Childhood Obesity: A look at Child Nutrition Education in schools and increasing Nutrition Education/MNT insurance referral hours for patients

By Grace Brinster, LWDI Intern

Educating children regularly about nutrition can help them make good food choices, inforce positive decision making skills, and effect behavior change – behaviors that might just stick with them well into adulthood. Also, establishing healthy eating choices at a young age can decrease the risk of future health complications and increase quality of life. However, according to the Center for Disease Control, (CDC) US students receive only eight hours of nutrition education each school year. (1) Let’s think. Where do kids spend most of their time? In school. Approximately 36 weeks (not including weekends) or 180 days to be exact. That’s almost half of an entire year, and only eight or so hours is spent on nutrition education. A CDC statistic states, “the percentage of schools providing required education about nutrition and dietary behaviors declined by 84.6%  to 74.1% between the years of 2000 and 2014.”(1)

Teachers have a lot on their plate, constantly. Therefore, and because it is not always a priority in the curriculum, nutrition education has been falling by the wayside for a long time. As healthcare professionals and teachers ourselves, we know the importance of any type of education. In fact, none of us would be here if we hadn’t chosen to educate ourselves in the fields we work or intern in. With that being said, why are we not providing our nation’s youth with the education they need to provide themselves with a healthy future? They don’t even have the chance, or choice, to step on the “rug of education” before it is pulled out from under them.

Adding to this, a drastic change in education has happened due to the Covid-19 pandemic, which forced schools to teach virtually. This means, at least for the past year, school aged kids may not have received any nutrition education at all, and have not been exposed to different eating behaviors or food choices. This bleeds into another question, what food habits are established in the home? Are the parents educated as well? So, to all dietitians, physicians, nurses, and other healthcare professionals, I ask you, what can we do to ensure nutrition education is increased in school systems, communities, and homes? Listed are some suggestions for what we can all do, regardless of your profession, to help bring awareness to this important need: 

  • Be more active in Public Policy and Advocacy – know what education programs assist in healthy school meals.
  • Write a letter to your State Senators asking for support in nutrition education programs.
  • Educate ourselves so we can educate others.
  •  Get active in your communities by:
    • Talk with or write letters to your State board of Education asking for support in nutrition education.
    • Research your community: Which schools need nutrition education the most?

Key facts 

  • Worldwide obesity has nearly tripled since 1975.
  • In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
  • 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
  • Most of the world’s population live in countries where overweight and obesity kills more people than underweight.
  • 39 million children under the age of 5 were overweight or obese in 2020.
  • Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
  • Obesity is preventable. 

Increasing MNT/Nutrition counseling services and referral hours


Some insurance companies cover nutrition services such as counseling services and/or medical nutrition therapy (MNT). Unfortunately, Medicare covers only 3 hours of MNT services for individuals who have been diagnosed with Diabetes, kidney related dialysis conditions such as End-Stage Renal disease, and some nutrition counseling for Obesity. (2) The hours can be extended if a physician determines a change in medical condition, diagnosis, or treatment. In order to see the referred patients, a dietitian must be enrolled as a Medicare provider. However, It is a lengthy process for dietitians to become contracted with insurance companies, and on top of that, requirements for coverage differ from state to state. (3,4) 

In addition to this, the client must have a physician’s referral in order to see the dietitian and that might only happen if their insurance includes nutrition services or MNT coverage. Otherwise, the individual would pay out of pocket. According to the National Conference of State Legislators (NCSL), the Affordable Care Act covers nutrition therapy for Obesity, Diabetes related diagnosis, and nutritional services in only twenty-three states. (5)

Although changes have been made in recent years to expand the number of people who can receive health insurance in general, there is still a chance clients will not be provided with enough MNT/nutrition education to improve their condition due to limited referral hours covered by insurance. Personally, I think increasing nutrition referral hours is a good place to start to help combat this issue. Improving access to specific medical care needs can only benefit an individual. Also, research shows those who are obese at a young age are more likely to be obese as adults – eventually leading to the need for nutrition counseling, education, or MNT later in life. This brings me to another point – weaving through the healthcare system can be complicated and often, patients don’t always get the one on one time that they need with a healthcare provider. Even if they do, the time spent is way too limited. 

