Diet is an essential aspect of good health. As children, we may have craved lip-smacking sweets and junk food munchies without understanding the consequences. But as we get older, most of us become aware of the direct relationship between the food we eat and how we feel. The implications can be significant. Poor dietary habits can lead to health problems including obesity, which potentially increases the risk for heart disease, stroke, type 2 diabetes, and certain cancers. When personal efforts to regulate diet are insufficient, people may seek help from medical experts. Sansum Clinic’s Health Education Department includes Registered Dietitian Nutritionists (RDNs) and a full team of professionals who provide nutritional guidance and personalized care.
Registered Dietitian Nutritionists Christina Archer, MS, RDN, IFNCP and Gerri French, MS, RDN, CDCES support patients before and after bariatric weight loss surgery as well as those who want help with nutrition associated with diabetes, kidney disease, cardiovascular health, high cholesterol, food allergies, weight management, longevity, and digestive issues. Patients are referred by physicians from Sansum Clinic as well as from other clinics and private practices.
The dietitians use a patient-centric methodology, providing care that aligns with patients’ needs, desires, and values. “Patient-centered care requires a partnership between practitioners and patients,” Ms. Archer says. “It is important that patients participate in their own care and contribute to decisions about their health.”
To provide patient-centric care, the dietitians need to understand patients’ lifestyles, habits, and personal goals. “We gather a lot of information to get a picture of all contributing factors in a patient’s life,” Archer says. “In our first meetings with a patient we ask them what a typical day’s diet is for them, and to recall what they ate over previous days. We inquire about their cooking equipment at home, whether exercise is a component of their life, and other considerations.”
Through education, counseling and guidance, the dietitians strive to provide a sustainable and personalized program that will enable each patient to eat the foods they enjoy and still reach their health goals. “We do something called motivational interviewing,” Ms. French explains. “It focuses on the patient’s perspective instead of our agenda. We share and we listen. And
sometimes we try to hear what they’re not saying.”
A Lifestyle Approach
Archer emphasizes the importance of patient awareness and involvement. “I remind patients that I’m only half the equation,” she says. “They need to take accountability for their own actions. They can’t simply rely on the dietitian to manifest change. Patients must groom their environment and mindset to make a lifestyle change. It’s a lifelong commitment. The dietitian only gets you so far, and then it’s up to you.”
“Patients who achieve success in their weight loss goals and other nutrition-related health objectives are those who eat well and exercise not because they have to but because they want to,” French adds. “They do it to get the life they want.”
The dietitians help people adopt that outlook by increasing awareness and cultivating mindfulness about what and how they eat. For example, they recommend that their patients keep a food record to track their dietary behavior and correlate it with results about how they feel. They also advise people to not multitask with food such as watching TV while they eat, but instead to allow the brain to focus on the taste of the food and the process of eating.
“We are not psychologists, but our work involves counseling,” French says. “Patients may create excuses and encounter obstacles. We work with people to help them move forward through the challenges. Our job is to provide positive reinforcement and support for that process.”
Referrals extend the reach of the care the dietitians provide. They refer patients who need formal psychotherapy to community resources for low-cost counseling. They also refer people to programs such as adult education classes for exercise. Lately, since gyms and in-person fitness sessions are closed due to the COVID-19 pandemic, they suggest home solutions such as apps and online instruction.
Both Archer and French began their professional paths with a love of cooking and a respect for the preventative aspects of wholesome dietary routines and sensible household nutrition. “Because both my parents died prematurely, I started early into preemptive health actions related to diet,” French says. “I would rather prevent people from needing to go to a hospital than treat them in a hospital. I advise a lifestyle approach. Learning to cook healthy meals from scratch, establishing good habits such as getting up and moving after you eat, these are things anybody can do.”
Ms. French has a master’s degree in physical education and wellness. She enjoys talking with people about finding exercise activities that they can maintain, and often promotes yoga for flexibility, strength, and relaxation. “Yoga-type breathing can be very beneficial during stressful times and when having food cravings,” she explains. “Pausing before eating can also help you slow down so you can savor your meal, and possibly eat less.”
“I became interested in health and wellness in high school when I became a vegetarian,” Archer says. “Out of personal necessity, I learned about taking care of myself through healthy cooking. The culinary program at Santa Barbara City College increased my understanding about how food relates to health. When I took a course on nutrition for the food service professional, I realized this could actually be a career. Today I enjoy being in the role of educator as I instruct people about how to cook healthy meals and what types of food to include in their diet. And I advise them to include exercise in their daily routine.”
Support for Bariatric Surgery Patients
Providing support for bariatric weight loss surgery patients is a key responsibility for the dietitians. Sansum Clinic’s Bariatric Surgery Center integrates surgical technology, dietary and nutritional counseling, emotional support, and long-term follow-up care. Sansum’s medical weight loss clinic is led by board-certified surgeon Marc Zerey, MD, CM, MSC, FRCSC, FACS, who specializes in minimally invasive procedures such as laparoscopic gastric sleeve, gastric bypass, and LAP-BAND surgery.
