this option available, the effort in drinking water would be decreased while the effort in purchasing/finding other SSBs would be increased.
I know personally that for my family, SSBs are most tempting when going out to eat. I would discuss other alternatives with my client such as unsweetened tea or water. I would also discuss the option of only having one glass of SSB, but not allowing for unlimited refills. This would hopefully provide the sensory experience that the client was wanting, but create portion control.
In agreement with Vivian, I know it would be extremely difficult to totally eliminate all SSBs at one time. This would rely on gradual changes to alter taste preferences and allow the client to try new alternatives.
I know that people have habitual drinking patterns, but as we know the body does not register the calories that we consume from beverages. I thought the supplementary article was very insightful in determining the most effective method of advertising the number of kcals in a SSB. I certainly know that reading that I would have to walk 5 miles to burn off a beverage that I would drink in 30 minutes would certainly make me think twice!
The Diet Coke addiction is always of interest to me. I am glad you were able to observe and learn from this situation Vivian :) I think reliance on SSBs is a common problem that many people have tried to overcome, but experience great difficulty with. I think the generation of behavior change strategies to assist with this will certainly be beneficial to future clients. Working to change habits such as these requires collaboration with effective nutrition knowledge, counseling skills, and behavior modification procedures for long tern maintenance and success.
This can be a real struggle for some people. In addition to the obvious beverage qualities mentioned by Vivian, which make soda an appealing choice, the soda industry had done an effective job of positioning soda as a go to beverage. Limiting the advertising of soda at the policy level could be a powerful, but challenging strategy to employ. If searching for an alternative is your strategy, finding out precisely what quality of soda makes them crave it is important. If it’s the caffeine, maybe coffee will work. If it’s the flavor, maybe ASBs are a good option. If it’s the carbonation, flavored sparkling waters can sometimes work. For some people it’s just a habit. We have learned many times over, telling someone they can have something just makes them want it more.
A strategy that worked for me this past summer with someone who was consuming a lot of soda was first raising awareness. I discussed her calorie needs for the day and described where soda fit into that amount. After subtracting the soda from her calorie allotment, I asked how she felt about the number of calories she had left for food in the day to maintain weight. She looked and me and said, “not much.” She was not interested I diet soda, but she wanted the carbonation. I bought some flavors of sparkling water to try, and we found a few she considered acceptable. She still buys soda, but she also buys the sparkling water still, and she keeps some at work. She is down to 0-1 sodas a day, which is certainly a step in the right direction.
Many of the strategies that came to mind were similar to Jenn’s and Vivian’s. Baby steps are important. Creating meaning and concrete purpose for reducing consumption is also important. Over summer, weight management was this person’s concern; others may be interested in different outcomes. Quitting soda cold turkey can cause headaches (if caffeine is not replaced) and cravings. You have to meet your client in the middle and be understanding of the challenge they are facing. Not purchasing SSBs or even going down that aisle in the store would be ideal, but not everyone is willing to go that far. Only keeping a certain number of sodas in the fridge at a time can be another strategy. Making water more interesting is a strategy I just used on a bulletin board promoting hydration for my rotation. Infusing water is trending (infusedwaters.com has some pretty good looking recipes) flavorings like Mios and Crystal Light are options too.
I agree completely with all other fore mentioned strategies, I feel that a holistic approach to understanding the root of the issue for the patient and strategizing ways to decrease consumption is very important. There may be different factors at play for each individual person and it is important to find out what may work best for each individual based upon these potential factors.
I feel that gradually decreasing SSB consumption over time and introducing more nutritious alternative beverages while properly educating the patient throughout the process is one of the most effective strategies in my mind. An individual that consumes very large quantities of SSBs will more than likely not be willing to trade in or give up their favorite beverage entirely so I feel that this must be a slow but sure elimination process for the individual.
I also feel that controlling the environment and finding ways to limit access to these products would also be extremely effective. As Gina mentioned, not purchasing these products and having them in your home and not going down the SSB aisle at the grocery store would be ideal to eliminating temptations. Also ensuring that you have always have an alternative beverage on hand such as flavored water or other low calorie/more nutritious drink could help.