This is the big, vague, picture of what’s happening in our healthcare system due to how insurance companies are set-up. In regards to childhood obesity, for the children, this process is probably confusing. Then, by the time they reach a nutritionist or dietitian who can educate them, they might only have less than an hour to talk about the problem because referral hours are limited or no coverage is applied to the session at all. Over many decades, the Obesity health crisis has been met with limited health insurance coverage, difficulty for providers to get covered in order to provide needs, and limited nutrition education in schools. How do we change this? 

Childhood Obesity: Is Nutrition Education enough? 


As we know, there is a lot of support advocating towards decreasing childhood obesity prevalence and occurrence. A few examples of this “support” are federal programs such as SNAP, WIC, the School lunch program, and research programs like the Childhood Obesity decline project and many more. However, data shows there still hasn’t been a huge decline in Obesity rates: 

Reference: Obesity Rates & Trend Data – The State of Childhood Obesity

Childhood Obesity can impact quality of health well into adulthood. It increases chances of stroke, cardiovascular disease, high cholesterol, and hyperlipidemia, all of which can lead to a diminished quality of life and death. Is nutrition education enough? If it becomes more pronounced in the curriculum, will we see a decline in childhood and adult obesity numbers in the next twenty years? We won’t know until the changes happen. 

Hence the need for a core curriculum in nutrition education and an increase in insurance coverage for nutrition services and MNT referral hours. Not providing enough nutrition education in schools and having a complicated health insurance system in order to access necessary medical care are problems contributing to this health crisis that need to change. 

References:

1.Nutrition Education in US Schools (cdc.gov)

2.Referral Requirements for Coverage for Nutrition Services (eatrightpro.org)

3.Medicare MNT (eatrightpro.org)

4.Guide to Insurance and Reimbursement – Today’s Dietitian Magazine (todaysdietitian.com)

5. Health Reform and Health Mandates for Obesity (ncsl.org)

The importance of not following/believing social-media influencers for weight loss recommendations; learning to get accurate information from Registered Dietitians

By: Kenneth A., LWDI Intern

Health Influencers in Social Media

If one were to ask the average person, “Where do you get most of your nutrition information?”, I’m sure many of the responses would be one of the following:

  1. Social Media platforms, such as Instagram, TikTok, or other
  2. Family and friends 
  3. Personal trainers or other health “certified” individuals

However, when have you ever asked someone this question, and they responded, “Oh, I get all of my evidence-based health information from a Registered Dietitian.” Chances are, not a single person you have ever talked to will give you this response. Unfortunately, it seems like the social media craze and the social media “influencers” are doing everything they can to sell their products, sell their so-called “meal plans,” and are easily taking over the amount of nutrition information that is being spread to most of society (and the downside is, much of the information that they are posting on their social media is not evidenced-based, false, and is usually only done to make a quick buck). 

According to an article in Medical News Today, The phrase “health misinformation” refers to any health-related claim under the assumption of truth that is false based on current scientific consensus. (1) The amount of growing concern among health professionals, especially Registered Dietitians, is increasing as more and more people are falling for the false information that is being passed around on social media. Just like the news today, many of the health influencers tend to put a “spin” on their information in order to make it sound more appealing to the average individual (by the way, have you heard of the “chlorophyll” craze that is making its way around TikTok?). They claim that if you purchase their product, it will solve all of your health and gut issues (insert name of pill or powder here). 

One of the biggest issues with these individuals is that they have absolutely no prior education in regards to nutrition and health, such as a degree in nutrition, or credentials such as an RDN. According to the Academy of Nutrition and Dietetics, the term “Registered Dietitian” is a protected title allowed only to those who have completed and finished the coursework, internship, and national board exam. However, the term “Nutritionist” is an unprotected title that can be freely used in many states, with no prior education or credentials required. In essence, anyone is free to call themselves a “nutritionist,” and this can cause lots of confusion to people in regards to differentiating a proper Registered Dietitian to other “health influencers.” 

