October 4, 2023
PAF Nutrition Outreach Fellows Share Their Advice
December 22, 2022
Holidays can be challenging for those who want to maintain their weight. Don’t let available holiday treats detract from overall healthy eating goals – yours or your patients!
AAPA asked several of the previous PA Foundation’s Nutrition Outreach Fellows to share their best tips and tactics for themselves or for patients including those with type 2 diabetes. They participated in virtual training that prepared them to deliver nutrition education to community groups and healthcare peers. Training focused on the role of nutrition in overall health, management of type 2 diabetes, healthy aging and Enhanced Recovery After Surgery.
Here is the best holiday eating advice from Karey Davis, PA-C, New Castle, Indiana; Nicole Fox, PA-C, Moab, Utah; and Stephen Cohen, MD, PA-C, Miami, Florida.
How do you generally counsel patients to manage holiday eating opportunities?
Davis: I advise patients to enjoy foods in moderation. I never tell a patient they cannot ever eat something they enjoy, or it seems they desire to overeat it. I never talk about “good foods” or “bad foods” but more about “sometimes foods” and “all the time foods.” For example, “sometimes foods” include processed foods with little nutritional benefit, sugary foods, desserts, high calorie drinks, and foods that contain empty calories. “All the time foods” include fruits, vegetables, whole grains, and lean meats/dairy.
Fox: I remind patients that what you put in your glass is also as important as what you put on your plate! If you are thirsty, you are more likely to interpret your thirst as hunger. Drink plenty of water before and during holiday meals and try to limit the number and amount of caloric beverages (sodas, wine, beer, eggnog) or substitute for calorie-free options (such as flavored seltzer water). If a special holiday drink is an important part of your celebration, try to limit yourself to one beverage followed by plenty of water.
Cohen: A beneficial technique is eating slower. That can help so you’ll “feel full” quicker and ingest less food. Being aware of that full feeling is a target signal to your brain that you are ready to stop eating. This brings the feeling of fullness into clear perception as you eat and prevents over-eating.
How do you recommend patients manage their diets while making meals and serving other family members who may not have the same priorities?
Cohen: Make it a family affair. Have the conversation about creating healthy food choices for holiday meals and snacks. Recruit family members to help relatives make better choices, support healthy foods in the home and create imaginative, tasty dishes for holiday meals. It’s amazing how creative family members can be if they work together toward improved health. In the end it’s about replacing the most unhealth food choices with better choices…out of sight, out of mind.
Fox: There are so many healthy, new ways to prepare old holiday favorites! Resources like Pinterest are filled with options for sugar-free dishes, low-carb substitutes, and low-fat alternatives. For example, consider making your favorite dip with plain yogurt instead of cream cheese, or making crust-less fruit cobbler for dessert.
If patients do gain weight over the holidays, is the old advice “eat less, exercise more” still something you share with patients? If not, what do you advise?
Davis: It is important to keep a food journal or log food consumed on an app to track total calories if weight loss is a goal. It is also very important to have an accountability partner or someone you can talk to for encouragement, advice and motivation!
Fox: Though weight gain is a bit more complicated than calories in, calories out, our bodies generally try to stay close to a certain weight. If we end the holiday season weighing more than we did at the beginning of Thanksgiving, starting the new year eating healthfully and increasing exercise is an important step to return to baseline. Losing that weight is possible, and it’s important to use the extra pounds as motivation rather than a sense of defeat or guilt.
Cohen: The new slogan should be “Eat less of the bad stuff, eat more of the good…and keep moving”. The focus of food is better served shifting to higher protein and fiber from vegetables and fruits to feel “full” more quickly and reduce the need to eat more of other foods. Round out food choices with healthy fats and carbs for energy with the idea to feel full on better food choices.
Intermittent fasting seems to be a current trend. Is this something you would recommend to keep weight in check?
Cohen: Yes, there is growing evidence that eating within windows of time can benefit weight management and glucose control. All intermittent fasting is essentially a new face on calorie reduction over 24 hours and shifting the body from burning carbohydrates for fuel to using stores of fat in the body.
Fox: I think intermittent fasting shows good promise as a tool to lose weight. If you can continue a normal healthy diet during feeding windows or after a fast, the missed calories in those meals (and the snacks in between!) can help to decrease total daily caloric intake. A recent review article in NEJM highlighted several promising studies, which showed intermittent fasting may also improve several biochemical changes associated with metabolic syndrome (such as hyperlipidemia, hyperglycemia, and insulin resistance).
What online resources do you recommend to patients for managing their food intake and getting regular exercise?
Fox: One of my all-time favorite articles about common mistakes that people make while trying to lose or maintain weight can be found on dailyburn.com. For websites, I suggest Eatright.org. For patients with type 2 diabetes, healthy eating tips on the CDC website. For exercise suggestions, two articles on Health.gov: Adult Fitness, and Move Your Way.
Davis: I love My Fitness Pal – an app which can be used on your phone and is very user friendly. It’s free and tracks Macros, calories, water intake and activity level. My Diet Coach & My Plate Calorie Counter are two more apps that are great to use. For quick and healthy recipes, I like Pinterest. Another great resource I use is Tosca Reno – she has multiple books written on healthy living, clean eating and wonderful recipes.
What is your advice for helping patients with type 2 diabetes manage to satisfy holiday cravings while managing their glucose levels?
Davis: I believe this depends on each individual patient, their age, activity level and how well their diabetes is controlled. I would recommend monitoring their blood sugar closely, especially with increased food intake and typically increased sugar intake from desserts.
Fox: My advice for patients with type 2 diabetes is really the same for everyone: Moderation is key. Enjoy smaller portions of favorite dishes with a lot of carbohydrates and sugar, and try to avoid taking seconds and thirds of foods that are known to spike blood sugar (sugary desserts, processed breads, sweetened beverages, alcoholic beverages).
How do you recommend patients with type 2 diabetes manage their diets while making meals and serving other family members who may not have the same needs?
Davis: Each patient is unique and if they are educated on their own chronic conditions, they are more apt to take care of themselves. I would recommend they offer to prepare some of the meal so they can prepare a few dishes they are able to eat more of. I prepare the salad and a side dish for our family gatherings so I know I have healthy options to choose from if there are not many dishes I would typically eat myself.
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This article was originally published in December of 2020.
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2020 Nutrition Outreach Fellows by the PA Foundation