Helping your patient to find a way to utilize social support either from significant others, family, or friends would also be another great way to help them in reducing their SSB intake. Perhaps they might have a friend or co-worker in mind who is also interested in or in need of reducing their SSB intake and they could work towards their goal together. Social support can provide tremendous encouragement and reinforcement towards helping them to change their behaviors.
John - I think your idea of collaboration or partnering with a co-worker or friend is an important key with decreasing SSB consumption. If the social influences around a client continue to consume these temptations, it may be difficult to resist with repeated exposure. I always find that having an accountability partner when working to achieve goals is helpful and motivating. I think this would have a greatest effect in transforming not only one member of a family's SSB consumption, but every member of the family making a lifestyle change together.
I agree with what everyone is saying! I think it is a great idea to add real fruit to try to flavor their drinks to give it more enjoyable. Since I have never been a pop drinker, I need to listen to the client and understand what they are going through. Like Gina said, it needs to be baby steps. It is unrealistic to expect someone to completely cut out SSBs and drink only water. I would initially recommend, they should try to cut down the number of times they drink SSBs and then try to replace with water. It is also important to get the client to think twice before they purchase their SSBs. They need to be mentally ready to decrease or cut out SSBs otherwise they will not be able to do it even with the help of a RD.
I like how Jenn had mentioned in a response how restaurants should charge for refills, and I think this would be great for people who are consuming large amounts of SSBs. Many times at restaurants they continue to refill your cup, but then the consumer doesn’t know how much they actually drank or they feel obligated to continue to drink because they don’t want to leave a full glass behind. If the customer knows they will be charged for a refill and they are asked if they want a refill, they will have to think twice which could have an impact.
I agree with several of the previously mentioned strategies to reduce/eliminate SSB from the diet. I think that, as Vivian said, understanding why the client regularly consumes SSBs is first and foremost important to finding a corrective solution for the specific patient. Whether it is a bad habit, a dependence on caffeine, or simply for the taste preference, identifying the reasoning is important. Once identifying the reasoning, educating the patient on the consequences of drinking SSBs in excess is important so they are aware of what they are doing to their body. As Gina mentioned, gradually reducing the amount consumed is key for success, because setting the bar too high with unrealistic expectations won't work for a person with an everyday habit. I would suggest that for the first week, they substitute every other SSB they usually consume with water to reduce the amount consumed in half. Gradually from there, they could further reduce the amount of SSBs each day. I also like John's approach of finding a support group such as a good friend, a boyfriend/girlfriend/spouse, or a coworker to motivate you to stay on track to eliminating SSBs from the diet.
Thus far, the flow of the discussion seems to be that everyone is in agreement that baby steps are key. Just like any other addiction, eliminating that aspect of your life is no easy task. Vivan also brings up an important point of speaking with the client and understanding the component of the SSB that the client is drawn to. Even if you yourself are not a soda drinker (as Abby mentions), it is important to listen to your client to understand where they are coming from. Gina also points to the importance of helping the client to find meaning in the changes they are implementing and then Steph discusses the importance of educating the client about the consequences of overconsumption of SSBs. The combination of these two strategies should help the client understand why it is in their best interest to work towards eliminating SSBs from their diet. Jenn also brings up the interesting point about availability and accessibility. Finding ways to change your environment may help reduce the temptation. I also thought John brought up an excellent idea of seeking social support. I think we can all agree that changes are easier when we have a support system and people to encourage us with any journey in life.
Excellent discussion!
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The social support idea definitely works John. The person I mentioned in my previous post who was able to find a flavored sparkling water substitute took them to work with her and now shes got a co-worker on the cherry-lime La Croix too. This was an ideal situation because the co-worker has type 2 diabetes so the benefit of opening one persons horizons to alternative options positively the life of another. Word of mouth about a new beverage option can expand the reach of our work. It is also important to be supportive and encourage our patients along the way. One thing I'm learning is to keep your eye on the long term prize, but do remember to celebrate every small win along the way. Recognizing the effort patients put is in key to keeping them moving forward toward the ultimate goal and it keeps them coming back.
