Question 2 - Carly
In the
HBI study the people who had low HBI scores typically did not consume enough
water, consumed to many calories from beverages, or did not meet daily fluid
requirement recommendations. What would you suggest clients with a low HBI
score do to improve their HBI score?
posted by Unknown @ 11:01 AM
12 comments
12 Comments:
Overall, the trend for these low HBI scores are seemingly linked to low consumption of beverages. These three criteria associated with low HBI scores comprise 75% (3 of 4) categories that attribute greater than 15 points to the HBI score.
If individuals who were under their daily fluid requirement filled their deficit with only water, I am curious how positively affected their HBI score would be. This one change in behavior could provide points in two different HBI categories - 15 for water comprising at least 20% of fluid requirements and 20 for meeting fluid requirements. This could add a maximum of 35 points to an individuals score! If an intervention were implemented to enforce this single change, I would assume that significantly higher HBI scores would result.
The index is highly flexible and allows for various combinations of beverage intake to attribute to high, healthy scores. The proposed intervention, however, would likely be a single behavior modification to improve scores. I would challenge my clients to start by increasing their water intake by one glass per day and gradually increase this goal until fluid requirements were met.
When helping a person with a low HBI score, I would want to look at what the factor is that is making the HBI score low. Is it because the person in not consuming enough water? Or is it because they are consuming too many calories from beverages? Or are they simply not meeting the daily fluid requirement recommendations? Knowing this information would help me taylor my strategy to help meet the client's needs. If the person is not consuming enough water, I would discuss strategies to improve their water intake. They might consider trying flavor infused water or using the Mio type water flavors to help promote water intake. If they are consuming too many calories from beverages, i would try to figure out what beverages those calories are coming from and come up with alternatives that would hopefully still satisfy the client. Hopefully asking the client questions would help me best know how to to focus my advice to improve their HBI score.
I agree with Amanda that finding out the reasoning behind the low HBI score for this specific client is the first and foremost important detail before beginning to counsel the patient. Interviewing the client right from the start and collecting a beverage recall would be a good start. Asking how many times they drink a beverage throughout a typical day and how much fluid is in each of those drinks to obtain data about their overall beverage consumption. For a client who is not consuming enough fluids in general and not meeting the daily fluid requirements, I would encourage them to try new healthy beverages such as a low fat milk, 100% fruit juice, a sugar free lemonade, or simply water and encourage them to set a goal to drink a glass each time they eat as well as carry a water bottle to consume more fluids throughout the day. If the client was consuming too many calories from beverages, similar to the previous question's answer, I would educate them on reading labels on beverages to determine if the beverage is nutrient dense and worth the calories (low fat milk or 100% juice) or if the beverage is simply a sugar sweetened beverage. Hopefully identifying one of these three components as a contributor to a low HBI score and helping the patient to change their habits will increase their HBI score.
I certainly agree that the intervention should be tailored to the specific needs and challenges faced by the client. There are MANY ways that modifications could be made to improve an individual's HBI score. I love all of the ideas that we are generating to improve HBI scores - I think that many individuals feel like their fluid intake is very monotonous, but there are many ways to incorporate variety while still consuming healthy and hydrating beverages.
One disadvantage that I think we face with the HBI score is that intake of fluids and beverages is typically the most under-reported on dietary recalls. Even for myself, I am not always very aware of how many water bottles or volumes of other beverages I consume in one day. I am curious if this factor played a significant role in the resulting HBI scores.
I would focus on adding mostly water with some nutrient dense beverages a little at a time. Number one, having a water bottle (flavors drops can help) to reduce the access barrier. From there, I look at it like the “just one more” concept. Do what you think you can, then push yourself to take that one extra step further. I would encourage a beverage diary for awareness raising and tracking to see when and where the smaller shortfalls are occurring over the course of the day. Intake diaries are very valuable for revealing opportunities to improve.
Another strategy I have come across is having a goal volume over the course of the day. That could be one large bottle with time marks to help pace consumption over the course of the day or knowing you need to consume X amount of water bottles in the day. Most people don’t think about the food they eat, and people really don’t think about if they are drinking enough fluids or not. Having the client bring in the diary and asking them where they think they could fit and extra four ounces or so could be a strategy to build up with. This is all assuming you have already established the benefits of appropriate fluid intake and have the buy in of the client to work on this.
