Diabetes and weight management

For me week 7 was spent in the type 1 diabetes (DM) clinic. I’ll be honest, DM is not my favorite topic and although a complex disease, it just doesn’t spark my interest. We also learn a lot about DM in school so I went in feeling very confident in my DM knowledge. Through my studies the focus has been predominately on the management and prevention of Type 2 DM, so being in a clinic where children are diagnosed with, and required to manage, a serious disease gave me a new perspective. 

I sat in on two different types of classes this week. One was a class for those who have just been discharged from the hospital with a new diagnosis of Type 1 DM and the other is a two week follow-up that goes a little more in depth to disease management. Having both of these classes is really important as parents and kids can be really overwhelmed when they are first diagnosed. The follow-up classes allows more information to sink in and set the families up for success. Additionally, these patients are also followed closely in outpatient clinics. 

What I learned most from these classes had nothing to do with DM management, because this feels like second nature to me now. But it really opened my eyes to the lack of basic nutrition understanding most people have. Almost everyday I think about the macronutrients: protein, carbs, and fat and what types of foods and nutrients my body needs to be successful. It’s second nature to me now. I forgot how ignorant I used to be on the subject, this is not something you learn about in high school, you may learn about the food groups but not the nutrients your body uses, I have to remember the hours I have dedicated to reading and researching food and nutrition that got me to where I am today. Now, I wasn’t expecting everyone understand the physiology of digestion and how eat nutrient affects our bodies, after all, that’s why I hope to have a job as a dietitian. However, I was not expecting to stumble across an adult that didn’t know the difference between a protein and a carb.

In this instance, I had to stifle a laugh because, like I said, I had forgotten how little nutrition is discussed outside of the walls that house my life. As a practitioner, I have learned that you always need to start with the basics, unless the client has a proven baseline knowledge. Making assumptions can seem condescending and does nothing for patient care. 

My biggest take away as I left the clinic is the importance of meeting people where they are at, and the affirmation that there are people who need the help of dietitians in the most basic way.

As I moved into week eight, I felt like I was really starting to get the hang of all this dietitian stuff. This week was spent in a children’s weight management clinic, and I thought this would be simple. After all, when you think of what a dietitian does it mainly revolves around maintaining a healthy weight. This week was not simple at all and I actually did a lot of shadowing this week.

The first and last days were spend with kids who overweight based on CDC growth charts but had no other comordidities. The challenge  with this population is dealing with parents. Children rarely have control over what they put into their bodies and when they do it’s normally the result of picky eating and parents not wanting to have a battle over food every day. So the first challenge we have is getting children to understand that they need to change their eating habits for a better quality of life later on down the line, to do this they may be eating things that are different than their friends which adds to the complexity. The second challenge is getting the parents to one, hold their child accountable for making healthy choices, two,  providing foods that are recommended, and three, changing their lifestyle and the habits of the family to support their child in need.

The counseling that comes along with this usually revolves around using the stop light approach. In the approach, fruits and vegetables can be freely consumed, yellow foods, which are not clearly defined, but contain the grains and protein food groups are to be consumed “less often,” and the red foods should be regulated to no more than 7 servings per week and no more than 2 servings per day. The red foods are what we think of as typical junk food or sweets. 

The rest of the week was spent with kids who were metabolically complex. This means that they have been in the regular weight management program and have participated in additional programs but are unable to loose the weight, and they also have other metabolic issues like sever insulin resistance or altered hormone levels. These children need more than just nutrition, many need medications to help manage their conditions and it can also be difficult to find out what is causing the elevated weight and what the remedy is. 
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This week really showed me that weight management is not as simple as eat less “bad” food,  eat more “good” food, and exercise more. Weight is not something that should define a person and those with increased weight do not always have control of their condition. This idea can be applied to all situations, reserve your judgments because we often can see what’s going on inside a person, metabolically or emotionally.