SSBs are a real challenge for many people. I know personally I love a coke once in a while, but being a nutrition student I realize I have to do this in moderation as opposed to the general public who tends to drink soda and sugary drinks to excess. Obviously strategies for reducing SSBs are going to vary based on the individual client's needs and lifestyle habits. I think a good place to start would be encouraging the client to simply cut back. For example, if the client had 3 sodas a day cutting back to two sodas a day and then the next week trying to cut back to one soda a day. Slowly removing the product from a client's life is sometimes more manageable than simply taking it away and replacing it with alternatives. I also suggest that if your client is a big SSBs drinker that you don't eliminate the SSBs completely because that can cause the client to crave it more and might lead to a binge of SSBs.
Viv made a great point that it is important to first understand why the patient enjoys the SSBs so much. Some times as nutrition professionals we forget to listen to why a food or drink is so appealing to a consumer and instead try to quickly advert the client from consuming the beverages. By listening to our clients we might find another deep meaning or a better way to approach the clients overconsumption of SSBs.
Jenn, my family has trouble with SSBs at restaurants as well. I try to have water before the meal comes and then I order a soda when my meal comes so that I only have one glass rather than 2 or 3 as we wait for the food to arrive.
When working with a client who consumes large amounts of SSBs I would first gather information on the specific beverage they like, is it soda, sugary juices, or energy drinks? From there I can suggest ways to reduce the intake. An example I used often when giving grocery store tours is to drink juice with 3 parts juice and 1 part water. Most juices are sweet enough that we don't recognize the change in sweetness with water.The approach I would take also really depends on the client and if they would be willing to switch to an artificially sweetened beverage. If they would be willing to do that I would enforce that change first and then try to increase water intake along with milk and 100% fruit juices.
I agree with Carly, one of the most important things to consider is cutting back and making realistic and individualized goals for your client.
I think that if I had a client who consumed a large amount of sugar sweetened beverages I would first want to know what "large" amount meant. After I actually knew a quantitative value for the amount of SSBs being consumed I would want to look at it as a part of the client's big dietary picture. Is SSB consumption this person's highest priority nutrition concern, or are there perhaps some more important issues to address? Assuming SSBs were the most important item on the list of nutrition related problems, I would want to work with the client to slowly decrease the SSB consumption (much like others on this thread have indiacted). I think having the client set his or her own goals would be a very important part of the behavior change process!
I like Sophie's idea about trying to substitute a mixture of juice and water as an alternative to SSBs. Perhaps they may even utilize sparkling water if the client really insists on having a carbonated drink. However, there are definitely healthier alternatives and baby steps to make towards reducing SSBs and hopefully eventually eliminating them.
I also think another compromise to make with a client who over-consumes SSBs may to be drink twice the amount of water they drink of soda. For example, if they want to drink a 12 oz can of Coke, then encourage them to drink at least 24 oz of water. I think that can increase their consumption of water and having more liquid in their body may help prevent them from drinking as much SSBs as they would without drinking water. I've learned that there are individuals who drink only soda/coffee and no water or maybe a cup of water at most in a day!!
This also makes me wonder though, what impact would successfully encouraging consumers to drink less/eliminate SSBs from their usual diet have on the economy? SSB industries are huge and employ many people, so I wonder if it is ever realistic to eliminate SSBs or reduce it drastically and could it hurt our economy?
Gina, I thought you made a very good point about celebrating the small victories. We often fixate on the end result. For example, when losing weight, people might say that their goal is to lose 50 lbs. However, it is easy to become discouraged along the way when you don’t celebrate those smaller achievements. Our goals aren’t reached over night, so why not enjoy the process?!
Carly also had a good idea for dining out. I think your idea of ordering water before the meal comes is a great idea. Just because we know that SSBs aren’t beneficial to our health doesn’t mean that we can’t have them every now and then, like when we dine out. This was a good strategy to help control over consuming them. I also liked Sophie’s example with drinking three parts juice and 1 part water to help dilute the drink. I had a coach who used to make a similar suggestion with drinking Gatorade to rehydrate.
I like that Jenn and Steph incorporated motivating factors into their responses. I think my knee jerk reaction when asked this question is to want to teach someone about the nutrition topic related to their situation (in this case, SSBs). I sometimes forget that you need to evaluate each client as an individual and work with them to build that motivation so that once they know the facts, they'll be more likely to make the change that they want to. Then we can celebrate the small successes along the way, right Gina?!
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