Keeping the “Heart” in Heart Health: Cardiovascular Risk and Ultra-Processed Foods, Pt. 3

Key Highlights

• The most significant barriers to reducing ultra-processed food (UPF) intake are structural, not motivational.
• Education alone is insufficient for creating lasting dietary change.
• Process-oriented goals rather than outcome goals can build shelf-efficacy.
• Culturally adapting nutrition counseling can be crucial for adherence and better health outcomes.

In part four of this four-part series, Lisa Jones, MA, RDN, LDN, FAND, and Grace A. Derocha, MBA, RD, CDCES, registered dietitian and a certified diabetes care and education specialist, discuss structural barriers to lowering intake of UPFs – such as time, cost, convenience, and cognitive load – rather than a lack of motivation.

Transcript:

Lisa Jones, MA, RDN, LDN, FAND: All right. Well, we're back again with Grace today, talking more about meeting patients where they are. And in our last episode, it was such a helpful reminder that small, meaningful steps make a big difference. Now we're going to explore how dieticians can navigate the real-world barriers that often get in the way of those changes. So welcome back, Grace.

Grace A. Derocha, MBA, RD, CDCES: Thank you so much for having me again. I love these topics. I'm excited to talk about today's.

Jones: Yes. Yes. Well, my first question for you is, what are some of the most common barriers you see, whether it be time, cost or convenience, really when it comes to reducing UPFs?

Derocha: Oh, it's a good one. I mean, all of those things, but I think some of the most common barriers we see in practice are structural and not motivational and the science supports that. I think most people do want to do better, but then some of the structural things get in the way. So whether it be time and convenience, you know this. People are busy. We're busy, busy. And it's not ... I always think of Leave It to Beaver and like good old June. She was just cooking in the kitchen all day for a lovely meal for everyone when they got home, but it just isn't that way. So time and convenience. Research is consistently showing us that busy schedules drive this reliance on UPFs because they're engineered to be fast, they're shelf stable, they're hyper palatable. So not only do the parents like it, but then your kids will like it. And this isn't a personal shortcoming. I'm going to say that one more time. This isn't a personal shortcoming. It's a response really to modern food environments. And I know people are listening, rolling their eyes like, "That's all true, Grace. So now what? So what do we then do about that?" And obviously there's other layers to this. There's cost and what whole foods can be affordable and what's perceived as real cost versus barriers to that, especially when we're talking about fresh produce and lean proteins. And studies show food insecurity is strongly associated with higher UPF intake and then in turn, increased cardiometabolic risk. Access, many communities, especially communities of color or low-income areas or rural areas have limited access to fresh foods or even grocery stores that have them. So then the push again comes back to packaging or processed options.

And then this one, I feel like this is a mom and I know you get this too, Lisa. The cognitive load is enough to just make someone feel so stressed, whether you're managing chronic conditions, juggling multiple responsibilities, work, family, decision fatigue. So again, pivoting into that convenience food becomes more likely because it's easy, it's faster, and it's there for you.

Jones: Yeah. It is. That's why they call it convenience, right?

Derocha: Yeah. And so we've named all of these things that we do know are real and are happening. I was like, yes, yes, check, check, check. And from a scientific standpoint, these barriers really highlight why the education alone is insufficient because I can tell someone what to do. And you know what? Most people know. Most people know what they should be doing. So education alone is just not enough. So this is where that pivot into really what does sustainable dietary change look like realistically that fits into people's everyday lives? Bum, bum, bum.

Jones: Yes. And that is the best advice you can give. And the other thing, and that's what you just kind of proved, that's why it's really important to meet people where they're at.

Derocha: Yes.

Jones: So we're trying to cookie cutter them into... This reminds me back when I worked as a clinical dietician in the hospital and you had to see so many patients and you're like, "Here's the handout." It was back when the handouts were, you gave them a physical handout. This is how long ago this was, Grace. I don't know what they do now. If they still give them physical handouts, print outs.

Derocha: I don't know, but I think we're about the same because I also did that.

Jones: Yeah. And then you're like, okay. But it was kind of like the same conversation because you didn't have the time to like where you're working with the client one-on-one, you can kind of tailor to that. I don't necessarily feel like I was meeting where they were at at that time.

Derocha: Yeah. And that window of opportunity for learning or soaking that in when you're in the hospital is just not the best. Yeah.

Jones: Especially if you're getting kicked out by a doctor that's like, "I need to talk to the... Who are you again? Dietician? Oh, you've got to go.”

Derocha: The eggs were cold. Yeah.

Jones: Yeah. Yeah, the food's good. Could you order me? Yeah, it was always something like that. So that's kind of interesting that that was brought up, but it's really, really important, like you were saying, to where they're at and kind of tailor that around to them. So the other question I have is how do you help clients stay motivated – because motivation is a really big, important part of this whole process – when progress feels to them slow or imperfect?