Weight Loss & Social Media

One of the biggest issues with social media today is how society constantly pushes what is the “ideal” figure or body image for people. If one were to do a simple search on Instagram, you wouldn’t even have to look past 2 or 3 fitness “influencers” or Instagram health/fitness individuals to see that this case is true. Social media indefinitely pushes people to “lose weight,” to “be thin,” and to do whatever it takes to “lose fat.” The problem is this – just like what was previously mentioned, most of these social media influencers are not even credentialed or qualified to be giving this (shall we say, dangerous) advice to people. 

Have you ever seen the content on social media influencers posting their “What-I-Eat-In-A-Day” videos? These types of videos could not be further misleading from the truth, as absolutely no one has the time to prepare five to six Instagram-worthy meals every single day, or else you would not be doing anything except meal prepping almost every hour of your life (examples include their extravagantly-prepared fancy fruits, avocado toasts that contain about 20 different ingredients, and their outrageously expensive seafood/steak dinners). According to an article written in PubMed, “The authors take a look at how social media is influencing diabetes with particular focus on weight perception, weight management and eating behaviours. The authors explore the concept of how the advertising of Size 0 models and photo-shopping of images which are easily available online and via social media is causing an increase in the number of young people with distorted body images. This has led to an increased number of people resorting to sometimes drastic weight loss programs.” (2)

With more and more influencers looking to promote their image and products in order to simply make a profit, the more dangerous social media health/nutrition information has become. 

What can we do to respond?

As current and future Registered Dietitians, it can be a challenge to respond and attempt to lure people away from false nutrition information on social media. How is it possible to call out someone who is making false claims, when they have more than 10,000 followers or more on their Instagram or TikTok? Responding to misinformation is challenging for many reasons. For example, psychological factors, including emotions and cognitive biases, may render straightforward efforts to counter misinformation by providing accurate information ineffective. (3) 

As health professionals, the best thing we can do is to provide people with sound, evidence-based nutrition information. When someone comes up to us and asks us about a specific nutrition topic or question, we need to clearly communicate what research shows, not what our personal beliefs or opinions are. This will help prove to people that we have their best interest in mind and want to do what it takes to truly help to optimize their health, not give them a runaround in order to make a quick buck that social media influencers are currently trying to do. If people are influenced by the presented misinformation in these sources, they can make harmful decisions about their health. (4)

 Viral information has become a tremendous threat to overall public health. We must find even more ways to combat the social media health craze, and put a stop to the spread of false nutrition information. Public health organizations need to improve their social media presence to help Internet users find accurate health information.(5) Unfortunately, the internet and social media will continue to exist and only get bigger, and along with that, the amount of false information regarding nutrition and health with it. As long as we truly care about our clients and patients, we must do our roles as Registered Dietitians to help them live fuller, more meaningful lives, and that includes helping them find better health information. 

References

  1. “Why do some people believe health misinformation?” Medical News Today. Retrieved from: https://www.medicalnewstoday.com/articles/why-do-some-people-believe-health-misinformation 
  2. Das L, Mohan R, Makaya T. The bid to lose weight: impact of social media on weight perceptions, weight control and diabetes. Curr Diabetes Rev. 2014;10(5):291-7. doi: 10.2174/1573399810666141010112542. PMID: 25311196. https://pubmed.ncbi.nlm.nih.gov/25311196/
  1. Sylvia Chou, W. Y., Gaysynsky, A., & Cappella, J. N. (2020). Where We Go From Here: Health Misinformation on Social Media. American journal of public health, 110(S3), S273–S275. https://doi.org/10.2105/AJPH.2020.305905
  2. “Health Misinformation in Search and Social Media” ACM Digital Library. Retrieved from: https://dl.acm.org/doi/abs/10.1145/3079452.3079483
  3. “Containing health myths in the age of viral misinformation” CMAJ. Retrieved from: https://www.cmaj.ca/content/190/19/E578.short

Prevalence of Type 2 Diabetes in Underserved Communities

By Trey Woods, LWDI Intern

What is Diabetes?

     Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel.(1)  This long-term condition results in too much sugar circulating in the bloodstream. Prolonged high blood sugar levels can lead to various health complications such as neuropathy, blindness, kidney problems, heart disease, or diabetic foot infections. 

Symptoms of Type 2 Diabetes

     Signs and symptoms of type 2 diabetes usually develop slow. People can often be living with type 2 diabetes and not even realize they have it. Some of the signs and symptoms include:

  • Increased thirst
  • Frequent urination
  • Increased hunger
  • Unintended weight loss
  • Fatigue
  • Blurred vision
  • Slow-healing sores
  • Frequent infections
  • Numbness or tingling in the hands or feet
  • Areas of darkened skin, usually in the armpits and neck

Risk Factors for Type 2 Diabetes

     Some individuals are at greater risk of developing type 2 diabetes than others. Risk factors include:

  • Weight: Being overweight or obese
  • Family history: The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes.
  • Race and ethnicity: Although it’s unclear why, people of certain races and ethnicities — including Black, Hispanic, Native American and Asian people, and Pacific Islanders — are more likely to develop type 2 diabetes than white people are.
  • Age: The risk of type 2 diabetes increases as you get older, especially after age 45.
  • Prediabetes: Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
  • Pregnancy-related risks: Your risk of developing type 2 diabetes increases if you developed gestational diabetes when you were pregnant or if you gave birth to a baby weighing more than 9 pounds (4 kilograms).

Diagnostic Criteria 

A1C

     The A1C test measures your average blood sugar for the past two to three months. The advantages of being diagnosed this way are that you don’t have to fast or drink anything.

  • Diabetes is diagnosed at an A1C of greater than or equal to 6.5%

Fasting Plasma Glucose (FPG)

     This test checks your fasting blood sugar levels. Fasting means after not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.

  • Diabetes is diagnosed at fasting blood sugar of greater than or equal to 126 mg/d

Oral Glucose Tolerance Test (OGTT)

     The OGTT is a two-hour test that checks your blood sugar levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar. Diabetes is diagnosed at 2 hour blood sugar of greater than or equal to 200 mg/dl. If diabetes symptoms are present and blood glucose is 200 mg/dl or greater, diabetes can be diagnosed with the one test. Otherwise, two tests (A1C, FPG or OGTT) are required for diagnosis.

ResultA1CFasting Plasma Glucose (FPG)Oral Glucose Tolerance Test (OGTT)
Normalless than 5.7%less than 100 mg/dlless than 140 mg/dl
Prediabetes5.7% to 6.4%100 mg/dl to 125 mg/dl140 mg/dl to 199 mg/dl
Diabetes6.5% or higher126 mg/dl or higher200 mg/dl or higher

(2) 

Prevalence in Underserved Communities

     According to a 2017 study by the American Diabetes Association, nearly 30 million children and adults have been diagnosed with diabetes, an additional 86 million have prediabetes.(3) The study found low-income populations with limited health literacy were more likely to be diagnosed due to a variety of environmental factors: 1)limited access to healthy food choices, 2) limited access to health care, and 3) limited access to health-promoting resources. The prevalence of type 2 diabetes among racial/ethnic minorities (8.0–15.1%) is greater than that of non-Hispanic whites (7.4%).(4) Another factor affecting the prevalence of type 2 diabetes in the underserved community is the ability to self manage the condition. Without the proper healthcare to provide to the underserved community, there will always be an issue with the people being able to self manage their condition.(5) Without proper educators, it will be more difficult for people to learn how to manage their condition. Without education classes, the population is reliant on using the internet to self educate on their condition, and internet services may not be available or affordable to underserved communities.

Prevention in Underserved Communities

     Both randomized clinical trials and real world implementation studies have proven that structured lifestyle change programs, such as the National Diabetes Primary Prevention Program, can help prevent or delay type 2 diabetes by 60% in people with prediabetes.(6) In order to prevent the higher prevalence in underserved communities, there needs to be more Diabetes Prevention Program (DPP) resources in place. DPPs are not very common in the underserved communities which is why we are seeing them have higher incidences of diagnoses. In order to step up prevention, the DPPs could be tailored towards a certain demographic setting. For example, get feedback from the community on where classes could be held, frequency of the meetings, and what topics should be discussed.

