An expert discusses food choice, nutritional deficiencies, and eating healthy

Patient food choices can be influenced by more than just whatever is in the refrigerator or the pantry right now.

Primary care physicians and clinicians are addressing more than just patients in the exam room, and there’s greater recognition that patient health affected by social drivers of health outside the doctor’s office. Those include hunger and availability of healthy foods.

March is National Nutrition Month and features World Obesity Day. Lauri Wright, PhD, RDN, LDN, FAND, president of the Academy of Nutrition and Dietetics, spoke with Medical Economics about the interconnections among patient health, food and nutrition, and primary care. This transcript has been edited for length and clarity.

Medical Economics: What are some common dietary deficiencies or imbalances that primary care physicians should be aware of when assessing patient health?

Lauri Wright, PhD, RDN, LDN, FAND: Most are familiar with some of the dietary imbalances or excesses – excesses in calories, excesses in fat, sodium, sugar. And so that's the big imbalance that most physicians are aware of. But even a normal weight or an obese patient can be deficient in vitamins and minerals. Iron deficiency, folic acid, calcium and vitamin B-12, especially as we age, those are common. And they can be due to a poor diet, they can even be from certain medication interactions. In addition to vitamin or mineral deficiencies, the typical American diet is not very high in fiber and even water, fluid. Many, many people are chronically underhydrated. What I always say is, don't just look at the person and judge, oh, they're obese, they probably have no deficiencies. In fact, we're seeing more and more through physical exams, that there are vitamin and mineral deficiencies and that obesity doesn't preclude that from occurring.

Medical Economics: How can primary care physicians navigate the cultural and socioeconomic factors that may influence patients’ dietary choices, and sometimes the social access or economic access to nutritious foods?

Lauri Wright, PhD, RDN, LDN, FAND: This is such a challenge for all of us in health care, but it's so necessary to recognize this in order for a patient to be successful. There is a higher prevalence of obesity and the diet-related illnesses like heart disease and diabetes among those that are food insecure. And from a primary care physician standpoint, I think one of the most important things to do is screen for those, that food security level. So just using the hunger vital, it's just two questions about having enough access to food, but that vital has been shown to positively improve care by identifying food insecurity. And then if you identify that a patient does seem to have some food security issues, ensuring that the staff is educated on food programs so that they know where to refer for the patient to get Meals on Wheels if they're an older adult, the SNAP, or the old food stamp program, for a mom, the WIC program. So, knowing if staff is educated on those referrals, what programs they can be referred to. And then finally, again, having a consultant dietitian that can really individualize a diet plan and the resources for that patient so that they can meet our health goals.

Medical Economics: If a physician wants to reach out and find a registered dietitian, how do they do that?

Lauri Wright, PhD, RDN, LDN, FAND: The Academy actually has Find a Nutrition Expert, a database that you can put in your area of the country and maybe what kind of conditions that you want your patients to be seen for, and be connected with dietitians that can do that. And also our reach has increased so much with telemedicine and so, we have more and more dietitians that are going into or providing services through telemedicine and so that really increases access to care because we do know in some of the rural areas, there aren't many physicians and there aren't many dietitians either. And so the telehealth aspect is really helping increase access.

Medical Economics: Our physician readers are consumers too. What nutritional advice do you have for physicians who are trying to eat on the go as they manage an incredibly busy work life and family life?

Lauri Wright, PhD, RDN, LDN, FAND: It may seem difficult or impossible to eat healthy when you have such a busy schedule but it is possible. We encourage thinking plant-forward, so a plate that is heavier on the fruits and vegetables and the whole grains, incorporating the lean meats, healthy fats such as fish. If it sounds familiar, it's very much like the Mediterranean lifestyle, the beautiful fruits and vegetables and the ancient grains, the fish and the olive oil. It's a lifestyle, it's something to move towards. You can't do it all overnight. It's baby steps, kind of thinking about, what are your top one or two issues in your diet? I'm too busy to grab breakfast so the nurses brought in doughnuts so I ended up doing that. So maybe planning ahead and doing some overnight oats so that you can easily grab those as you're running out the door and then you're not set up to eat the doughnuts. Looking at one or two things that might help you live a healthier lifestyle, and then making those small changes. And you can always work with a registered dietician, we'll help you do that.