Question 3 - Vivian
What obstacles do you see if you were introduce digital photography and dietary recalls to assess your client’s energy intake for a week?
posted by Unknown @ 6:59 PM
14 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.
14 Comments:
I can certainly see an obstacle with training clients before use of the digital photography to ensure that they captured their food items at the correct distance and angles for best results in determining their intake.
I think the greatest battle with this method is the training for interpreting the intake and portion sizes based off of the pictures. The researchers had to go through numerous training periods to be able to estimate intake with less than 5% error, and not every individual will be able to interpret these photos with the same accuracy. Moving forward, I am interested to see if trained nutrition professionals will be the only persons to interpret the photos or if training can be completed to allow any person capturing the photos to estimate their intake accurately. I think the balance of burden between the researcher and the subject is a major point of discussion in this method moving forward.
I can see digital photography paired with dietary recalls as a very innovative and exciting method for younger generations - especially with high interest in food photography. For older populations, however, the use of technology may be a challenge.
I can certainly see a great use for this method with Alzheimer's patients and other patients with poor memories in recalling what they ate. The physical pictures would be highly useful in determining their overall intake.
I think that the biggest challenge of using digital photography for dietary recall is that not everyone has access to cameras. Although most people have their phones when working with a lower income individual this might be a concern. I also think that people in America have a very warped view of what are proper portions and therefore if the clients are not properly educated on what proper portion sizes are they may interpret their intake and portion sizes as normal or healthy when in reality their intake and portion sizes are much larger than recommended.
I also agree with Jenn that although technology is very appealing to the younger population I can see the older population having more difficulty with this type of recall. I think it will be important to talk to your client on what method they prefer (Digital or hand written food diaries.
I agree that first and foremost, the biggest issue will be the clients without access of digital photography or the knowledge of how to work it. However, it is definitely a step in a new and exciting direction, since majority of individuals do have the access and knowledge for this to work!
Another concern of mine is forgetting to use it or choosing not to count every intake. It would be fairly easy to remember at majority of meals to snap a picture, however snacks and on-the-go meals would be more challenging. Also, calorie-consuming beverages may be forgotten or left out and this would mislead the RD while figuring the patient's average intake.
Steph brings up a GREAT point regarding calorie-containing beverages and snacks. Many times when we are on the go, we don't feel like we have to time sit down and eat. Therefore we turn to convenience options that can be transported with us. If people feel like they cannot take time out of their day to stop and enjoy a meal, the idea of stopping to document this food with pictures - or even in a diary - is likely overwhelming and not a priority with all of the other stressors that must be dealt with throughout the day.
I think consumption of snacks may be a major weakness of dietary recalls overall - many times individuals do not have to go through a lot of preparation or thought when consuming snacks. Therefore, they are probably more likely to go unreported. This is really not an aspect that I considered before - I'm interested to see how others would combat intake of these caloric beverages and snacks between meals.
Jenn brought up a great point about interpretation of these photos. The photos in this study was interpreted using a software by the researchers. I suppose if this technology was to be available to the public, we would need to have a proper software to analyze the pictures rather than have people guestimate. So as a future RD, would you like to use digital photography in addition to dietary recall (to capture those snacks and beverages not included in the pictures) with your clients?
Great points about not being able to cater to low-income families. What situations or type of clients do you think would benefit the most from utilizing this technology?
One concern I have in my mind is that digital food photography to analyze a person's meal may begin an obsession with calorie intake, which can be damaging for someone with disordered eating patterns. Any thoughts?
I would be concerned about theft and damage, but that is likely just me. It would be very costly from that perspective in that you not only have to furnish these digital cameras, you have to pay for adequate security measures, and pay for maintenance/repair. I could see it working in some settings with higher end clientele, but there may be a lot of barriers to implementation for those serving a low income patient population (think poverty and obesity connections) which is likely on the governments tab or unable to afford the appointment in the first place.
Implementation barriers aside, I agree with those who pointed out the "fun" aspect of it. If we can make something fun rather than make it feel like were grilling them on their diet failings of the week (despite our best attempts to convey that we are not judging) of course people would be more likely to take an active role in recording their intake. The new technology aspect is always a draw in for a young client base. This brings me to another concern. What about an older client base who may be unfamiliar or uncomfortable with the technology? It may seem ridiculous, but I ran into someone just yesterday who said they don't know how to work a computer. It blew my mind and gave me a serious reality check, all in about 5 seconds. You might not get accurate images and records if the person can't properly operate the camera.
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I agree with what Carly and Steph had to say about limited access to low income populations. This would be a very large obstacle to overcome if planning to establish this type of dietary recall method, especially when considering your population. I also agree with Gina on her points; I think that you would almost have to have several of these specified cameras on hand for people to borrow/rent and then you have to factor in the cost/maintenance and potential for accidental damage, which could be problematic.
Another obstacle that I could see is how would you accurately estimate energy intake at home if your clients are preparing meals there and using different recipes or not following a recipe at all? It's much easier to obtain an accurate DP + R with using the food service cafeteria which already has established recipes and accurate nutritional information. You could of course still use estimates based off standardized recipes but I feel that this would not be very accurate.
I think Steph makes a great point that having access to the technology would limit who could use this, and Jenn and Carly mentioned that people who are not tech savy would also struggle using this technology. I think that using digital photograph for dietary recall assessment would be appealing to younger generations, but I think it could only work for a short term. If people had to do this for over a couple weeks I think they would get bored of it and find it too much of a hassle. To remember to take pictures of meals and snacks throughout the day may get difficult. I think I would start eating my meal and then remember to take a picture of it, so that wouldn’t make it as accurate.
Abby brings up a great point about the length of success rate for this type of diet log. I agree that people would get bored and see it as a hassle to have to always take pictures of their foods. The good news is that food logs are usually only short term in order to determine the problem areas in someones diet and therefore maybe the length of time people would have to take pictures of their food for their log would not be that great in length thus making long term adherence to the log unnecessary.
One concern I would have would be making sure my clients know how to operate the technology and ensuring the program was user friendly. I also think that my client would come across instances where it was not appropriate to take a picture of their food forcing them to have to remember to record their intake at another time. This could cause issues with the client having food records in multiple places possibly causing confusion.
I think one obstacle that I might encounter is getting my clients to take pictures of everything they eat…that might not include even those little bites of food we sneak in each day. Steph talks about this in her discussion as well. I was recently reading the book “Mindless Eating” by Brian Wansink and he discussed several times throughout the book about how even those extra little bites or pieces of candy we sneak throughout the day can result in weight gain throughout the year. If we, as dietitians, were not aware of those extra foods eaten, we might not be able to accurately identify the reason for weight gain or a halt to weight loss.
Another obstacle I might foresee is being able to actually interpret the amount of food eaten from a picture. Perhaps the client uses a large plate and so it might look like they are eating a small amount of food if it is not full. Or vice versa. I agree with Jenn’s point about the interpreting of intake and portion sizes to be a challenge.
I agree with Sophie's observation that ensuring clients knew how to operate the technology could be an obstacle to successful implementation. The older adult population specifically comes to mind (as mentioned by Jenn and Abby). I feel as though using technologically advanced methods of dietary monitoring could possibly exclude a large population of people who don't want to learn how to use it from receiving nutritional counseling and other services if digital pictures were to become the industry standard.
I think another obstacle would be actually getting people to comply and record their food (even in picture form). I feel like mindless eating and eating on the go could really hamper this method's success as a few of the other interns have mentioned.
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