  • For the racial/ethnic minority groups, there were better outcomes when the educators were from the local community, bilingual, and had a racial/ethnic match to the participants. 
  • For rural communities, there has been more of a telehealth effort into providing DPPs. The healthcare availability is still low for rural areas, so providing telehealth over the internet is a way to help with the prevention of type 2 diabetes in those communities. 

Low income individuals may be less likely to get screened for type 2 diabetes or to live near options for healthy eating or physical activity. This is why it is imperative that we strive to create more opportunities to provide DPPs in these underserved communities. Making resources both available and affordable should make a significant impact on the prevalence of type 2 diabetes.

References

  1. “Type 2 Diabetes”. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
  2. “Diagnosis”. American Diabetes Association. Retrieved from https://www.diabetes.org/a1c/diagnosis
  3. “Providing Diabetes Care to Underserved Populations”. CareMessage. Retrieved from https://www.caremessage.org/blog/post/diabetes-care-underserved
  4. AuYoung, M., Moin, T., Richardson, C. R., Damschroder, L. J. “The Diabetes Prevention Program for Underserved Populations: A Brief Review of Strategies in the Real World”. Diabetes Spectr. 2019 Nov. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858084/#:~:text=Although%20the%20Centers%20for%20Disease,in%20the%20Southwest%20(2).
  5. Reyes, J. et all, “Factors Influencing Diabetes Self-Management Among Medically Underserved Patients With Type II Diabetes”. Sage Journals. 14 Jun. 2017. Retrieved from https://journals.sagepub.com/doi/full/10.1177/2333393617713097

Albright, A. “How Effective Are Diabetes Prevention Programs?”. CDC. 13 Aug. 2014. Retrieved from https://www.cdc.gov/diabetes/prevention/pdf/transcript_doctor_albright_medscape.pdf.

Diabetes & Mental Health- Is there a Connection?

By: Hourig Attarian, LWDI Intern

Diabetes is a disease that affects over 30 million Americans and is no walk in the park.1 Affecting almost every age group diabetes can consume the thoughts of the people it burdens. Imagine waking up one day not feeling too good, maybe even going to the ER and then you get the diagnosis, you are now diagnosed with diabetes! This changes everything and you feel like your entire life has been changed. Your relationships, your diet, your health everything is a little different now and it causes some anxiety, depression and may even worsen the symptoms of your diabetes. There even is a term for this negative feeling and it is called “diabetes distress”. 2 However, with proper lifestyle changes, education and support groups there is a solution and diabetes patients do not have to suffer alone.

https://www.diabetes.ca

What is diabetes distress?

There is no denying that the scene described above seems overwhelming, confusing and anxiety inducing. According to the CDC Diabetes Distress is a term that describes the overwhelming feeling persons with diabetes have when trying to manage their condition. When one has Diabetes Distress they can begin to have feelings of hopelessness, loss of control and they may even stop caring for their diabetes full stop. They will disregard their diet, stop checking their blood sugar and even skip out on important doctor’s appointments. All of these things can worsen the symptoms of diabetes which in turn causes even more distress and the cycle can feel endless.2

https://www.npjournal.org/article/S1555-4155(19)30491-X/fulltext

Is there a treatment?

The treatment for Diabetes Distress is for patients to become educated on diabetes by a healthcare provider they trust, get therapy from a therapist who is specialized in treating chronic health conditions, and joining support groups.2  Social media can also be a very helpful tool especially for young people. In one study the researchers found that young people aged 18-30 were using social media to gain a better understanding of their diabetes self-management by consuming content that was specifically tailored to them. The young people stated they felt more supported by creating relationships with others online who were going through similar experiences and could relate to them on daily life activities.3

Diabetes and depression

There is definitely a correlation between diabetes and depression. Some things may put a person more at risk for developing depression. These things might be gender; females are more at risk, being low income, having stressful life events happening, and having a lack of social support. The treatment for depression for people with diabetes could be pharmaceutical with antidepressants or non-pharmaceutical with lifestyle changes. One study took 50 patients with moderate levels of depression and put them through 12 weeks of cognitive behavioural therapy (CBT) for 10 sessions and combined that with 150 minutes of aerobic exercises a week. The study showed a significant improvement in the patients’ depression with most only having mild depression within 3 months of the trial. 4 The treatment of depression should be discussed between the healthcare provider and the patient to create the best plan to improve the quality of life. 

