Create Enduring Change
Alison L. Steiber, PhD, RDN, serves as chief science officer at the Academy of Nutrition & Dietetics. She previously served as an associate professor and direc- tor of the coordinated dietetic internship and master’s degree program at Case Western Reserve University, where her research focused on nutritional assess- ment, quality of life, functional status, pancreatitis and probiotics. Steiber is the author or coauthor of dozens of scientific research papers, as well as a chapter on “Nutrition Management of HIV/AIDS in Chronic Kidney Disease” in Clinical Guide to Nutrition Care in Kidney Disease (2nd edition). She has also worked as a clinical dietitian and dialysis center man- ager of nutrition services for facilities in Nebraska. Steiber holds a bachelor’s degree from Minnesota State University- Mankato, a master’s degree in nutrition from the University of Kansas and a doc- torate from Michigan State University.
ACE: How have you seen the obesity epidemic affecting our society—families, health care and workplaces?
Alison Steiber: Obesity is a major issue in our society. It impacts every- thing from an individual’s self-percep- tion and quality of life to our nation’s healthcare needs and costs. It impacts the very young through the elderly. It has detrimental effects on children’s ability
to participate in school activities, and it may lead to bullying or unfair treat- ment by teachers, administrators and healthcare workers. That being said, I feel that families, schools, places of work and healthcare systems are now begin- ning to turn the tide of obesity. There is more attention being paid to screening and intervention in both children and adults; work sites are promoting well- ness and incentives to employees who demonstrate healthy behaviors; and the healthcare system has programs in place to teach individuals to be healthier.
One aspect of obesity still not quite understood is the double burden of being undernourished and overweight. Individuals (children and adults) may consume excessive kilocalories through high-fat, low nutrient-dense foods and thus become overweight. However, those same individuals may have suboptimal status in nutrients beyond kilocalories, such as calcium, iron, zinc and vitamin D. These people are rarely identified as mal- nourished in the healthcare system, but because of their poor nutritional status, they may have poor outcomes in school and work. They may also be more suscep- tible to chronic conditions.
ACE: How do you feel our society’s attitudes about food have changed over the past 30 years?
Alison Steiber: Food is very integral to culture and is used to celebrate, to grieve and to nourish. As our lives have become more hectic, food consumption has gone from primarily occurring in the home to increasingly occurring outside the home. Foods from restaurants and fast-food establishments, as well as ready-to-eat foods from convenience and grocery stores, tend to be higher in sodium, fat and simple sugars. When consumed in high amounts and when coupled with a lack of regular exercise, these foods can contribute to an energy imbalance and, thus, to weight gain. Additionally, many people live in areas where access to a grocery store does not exist. They have a more difficult time purchasing healthy, fresh foods to make meals with and instead rely on ready-to-eat foods as staples.
ACE: What do you think is most challenging for people when it comes to adopting healthy eating habits?
Alison Steiber: There are many ways to adopt healthy eating habits, including packing your own lunch and snacks when going to work or school; cutting up vegetables and having them ready to grab when kids and adults are looking for a snack; limiting high- fat or high-sugar foods in the house; and learning to eat only at the table. However, these changes are difficult if you do not have access to healthy food, do not have a clean, safe place to prepare and cook food, or lack the skills and knowledge to prepare food from scratch. Furthermore, many people work long hours or multiple jobs and do not have the time or energy to prepare healthy food. Instead, they have to rely on convenience foods for most of their meals.
For individuals faced with those challenges, some ways of adopting healthy habits may be to utilize slow cookers for making low-fat stews and soups. That allows families to prepare healthier food days in advance for easy access. Also, whole-grain and legume-based foods tend to be less expensive and healthier than foods higher in animal proteins.
ACE: Keeping scope of practice in mind, what are some ways that you feel well-qualified health and fitness professionals can approach the subject of nutrition with clients?
Alison Steiber: Use of the dietary guideline recommendations is a great
way to promote health and stay within scope of practice. Advocate for low-fat, high-fiber foods such as legumes, fresh fruits and vegetables, low-fat dairy foods, whole-grain pastas and rice, and small portions of lean animal proteins such as fish or seafood. Cooking demonstrations and healthy recipes are other great ways to help clients implement easy-to-make healthy foods into their diet. Portion control of foods can assist those trying to lose weight or monitor sodium or sugar intake. Empower clients with tools such as MyPlate or SuperTracker, from the U.S. Department of Agriculture.
ACE: When it comes to nutrition education, what places do you feel need our attention the most? Why is it essential to meet people in those places?
Alison Steiber: I think that as healthcare providers, educators or health coaches, we need to meet people where they are in a nonjudgmental way. Since adults spend a lot of time at work, and children at school, both of these locations are perfect for education and training on healthy behaviors. Many schools have begun incorporating nutrition into the school curriculum and adding exercise during recess and physical education classes. However, much more should be done in these areas. Weaving healthy behaviors into classwork reinforces behavior. For example, various school sub-
jects (e.g., science, social studies, English) can use themes of nutrition, food science, exercise or physical activities to promote health and fitness. For adults, incentives to engage in physical activity or make healthier food choices can become a part of the work culture. Teams or individuals can be rewarded through accolades, insurance-cost reductions or other monetary incentives for participating in healthy activities.
Beyond school and work, communities need to be safe for regular physical activity by having sidewalks, ramps and playgrounds. Use of school gyms or tracks by the public can promote a culture of health and community. Finally, community gardens can add inexpensive vegetables to the neighborhood diet, and they have an added benefit of bringing people together.