Improving America’s Nutrition, One Patient Call at a Time: How Registered Dieticians Use Patient Engagement Strategies to Improve Population Health
Health Dialog is full of devoted employees committed to our mission of helping clients improve population health, reduce costs, and engage patients to make the best decisions about their health. In this series, we spotlight the hard-working healthcare professionals who help us realize that mission each and every day.
On National Registered Dietitian Day, we celebrate our hard-working registered dieticians who engage patients to develop and sustain healthy eating habits, and in the process, reduce their risk of disease complications and progression. Today, we’ll introduce you to Erica Rew, a registered dietitian coach in her 5th year at Health Dialog, who loves helping people reach their diet and exercise goals. With many patients turning to Health Dialog to work on preventing or managing chronic disease, her expertise helps us deliver high-quality patient engagement and population health management services on behalf of our clients.
What work did you do before joining Health Dialog?
Before Health Dialog, I worked as a registered dietitian nutrition coach at a fitness center. In this role, I met with the center’s clients to review their eating habits and collect important information on their health, such as their weight, body fat percentage, cholesterol levels, and metabolism. Together, we came up with a healthy eating and exercise plan. If the client was also doing personal training, I collaborated with the trainer so they understood the client’s diet needs. I also led some basic training group classes, in which I did some nutrition counseling.
What made you decide to become a dietitian?
I got interested in being a dietitian when I was training for a half marathon with my mom. For our training, we were paired with a dietitian. During this process, I was intrigued by the science of how diet helps with any kind of training. At the time, I was a few years out of college with a bachelor’s degree in biology, and I wanted to go back to school, but I wasn’t sure what to focus on. I was interested in going into the sports realm, and after that experience, I knew that I wanted to become a dietitian.
After spending a few years working in the fitness world, what drew you to Health Dialog?
The mission statement is really what pulled me in—I loved the focus on patient engagement. It aligns with my own personal mission as a dietitian, which is to improve the health of the community. I believe that everyone at Health Dialog wants to really help people, and that’s just what we do. On our coaching calls, we keep up with the patients, support them as they progress, engage them to stay motivated, and get them to a place where they can see improvement over time.
“We are working [with patients] to reach goals that will affect their overall lives for the better.”
What are some of the biggest differences between working as a dietitian at the gym and working as a dietitian at Health Dialog?
At Health Dialog, I work with people with different kinds of issues and goals. At the gym, people came in with a greater interest in weight loss or muscle building. Their goals tended to be more physical—changing their body composition, lifting more weight, or running faster. Or they wanted to fine-tune their diet. At Health Dialog, I am more likely to work with people who want to make lifestyle changes because they need to improve their health, which involves a deeper level of patient engagement. For example, they may have a chronic disease like diabetes, and their goal is to lower their blood sugar levels. With this population, I am more likely to work with people who may not be used to healthy habits, so I may be helping them learn a whole new lifestyle. We are working to reach goals that will affect their overall lives for the better. In many cases, if they don’t improve their habits, their life may be significantly impacted. It may even limit what they can and can’t do in the future.
Another difference is the cost. At the gym, I only worked with people who could afford it, which is a barrier for a lot of people. At Health Dialog, I am usually working with people who have access to coaching through their health insurance, so there is more diversity in the types of people who are able to benefit from our services.
“When it comes to goal-setting, we start with something that is realistic, and that might be something small.”
As a dietitian health coach, can you describe a typical example of how you engage patients through the coaching process?
Diabetes, and the effective management of diabetes and weight loss through proper nutrition and physical activity, is one of the primary reasons our patients call us—we get these types of calls every day. Let’s say we talk to a patient and they want to improve their blood sugar. In order to do that, we first need to assess their current diet and their level of knowledge in regards to nutrition. Then we look at how their blood sugar is affected by their current diet.
Once we determine this baseline assessment, we work together to create a list of goals that they can focus on, and I might provide tools and resources to help them (if appropriate). When it comes to goal-setting, we start with something that is realistic, and that might be something small. For example, if they are looking to increase physical activity, a starting goal for someone who never moves at all might be to walk 10 minutes a day, 3 days a week. We’ll do the same with diet—aim for something realistic. Resources I send to patients are evidence-based and are always specific to their goals. For example, I might send information on how to read nutrition labels, how to stick to a diet when eating out, or how to create a healthy meal at home.
Once we establish goals, I’ll check in with them after a few weeks to see how they’re doing, ask about their blood sugar, and to see if there have been any changes in their weight. As we discuss their progress, we begin to introduce more things they can do to improve their health. As far as how often we have our check-ins, that changes from person to person. Some people want weekly follow-ups because they know they need a higher level of support to stay on track, while others may want to be contacted every-other-week; some people are happy to speak monthly—we tailor our approach to the patients’ needs and preferences.
In general, the key to success with each patient is to gain their trust from the start. Once you have that, you can effectively engage patients to set realistic expectations and help them be successful.
What sorts of gaps in knowledge have you noticed among patients you’ve worked with?
More often than not, there is a knowledge gap in regards to processed foods. So many foods are packaged these days, and some people don’t understand portion sizes. When I ask our patients to read the labels, they’re always surprised. Many of them don’t realize how much sodium or sugar they are eating.
For some people, addressing issues related to diet, exercise, and weight can be very sensitive. How do you engage patients in a way that helps them let their guards down?
I always let people know that they are not the only person dealing with weight issues. I tell them that it’s very common and that most people have something they can improve when it comes to diet and exercise. I let them know that we are here to help them set goals that are realistic for their own situations. And I always say that we can’t be perfect overnight—that perfection will never be an expectation and we wouldn’t want it to be their expectation.
“To truly help our patients, I can’t just focus on diet and exercise. I have to look at the whole picture.”
Can you talk about the emotional impacts that patients experience when they work with you?
People may eat because of issues with their emotional well-being—not because they’re hungry. Stress is a big one I always come across, so we have to help them determine what to do instead of turning to food. Something that might work is walking, and of course that also helps with weight loss. I do a depression screening with anyone who hasn’t been screened recently, because it can be hard to tell if someone is going through something else that may be affecting their behavior or motivation. And I always let them know that behavioral health support is available and that there is someone they can talk to 24/7. (Most health insurance companies offer this service, so I can refer them to that number.) Getting help for mental health issues is very important for improving and maintaining health—just like eating well and getting exercise are important. To truly help our patients, I can’t just focus on diet and exercise. I have to look at the whole picture. All of these things come together and affect a person’s health, so we need to look at everything and take a holistic approach.
What keeps you motivated day to day?
I love being able to help people. It’s always rewarding to engage patients, help them reach their potential, and then get to see the results they’re aiming for—such as losing weight or improving management of their condition (if that was one of their goals). Some patients with diabetes are able to lower their blood sugar levels to the point where their doctors reduce their medication or even take them off the medication altogether. It’s wonderful to see these kinds of results.
What do you enjoy doing when you’re not helping patients?
I like to work out. I’ve trained for different events, like CrossFit and Strongman competitions. I think it’s interesting to learn how different diets impact the type of training I am doing. Sometimes my professional life and my personal life collide!
Thank you, Erica, for your dedication to the Health Dialog cause!
To meet more Health Dialog team members, check out these posts:
- Gini Lea Quinn – a dedicated nurse health coach who is proud to be a part of Health Dialog’s can-do culture
- Ryan Croteau – An 11-year veteran of Health Dialog who works side-by-side with our clients to launch population health management and patient engagement programs
- Esther Shapiro – a dedicated nurse health coach who loves making a difference in the lives of our patients