Stop the stigma!

As if living with diabetes is not stressful enough there has been research done that shows how much stigma diabetic patients have to deal with on a daily basis. One article surveyed a diverse group of persons with diabetes and found that the stigma was higher for patients who were overweight or obese, had poor blood glucose control and had higher insulin therapy needs. 5 The public would specifically judge type 1 persons with diabetes for having to openly check their blood sugar levels and monitor their insulin pumps. Whereas, persons with type 2 diabetes were being stigmatized for overeating, “lazyness” and being overweight or obese. The author of this article stated that the best way to stop the stigma associated with diabetes is to educate the public on the different causes of diabetes. It is important for people to understand that the patient is not solely responsible for having diabetes it also could be genetic and environmental issues.5 Stopping the stigma will allow people with diabetes to live more freely and openly without fear of being stigmatized due to their medical condition.

Looking forward in the future

The most important takeaway from this blog is the importance of prevention, diagnosis and treatment of mental health issues in persons with diabetes. It is critical that healthcare providers acknowledge their patients mental health as being part of the bigger picture in heath maintenance. We must not let depression and other mental health issues become underdiagnosed.6 With the proper treatment plan and support group, diabetic patients can beat mental health issues and live the best quality of life they can!

References:

  1. Statistics About Diabetes | ADA. Diabetes.org. https://www.diabetes.org/resources/statistics/statistics-about-diabetes. Published 2020. Accessed November 1, 2020.
  2. Diabetes and Mental Health. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/mental-health.html. Published 2020. Accessed November 1, 2020.
  3. Fergie G, Hilton S, Hunt K. Young adults’ experiences of seeking online information about diabetes and mental health in the age of social media. Health Expectations. 2015;19(6):1324-1335. doi:10.1111/hex.12430
  4. Robinson D, Coons M, Haensel H, Vallis M, Yale J. Diabetes and Mental Health. Can J Diabetes. 2018;42:S130-S141. doi:10.1016/j.jcjd.2017.10.031
  5. Liu NF, Brown AS, Folias AE, et al. Stigma in People With Type 1 or Type 2 Diabetes [published correction appears in Clin Diabetes. 2017 Oct;35(4):262. Folias AE [added]]. Clin Diabetes. 2017;35(1):27-34. doi:10.2337/cd16-0020
  6. Alajmani D, Alkaabi A, Alhosani M et al. Prevalence of Undiagnosed Depression in Patients With Type 2 Diabetes. Front Endocrinol (Lausanne). 2019;10. doi:10.3389/fendo.2019.00259

LWDI Intern Spotlight: Ivette Receives Grant from Diversify Dietetics!

We are so excited to congratulate Ivette on receiving one of the 2021 Enlightened Grants from Diversify Dietetics to help support her during her Dietetic Internship! Diversify Dietetics works to increase the racial and ethnic diversity in the field of nutrition by empowering nutrition leaders of color.

We are beyond proud to have Ivette in our program. Ivette has big plans on how she will add “something extra” to the world of Dietetics.

Here’s what she has to say about adding her unique and amazing “lagniappe” as a future RDN:

After practicing as a registered dietitian nutritionist, I would like to focus on more community-based programs to improve health outcomes. I plan to develop a ‘food intelligence’ initiative in black and brown communities. There is a lack of supermarket dietitians in less populated lower-income neighborhoods. Supermarket chains like Acme or Shoprite typically have an in-house dietitian. Yet, some black and brown neighborhoods that could benefit from having health and nutrition experts are not afforded equitable services than their more affluent counterparts. In collaboration with two registered nurses, we aim to allocate our healthcare expertise to communities that do not have nutrition education resources readily available. We intend to even out the playing field for people of color. We see incentives in these communities to improve individuals’ professional, financial, and academic outlooks, but there is a lack of investment in individuals’ health and overall well-being. Ideally, this would become a full-time career after becoming well-versed in charitable organizations and funding. The knowledge I will gain from graduating from the Lagniappe Wellness Dietetic Internship will provide a solid foundation as a registered dietitian and diabetes educator as I move forward in this career endeavor.

