Top Tips to Counsel Your Patients on Diet, Exercise

JANUARY 24, 2018
In the community, quite often we see patients who are in poor health at least partially because of lifestyle choices that they have made, and many of the medications they are taking are treating conditions brought on as a consequence.

We fill their medicine, talk to them briefly about diet and exercise, and watch them as they continue to eat poorly, not exercise, and see their health decline. A recent transaction that has stuck in my mind is ringing up a 20 oz. Mountain Dew (with 77 grams of sugar in it, by the way) with a patient’s metformin. I’m pretty sure she bought potato chips or a candy bar with that too.

Unfortunately, too often we miss the opportunity to encourage some level of change in their life that could make a long-term, positive impact in their health. We might either not have the time, not know how to, or maybe just are not sure it will make a difference. Sometimes we are right; however, too often we’re missing the chance to really reach a patient who needs us. Follow these tips and you can certainly work some lifestyle counseling into your day:      

1. Keep it simple. There are so many diets out there that it is impossible to even keep up with. Mediterranean, Paleo, DASH, Weight Watchers, Mayo Clinic–just to name a few. Many of them are healthy and no one diet is necessarily better than the other. However, healthy diets include a “base” of mostly fruits and vegetables, whole grains, and healthy proteins. Red and processed meat has been associated with diabetes, cardiovascular, disease, and cancer and should be eaten sparingly.1 Healthy proteins can include beans, tofu, chicken, turkey, fish, or vegetarian meat substitutes.2

I think it is helpful to make sure they don’t think of it as being ‘on a diet’, where they can easily get ‘off’ their diet, but rather on finding foods they really like that are also good for them and so will be easy to make a permanent change in habit. Also, some people might do better in the long run by making small changes over time, rather than picking a day to completely change everything they have been doing for years by going ‘on a diet.’

One tip, instead of a generic statement like “eat more fruits and vegetables,” try something patient-specific like “this week, why don’t you pick up a loaf of whole-grain bread instead of white bread?” If they aren’t ready for that yet or say they don’t like it, maybe they can start by having a sandwich with 1 piece of white bread and 1 piece of whole wheat bread first; then, as they become more accustomed to the taste, they can move over to only whole-wheat.

2. Encourage them to try new foods, and focus on foods that are affordable and easy to make. I am a foodie and self-proclaimed chef (I like to think I run a Michelin-star restaurant out of my kitchen) and I love to cook foods from all over the world, so it is easy for me to forget that not everyone is comfortable with ingredients like lemongrass, guajillo chiles, malanga, or galangal.

My parents have told me avocados were not even available in the store when they were growing up. In pharmacy school, I met someone my age who had never eaten a plantain before and refused to try it, saying ‘it’s weird’ (it’s just a starchy banana!). So it might take a little prodding to get your patients to try something new. But hopefully, if you can focus on things that are both affordable and not too far off from what they are used to, then you can convince them to experiment a little. If they are familiar with pinto beans or black-eyes peas, then hopefully black beans won’t seem like much of a stretch.
 
Try easy preparation methods too. For example, for kale and other cooking greens, instead of cooking them in a boiling pot of water, try putting them in a colander, boiling water in an electric kettle, and then pouring the boiling water over the greens. It cooks them perfectly and takes almost no effort. Then, add lemon juice and olive oil, or instead try sesame oil, sesame seed, and soy sauce.
 
3. For exercise, find things that they enjoy. Exercise does not necessarily mean going to the gym, running, or doing other activities that many people just do not like to do. Also, many people either don’t have the money or don’t feel like they have money for a gym membership. However, fun activities like hiking, swimming, canoeing, biking, or just walking around the neighborhood can help them. Getting out there and mowing and raking their lawn will also give them a lot of exercise. If money is not an issue, then this might be the time for them to try ballroom dancing or exercise classes that they’ve always wanted to try. The point is, they just need to get moving regularly and often, and develop a change in habit, just like with their diet.
 
4. If you are able to, make your store the example. If you work for a chain you won’t have any choice over the matter of course, but one of the first things I did at my store was take the candy away from the register. It’s even better if you can take it out of the store entirely. It makes no sense for us as pharmacists to tell patients not to eat it very often and then to sell it to them on the way out. The same goes for sugary sodas, energy drinks, and other junk foods. We need to start thinking of those types of foods as a public health threat, the same way we currently think of tobacco.
  
References:
1.       Wein H. Risk in red meat? NIH Research Matters. National Institutes of Health. Accessed online January 22, 2108 at https://www.nih.gov/news-events/nih-research-matters/risk-red-meat.
2.       Protein Foods. American Diabetes Association. Accessed online January 24, 2018 at http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/meat-and-plant-based-protein.html
 

Alex Evans, PharmD, BCGP
Alex Evans, PharmD, BCGP
Alex Evans, PharmD, CGP, works in community pharmacy in Jacksonville, Florida, and is preceptor at the University of Florida and Florida AM University. He graduated from the University of North Carolina-Greensboro with a BS in Biology and graduated from the University of North Carolina-Chapel Hill with a Doctor of Pharmacy degree. He has worked in both the community and long-term care settings. He can be reached at alex.evans.pharmd@gmail.com
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