By Denise Williams | News & Views
You hear it all the time: You have to meet people where they’re at.
Maybe the phrase is a bit cliché, but Julia Elliott, RD, LDN, wants you to understand how it applies to encouraging cardiopulmonary patients to eat well.
Before she went back to school to study nutrition, Elliott earned an undergraduate degree in psychology – chalk it up to a longtime desire to counsel others. Leaning on her previous training, she couldn’t wait to put her new learning to use. Currently a cardiac rehab clinical dietician at Emerson Hospital in Massachusetts, she remembers bursting with excitement as she started talking food with her first clients more than 20 years ago. Elliott had so many ideas and so much science to validate them…everything necessary, she thought, to work magic on any case that landed on her desk!
Although nothing could quell her love for the work, Elliott soon recognized that her enthusiasm wasn’t always matched by patients. So, over the years, she fine-tuned her idealistic coaching style into a more realistic approach.
And this is where that popular catch phrase comes in and nails it. “Where we, as clinicians, want the patient to be might be very different from where he or she is actually capable or willing to go,” Elliott concedes. The task, she suggests, then becomes to identify the right intersection of ideas and commitment to serve as the starting point for later, even more meaningful lifestyle changes.
- IDEAS. Elliott emphasizes that patients need to understand that interventions don’t have to be cut-and-dried. “There’s flexibility with the definition of what we need to do,” she says. If a patient balks at the initial strategy, for example, she advises removing the disagreeable components and keep replacing them with alternative tactics until the mix is manageable.
- COMMITMENT. The patient’s voice is so important, Elliott continues, because “we can have all these grand ideas, but if the patient’s not going to cooperate…then it’s back to the drawing board. It’s got to be something that can be maintained.”
Yo Hablo Español
Elliott draws a parallel between eating better and learning to speak Spanish (or any other tongue). To reach a desired level of mastery, a private tutor might encourage the student to attend 2-hour language labs several times a week. After months of blowing off the assignment, the pupil wonders why he can’t speak Spanish yet. The tutor recognizes that the time investment is too high for the patient and instead suggests 30 minutes of learning each night using an online app, but the pupil continues to miss sessions. Finally, he finds his rhythm with 15-minute learning modules every other day. He’ll still learn Spanish, but it’ll take longer to become fluent. In the meantime, maybe he’ll learn enough to get by without a translator on his Cancun vacation.
By the same token, cardiopulmonary patients may come to their nutrition adviser with a specific goal in mind, and the provider is there to guide them down the path to achieving that objective. As a hypothetical, Elliott points to a diabetic who wants to stop relying on glucose-lowering medications. She is advised to start checking blood sugar levels more frequently and limit pasta dinners to just one night out of the week instead of daily. The patient does neither and, not surprisingly, remains dependent on a multi-drug regimen to manage her disease. The provider can dial the plan back to less aggressive strategies; but when the options inevitably run out, Elliott says it’s time to start reconsidering the goal itself. Importantly, she underscores that each person’s unique circumstances dictate the steps they take to get where they want to be.
Popular Pathways
That being said, there are a handful of go-to solutions that Elliott finds particularly useful, which she shared during a live AACVPR webinar on February 9, 2023. During the 1-hour presentation, attendees received insight on:
- the importance of balancing meals with protein and carbohydrates and/or healthy fats,
- the potential benefits of time-restricted eating in select, appropriate patients,
- the need for accountability through food diaries, online communities, apps or other tracked environments.
Elliott also reinforced her belief that the journey is that of the patient. It’s the provider’s role to guide and empower; and to her, that means ceding some control and giving patients a say in what they can or can’t do. In other words, meeting people where they are.
Click here for access to the webinar recording.