Ivette, Lagniappe Wellness Dietetic Intern

LWDI Alum Spotlight: Kim lands a position at the National Diabetes & Obesity Research Institute!

Kim has landed a position with the National Diabetes & Obesity Research Institute on their team of amazing Dietitians!

LWDI’s unique affiliation with NDORI allowed Kim to intern on-site with their team. We are beyond proud of her for being offered this valuable and important position to help lead the charge in Diabetes & Obesity prevention and treatment.

Please join us in congratulating Kim on her accomplishment!

LWDI Intern Spotlight: Grace Helps American Heart Association Win Grant for Underserved Clinics in Her Area!

While Grace was an intern with the American Heart Association, she collected data and created a Community Needs Assessment for her area. The Community needs assessment helped the American Heart Association write a grant proposal for race equity funding for low income low food access households. Grace was recently notified by her AHA preceptor that the grant proposal was accepted and they received $15,000 for underserved clinics to get BP and nutrition info in the hands that need it! Grace’s hard work as an intern helped make this happen and we are so proud of her! 

Here is what Grace had to say about her amazing accomplisment:

“I am overwhelmed with joy, and super excited to be a part of something bigger than myself.”

Grace, LWDI Intern

Obesity and Mental Illness: Can one lead to the other?

By: Cassidy Shumway, LWDI Intern 

It is commonly understood that obesity and mental health are correlated to each other. In fact, it  is almost hard to acknowledge one of these topics without eventually addressing the other. We  know that there is some sort of connection, the question that remains is: what is it

In order to set the stage for the rest of this post, consider these two questions:

• Can obesity lead to developing a mental disorder? 

• Can a mental illness increase a person’s risk for developing obesity? 

Let’s start at the beginning: 

It is no secret that obesity is increasing not only within the United States, but worldwide as well.  According to the Center for Disease Control and Prevention (CDC), data from a National Health  and Nutritional Examination Survey found that in the United States between the years of 2017- 2018, the prevalence of obesity in adults was 42.4% which is more than a third of the population (1).  

CDC: Estimates for adults aged 20 and over were age adjusted by the direct method to the 2000  U.S. Census population using the age groups 20–39, 40–59, and 60 and over (1). 

This is a public health concern because: 

1. Obesity raises the risk for most chronic conditions 

2. Obesity can lead to poor mental health

3. Obesity can increase your risk for mortality (2).  

What is obesity? 

Obesity is a complex, multifactorial disease that is typically defined as excess body weight for  height. Body Mass Index (BMI) is the most widely used criteria for determining obesity and is  classified by a BMI of 30 kg/m2 or greater (2).  

Mental Health 

In addition, not only is obesity rapidly increasing, but mental health illnesses  as well. According to the American Psychiatric Association, one in five U.S. adults live with a mental illness which is roughly 51.5 million people.  A mental illness is a health condition that results in changes to an  individual’s emotions, thinking, or behavior and they are often associated with distress and result in an individual having difficulty functioning normally in  social, work, or family situations (3).  

Common mental illnesses include: 

• Depression 

• Anxiety 

• Bipolar disorder 

• Eating disorders 

• Personality disorders 

• Psychotic disorders 

• PTSD disorders. 

Nearly one in five U.S. adults experience some form of mental illness.

Individuals who are obese have an increased risk of developing some sort of neuropsychiatric  disorder such as depression and anxiety and individuals that have neuropsychiatric conditions  may exhibit features that can lead to the development of obesity (4).  

Let’s dig in and look into those questions from the beginning a little further: 

Can obesity lead to developing a mental disorder? Short answer: Possibly 

Individuals who are obese have a higher chance of developing some sort of  neuropsychiatric disorder such as depression and anxiety than non-obese people.  Unfortunately, because of high social expectations, beauty standards, and media, an individual with obesity can negatively influence a person’s self-image with a self depreciating perception. Ultimately, this can make an individual vulnerable lead to  depressive symptoms.  