Ms. Archer leads the support group for bariatric surgery. The group meets monthly (currently virtually during the COVID-19 pandemic) to provide pre- and post-operative guidance for bariatric surgery patients. “The frequency of visits with the dietitians including the monthly support groups is very helpful in maintaining patient success,” Archer says. “That sets Sansum’s program apart from many others. We follow up with bariatric patients at two weeks, one month, three months, six months, a year, and beyond. This long-term care is applicable to all our patients. There is still a lot of relevance in working with dietitians even after patients reach their health goals and are doing well.”
Patients who recently underwent bariatric surgery and those who are preparing for it attend the bariatric support group sessions. People who had the surgery years earlier also attend to fortify long-term success. “The more information patients have before surgery, the more successful they will be afterwards,” Archer continues. “They know what to expect and they are able to plan accordingly. Due to COVID, people’s schedules are thrown way off. Bariatric patients who listen to the advice of implementing a schedule and routine have better post-operative results. The monthly support groups cultivate that structure and help establish lasting habits to help patients stay on track with diet, exercise, lifestyle, and mindful awareness.”
Bariatric Coordinator Jessica Orozco plays a significant role in patient success. She ensures that patients are informed about appointments, and she alerts them via text messages about events such as the monthly bariatric support group meetings so there are never interruptions in care. The dietitians, bariatric coordinator, nurses, managers, and surgeons meet monthly to maintain continuity and communication between departments.
Latest Discoveries Help Dietitians Personalize Nutritional Guidance
Looking ahead, French and Archer believe nutrigenomics is an important direction in the field of dietary health. Nutrigenomics is the study of the effects of food on gene expression and the relationship between the human genome, nutrition, and health.
The completion of the Human Genome Project in 2003 provided medical science with a map of approximately 20,500 genes and how they function in the human body. Among other insights, the project helps medical professionals understand how food interacts with our genes. “Certain foods can influence how our genes operate and express themselves,” French says. “Using this information, we can provide our patients with deeper guidance about nutrition and health. For example, certain bioactive ingredients found in colorful plant foods can change gene expression and reduce inflammation in the body.”
Ms. French explains that the lining of a person’s digestive tract is covered in microscopic beneficial bacteria, fungi, and other microorganisms. This microecosystem, called the microbiome, exists throughout the human body and plays a large role in health. A healthy microbiome promotes a healthy immune system, supports weight management, and may play a role in preventing or improving symptoms of many common disorders including allergies, asthma, colon cancer, and more.
“Christina and I are fascinated by the microbiome and new research identifying and describing molecular-level interactions between nutrients and the human genome,” French says. “You can maintain a healthy microbiome by adding living microbes directly into your system through probiotics such as yogurt, kefir, fermented vegetables, and kombucha.”
By applying new research and discoveries about nutrigenomics, dietitians can assist patients in a much more personalized way. “We don’t want to apply a cookie-cutter approach to nutrition,” French continues. “Every patient is different. That’s why communication is so important between patients and care providers. Once we understand the details about who we’re treating, we can help them support their microbiome with wholesome foods. The first step is increasing awareness about current food habits by evaluating not only what people eat but when, where, and how. One recommendation may be to consider some type of intermittent fasting where food is eaten during specific hours. Intermittent fasting has been found to assist in modifying our cells and biological pathways that may increase longevity and reduce late night eating habits.”
Ms. Archer warns people to be careful with trendy diets that become popular in mainstream culture and may be perceived as general-purpose plans. “Programs such as the ketogenic diet, which is high-fat, moderate protein, and low-carbohydrates are not necessarily appropriate for everyone,” she explains. “That diet forces the body to burn fat, but it wasn’t intended to be a universal weight-loss program. It was primarily designed to treat hard-to-control epilepsy in children and other medical necessities. Nutrition therapy has the best chance for success when it is administered under the supervision of a medical professional who understands the specific needs of the patient.”
Some people avoid professional nutritional care due to fear or shame around seeing a dietitian. “Patients may worry that we’re going to wag a finger at them and give them a strict program,” Archer says. “That’s a misconception. We are here to educate, to brainstorm ideas, and to help people get onto a healthy path. My advice is don’t let fear hold you back from putting your health first.”
“We’re here to help patients understand themselves better,” French summarizes. “We love people and we want them to be successful. Everybody deserves to be the weight they want to be. Over the years I have told my patients: On the other side of that door there’s the new you. You can do anything you want to do.”
Christina Archer is a clinical dietitian, diabetes educator, and bariatric support group leader who was born and raised in Lompoc, California. She has worked with Sansum Clinic since 2017. During her undergraduate education she worked as a nutrition educator in rural communities and as a hospital dietary aide. She received her master’s degree in nutrition science from California State University, Chico.
Gerri French is a clinical dietitian, culinary nutritionist, diabetes educator, and cooking instructor. She has worked with Sansum Clinic since 2002. She also sees clients in her private practice, teaches nutrition at Santa Barbara City College, and is the food and nutrition editor for Diabetes Health Magazine. She received her master’s degree in wellness and physical education from California Polytechnic University San Luis Obispo.
To schedule an appointment with the dietitians, please contact Sansum Clinic’s Pueblo Multi-Specialty Clinic at (805) 681-7500. To schedule an appointment with Sansum Clinic’s Bariatric Surgery Center or to sign up for an upcoming weight loss surgery seminar, please call (805) 898-3472.