Expanded access to nutrition experts helps families across the state lose weight

October 26, 2016
Jeremy Rhodes
When Jeremy Rhodes started seeing a dietitian via telehealth, he wasn't the only one who lost weight. His dad dropped more than 60 pounds. Provided.

An 11-year-old all-star baseball player in Hampton, South Carolina, has changed his diet with some coaching from an MUSC Health dietitian, and his family couldn’t be happier. Jeremy Rhodes’ mother said they all saw the difference when they looked at a baseball photo from last year.

“His face and his tummy were completely different than he looks like now. And he laughs at it and says he couldn’t believe he was that fat,” Cindy Rhodes said.

Jeremy upped his health game after his mom told his pediatrician she was worried about his weight. The doctor referred him to MUSC Health, which has dietitians who treat patients in person but can also take appointments via telehealth for people who don’t live nearby. Jeremy went to his local doctor’s office, which had a special cart with a video camera and monitor, and got the counseling he needed.

Dietitian Nina Crowley wishes more families would follow suit. While Jeremy was overweight but not obese, obesity is a serious problem for adults and children in South Carolina. Statewide, about 22 percent of kids between the ages of 10 and 17 are obese, and almost a third of adults are. Too few of them are getting the help they need, Crowley said, although access to dietitians is improving in significant ways. 

“South Carolina is one of the first states where Medicaid reimburses dietitians directly without requiring them to be nested under a doctor,” Crowley said. Meanwhile, the MUSC Health Center for Telehealth is expanding its reach to try to make sure more rural South Carolinians with weight issues have access to help.

“Nutrition counseling is now being recognized as something that can and should be covered by insurance,” Crowley said. “There are statistics that say 74 percent of primary care docs don’t feel confident in treating patients’ obesity. Dietitians do.”

She said people have misconceptions about what seeing a dietitian involves. “People think, ‘They’re going to put me on a diet and tell me what to eat.’ That’s not what we do,” Crowley said.

Fellow MUSC Health dietitian Melissa Macher agreed. “Patients start to feel a lot more comfortable when they realize they’re not coming to see the food police.” 

Patients don’t want a lecture, Crowley said. “They know a lot about nutrition and they could teach a class about what you’re supposed to eat and not eat. The problem, like many of us deal with, is just consistently doing it all the time.”

The dietitians offer their patients advice such as which foods will help them feel full longer, and which foods can cause problems. “Maybe it’s a hundred-calorie pack of Oreos,” Crowley said. “They eat that, and it sets them up to eat more during the day. They get food cravings and bingeing and all these other things that you need to work through.”

Macher said she can tell when her patients shift from thinking she’s going to lecture them to realizing they’re in charge. “They think, ‘You’re not talking down to me. I have control over this whole thing.’ And they’re the ones driving it.” Crowley said dietitians are like facilitators or guides. “The patients are the ones doing all the work.”

It’s important for people with weight problems to address them in sustainable ways, the dietitians said. Fad diets and taking extreme measures to lose weight, like the contestants on “The Biggest Loser,” don’t work over time, Crowley said. “Whatever it takes to lose weight, you’ll have to always have to do.”

Jeremy’s a great example of that, in a positive way, according to his mother. “When we go out, he orders the things that he knows he should be eating. He has developed a taste for it, I feel. If we were going to McDonald’s, he would not order a hamburger. He would order the grilled chicken artisan sandwich.” Rhodes said.

“I think that over the year we’ve been with the program, he’s adjusted to eating healthy and enjoys his food. It’s just this natural way of eating. It just took him a little bit to break those habits. 

The sugary drinks were the hardest, Rhodes said. “He had one visit where results were not as good and we identified sugary drinks as problem. I told him we would do it together and drink water. He also likes sparkling water, which is on the list of approved drinks, if he has a taste for something other than water. He does all of that. I don’t have to remind him. He does it all on his own.”

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Helen Adams