Research Says: 

• A systematic review in 2017 was conducted which indicated that depressed adolescents  had a 70% higher risk for being obese and another study showed that older women with  obesity had a 38% increased risk for developing depression (5). 

• In 2019, a study was conducted to understand obesity in college aged women. This study  found that: 

o Obese women had significantly lower body image, self-esteem, and high  depressive symptoms than non-obese women. 

o The obese women who reported depressive symptoms reporting more eating  problems, and poorer body image (6).  

• A meta-analysis conducted in 2018 ultimately showed that individuals with central  obesity had a 38% increase of having depression than non-obese individuals (7).  

Within society, it has been established that there are many negative weight-related issues  prevalent in society today including (6): 

Because of this, individuals might look for ways to restrict their diets in an effort to lose weight.  Ultimately, that behavior has the potential to exacerbate depression and put obese individuals at  an increased risk for developing a mood disorder (7).  

Can a mental illness increase a person’s risk for developing obesity? Short answer: Possibly 

For the most part, it is common knowledge that obesity can increase an individual’s chance of  developing mental health disorders and maybe it is common knowledge because we are all aware  of the weight bias, discrimination, and stigmatization that exists in society as a whole, within the  media, but is also apparent on a normal basis in our day to day lives (4). How often do we think  about how mental illness can increase a person’s risk for developing obesity? 

Research Says: 

• Depressive symptoms can lead to an unhealthy lifestyle including being sedentary and  poor eating habits. 

o In college students, it was found that depressive symptoms lead to the  consumptions of sweets, cookies, snacks, and fast food. 

• Food preferences may change during states of stress of depression. 

• High carbohydrate food can temporarily life a person’s mood. 

o Leads to the consumption of pleasant tasting foods (usually those that are high in  fat and sugar) which activate the brains opioid system. 

o Carbohydrate consumption may increase serotonin production in the brain. • Mood disorders can cause sleep abnormalities and sleep impairment is associated with an  increase in the hormone ghrelin (hunger hormone) and decreases the hormone leptin  (inhibits hunger). 

• A high fat diet that can come from having depressive symptoms can potentially lead to  hypothalamic inflammation in the brain which ultimately compromises the regulation of  satiety and can promote weight gain.  

• Antidepressants and mood stabilizers that are prescribed in the treatment of mental health  disorders have been found to be associated with weight gain (4).  

Conclusion: 

Within the past couple of decades, studies are being conducted and evidence is being  accumulated that shows that there is an association between mental health disorders and obesity.  However, more specific studies are needed as there still a lot of unknowns and unanswered  questions. However, the evidence and literature that is currently available is significant and may be impactful by leading efforts towards further research and to the development of better  therapeutic strategies for these conditions. 

RESOURCES 

1. Products – Data Briefs – Number 360 – February 2020. Centers for Disease Control and  Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm. Published  February27, 2020. Accessed November 25, 2020.  

2. Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmaco Economics.2015;33(7):673-689.  

3. What Is Mental Illness? https://www.psychiatry.org/patients-families/what-is-mental-illness.  Accessed November 25, 2020.  

4. Martins LB, Monteze NM, Calarge C, Ferreira AV, Teiziera AL. Pathways linking obesity  to neuropsychiatric disorders. Nutrition. 2019;66: 16-21.  

5. Rajan TM, Menon V. Psychiatric disorders and obesity: A review of association studies. J Postgrad Med. 2017;63(3): 182-190. 

6. Sarigiani PA, Olsavsky AL, Camarena PM, Sullivan SM. Obesity and depressive symptoms  in college women: analysis of body image experiences and comparison to non-obese  women. International Journal of Adolescence and Youth. 2019;25(1): 765-779. 7. Mulugeta A, Zhou A, Power C, Hypponen E. Obesity and depressive symptoms in mid-life:  a population-based cohort study. BMC Psychiatry. 2018;18: 1-10.