I agree that it is important to assess the source of the low score as Amanda and Steph touched on to develop a full plan of intervention. When working with the bariatric patients at SPEC (DMH outpatient) this summer. I found the biggest barrier for fluid intake with clients to be volume. Post surgery these patients face extreme barriers to hydration due to the size of their new stomach. They must drink constantly to meet their needs. As part of their pre-surgery approval process, they have to be drinking at least 80 ounces of non-carbonated, non-sugar sweetened beverages daily. I think we could build with both of our approaches like a 1-2 punch. Focus on adding enough non SSBs to meet minimum requirements for fluids by adding mostly water, keeping at or below current SSB intake. Then work on reducing SSB intake to seal the deal for a better HBI.
Working on things in a step wise fashion may keep goals more realistic and prevent the client from becoming overwhelmed by trying to think about too many things at once. As mentioned above though, it is wise to always tailor to the clients level of motivation and challenges. Some people are ready to make big changes and achieve larger goals. Others have too much going on to do anything more than baby steps.
I liked Steph’s idea of incorporating taught knowledge of label reading to encourage clients to make educated decisions about beverage choices to improve their HBI score.
I do also agree with Jenn that fluid intake and beverages do often go unreported. In fact, I think we sometimes even forget to ask our patients about their fluid intake when we are performing 24-hour recalls. I am sure that I am guilty of this. I think this study will help me think more about talking about a person’s fluid intake in counseling sessions.
I think encouraging that client to drink more water would be beneficial because it would increase water consumption, it is a zero calorie option, and it would increase their overall fluid intake. Like Steph, Gina, Jenn, and Amanda have all said, we need to make sure to talk with our patients to identify any barriers and to plan what goals and strategies would work best for them. Sometimes it may work for them to set a timer to remind them to drink water, or it could be as easy as getting a new water bottle that they would be willing to carry around all day. I have also seen water bottles that keep track of how many cups of water you drank that day and how much more water you need to drink to reach your daily goal. I like Amanda’s suggestion of using a zero calorie water flavor such as Mio because that could encourage someone who doesn’t like the bland taste of water and there are many flavors and brands available.
I completely agree with Steph in that the first step to making any sort of HBI improvement would be to collect some sort of beverage recall. When it comes to making any sort of behavior change (dietary or other wise) I think awareness is key. How can you mindfully work towards a goal if you a.) aren't mindful (aren't aware) of your desired behavior or b.) aren't aware of your actual starting place.
I would like to piggy back on to the 1-2 punch approach Gina talked about. Gina you mentioned keeping a beverage diary or setting a volume goal and marking off on a water bottle as the day goes on. I think these are really great strategies. Another strategy I read about once somewhat combines these principles. One idea for clients (this would work especially well for ladies or any jewelry loving client) would be to divide the clients total fluid goal into smaller increments and have them use the position of bracelets to help them keep track of where they are at fluid wise. An example: If you were working with a client who's daily fluid goal was 64 oz. you could encourage them to break it down into four 16 oz. increments. You could have the client start off with four bracelets on their right wrist and as they finish each of their four 16 oz water bottles they could switch one of their bracelets over to their left wrist. By the end of the day each of the bracelets should be on their left wrist. Just a simple, out of the box idea that might get a client excited about working towards a fluid goal.
I believe one of the most effective ways to help a client better their HBI score would be to increase water intake. By increasing water consumption they are also increasing their overall fluid intake. From what I have observed water is often forgotten about and focusing on increasing water consumption could decrease sugary beverage consumption inadvertently. I agree with Abby about figuring out strategies that work for the individual, like she suggested a timer. Making realistic and achievable goals would also be crucial.
I definitely agree with Amanda's perspective on helping a client with a low HBI score. I would first want to find out exactly what the root of the problem is. The low score could be a reflection of many different things that are going on related to beverage intake. Once we understand exactly is causing the low score then we can determine the course of action. I also liked Amanda's idea about using flavored water as a way to increase the HBI score. That seems like one of the easiest options for people that are struggling to include water in their diet. In addition to products such as Mio or Crystal Light you could even suggest water-infuser pitchers to clients as a way to make water more exciting. Adding lemon, strawberries, or even cucumber to water can give it a much better taste profile and make it much more appealing.
It would have to depend on the individual assessment of the individual's habit that is attributing to the low HBI score. If they're not drinking enough water, I would suggest they slowly increase their water intake by trying to drink a cup of water for every sweetened beverage they drink and carry a water bottle around. If they were consuming too much calories from beverages, I would discuss with my client to see where and how we can reduce those calories. It's important to work on reducing it, not eliminating them. If the client is not meeting fluid requirements, I would suggest for them to carry a water bottle around and perhaps utilizing apps or other ways to remind themselves to drink a cup of water every hour or a specified time period. I think it would be wise to recommend clients to carry a water bottle around with them anyway though regardless of the area they may be lacking in.
Post a Comment
<< Home