Try nutrition counseling for better patient care

We physicians have many constraints on our precious professional time, so it's not surprising that addressing a patient's nutritional habits is often placed lower on the priority list than other more pressing medical matters. However, poor nutrition directly impacts most, if not all, of the chronic diseases that afflict a majority of our patients.

Here's a checklist of brief questions that you can raise to foster discussion about nutrition. You can cover them all in a 15-minute office visit. And, depending on the insurer, if your patient has a weight-related illness, the office visit may be payable using the ICD-9 code for a comorbid condition, or a V-code such as V65.3 for dietary counseling.

Are you happy with your current weight? Most patients are likely to acknowledge that their weight needs attention. A nonjudgmental approach on your part is the key to unlocking the secrets regarding your patients' weight-related woes and struggles. From there, you can probe further regarding weight loss attempts, successes and failures, and goals.

How much water do you drink each day? Water is the body's universal solvent. Up to 60 percent of the body is made up of water. Hydrating the body-particularly prior to eating meals-helps to:

Water should be the drink of choice for everyone. It's especially important for the elderly population to drink water, as the sense of thirst diminishes naturally over a lifetime. The more H₂O consumed, the more likely dehydration can be prevented, especially on hot and humid days.

Who buys the groceries-and where do they shop? Most people purchase food at the neighborhood grocery store or supermarket-but what if there's no major market nearby? Traveling a long distance for fresh groceries isn't an option for the poor or elderly, or for those who rely on public transportation and have to walk to the corner store for whatever's available. Inner-city residents often have less choice of food, particularly fresh produce, since the grocery stores are smaller and have limited selections.

If someone other than the patient does the food shopping, it's important to communicate with that person. You can learn whether cost is a determining factor in purchases, and whether the patient needs nutrition assistance from community resources, through such organizations as Meals on Wheels. You should also make sure the food-buyer knows which foods can lessen or aggravate the symptoms of the patient's medical condition.

What are your favorite foods? Knowing a patient's food preferences will give you greater insight into his eating habits than simply asking a general question about his diet. If a patient replies that he likes eating pork and bacon, for example, you can discuss the benefits and disadvantages of eating pork products, including topics such as protein, salt, fat, and calories. If the patient enjoys snacking on almonds, you can talk about healthy snacks that might complement the almonds, such as figs, raisins, or other dried fruits. Either way, you're talking about what the patient wants to eat, not what he doesn't want to eat.

How is your food usually prepared? This question may pave the way toward discussing healthier methods of cooking. You might suggest stir-frying or steaming vegetables instead of sauteing them, for example, or grilling meat, rather than frying it.

You are what you eat. Sharing this common aphorism with your patients may seem boring and trite, but no truer words can be said. Conveying the value of good nutrition and its direct link to a healthier heart, liver, brain, etc., can have a potentially life-altering impact on your patients. Want a better heart? Eat more foods containing heart-healthy fats. Healthier eyes? Eat more fruits and vegetables containing beta-carotene and vitamin A. The list goes on. You be the judge of how much, or how little, your pa-tient wants to learn. Good luck and remember: Nutrition education will pay many dividends to both you and your patients