Derocha: So I love all these different memes and the photos, but the evidence is very clear. Behavior change is not linear. And people in our minds, we want it to be this upward slope of getting better at everything, including eating and nourishing our bodies, but it's not. It's more like a rollercoaster. There's ebb and flow. So expecting rapid or perfect progress will usually predict that a person is just going to drop out of whatever goals they're kind of trying to attain. So if we can anchor some of that motivation and process goals or action goals and not just the outcomes, that can be really helpful. So instead of, for example, just focusing on weight or cholesterol numbers coming down, maybe celebrating behaviors that have changed like if they added more veggies or if they're cooking more meals at home and research shows that this kind of self-efficacy of the patient, being able to do this and believing change is possible because they're seeing it in these process action goals is really one of the strongest predictors of the long-term success for the long haul. And they're also building healthy habits that are doable for them in their life.

Jones: Yes. You said the magic word, doable. Because a lot of times we're given just in life in general and in dietician when they're counseling, you want to make sure that you're giving them doable goals. And I'm sure when you're counseling somebody, you're checking in with them, is this something that you can do? That's what we're trained to do. And I think that's what falls short in other areas.

Derocha: Yeah. And a lot of times with that, I let them make the goal. You know what I mean? And I also try to normalize some of the plateaus. The tortoise and the hair story is forever infamous because slow progress doesn't mean failure. It often just means your body's adapting and building these habits. And that's what you want to do. That's why we always talk about how fad diets aren't the best thing because it's this short-term, quick, quote-unquote, what people think is a solution, but really it's just something they stop doing later.

Jones: Yes, because it's not sustainable. And that you said you were talking about sustainability earlier, so important. So how about your approach to balancing education with empathy, especially when someone feels stuck or ashamed about their eating habits? I’m sure that comes up frequently.

Derocha: Yeah. Shame. We've talked about it a little bit, shame and the guilt. It really is one of the biggest barriers to behavior change, and the science does back that up. Research and psychology and nutrition show that weight stigma and food shame, increase stress hormones, increase emotional eating, and increase cardiometabolic risk. So if someone is feeling stuck, my first step is usually not to bombard them with more education, like, "This is what you need to know. This is what you need to do." It's really coming to them with empathy and wonder and curiosity.

So I often say things like, "My name is Grace." Everyone can't say this because their name isn't Grace. And I think it's important to give ourselves grace in our day-to-day lives. Or if your name's not grace, maybe something like, "This makes sense given your life right now." And just something that simple to help transition them to feel like they can exhale and give them that simple validation that this is your life right now. This is where you're at. It kind of lowers their defense and hopefully opens the door to learning. And again, keeping them also curious and in wonder of what they could do and what they could accomplish.

Jones: Yes. I'm thinking that it would be really good if your name is Grace, Hope, or Faith, and then that kind of works. But yeah, just in general, I love the language that you provided to people that aren't named Grace, Hope, and Faith to utilize when they're doing this because it's one of the crucial things, the empathy piece. And I think that's what really helps the clients and patients come along the ride with you in terms of making better changes and having a better outcome in the end and being able to make it a lifestyle change, not a diet. And I like your point about fad diets and this is why they don't work.

Derocha: Yeah. And problem solving together rather than me prescribing any rules. And I think framing science as a tool instead of a judgment is also helpful way to kind of look at it when you're trying to meet them where they are and really help them through their process. And sometimes I even ask for permission before I start sharing any education because maybe they're just not ready. They're not ready to hear that yet because then they feel like, so am I supposed to be doing that? Nowhere near that yet. You know what I mean?

Jones: Yeah. So we're giving everyone Grace, you, today, but also give yourself grace. So that's a great key message, a takeaway message. Another question I have is how can dieticians maintain the cultural relevance and flexibility while still aligning with heart healthy guidelines? Because that's what we're talking about today. That's this whole topic, heart healthy guidelines.

Derocha: Yeah. Research does show that culturally adapting nutrition counseling leads to better adherence and then in the long run, improved cardiometabolic outcomes. So coming back to, I use an approach of definitely honoring traditional foods first. So again, being Filipino American, I eat rice and yes, and a lot of times it's white, but if you told my mom that she couldn't have white rice, you've lost her. Do you know what I mean? So with that, many cultural diets do have great nutrition, as does any cultural and traditional food scope. So there are rich beans, there's veggies, there's whole grains, there's herbs, there's plant oils, and these definitely can align with how we can be protective of someone's cardiovascular health.

So avoid labeling cultural foods as unhealthy, definitely don't do that. Often it's kind of that shift in noting this is a traditional dish and something that I enjoy. And also sometimes what is in this that is offering some good nutrition for them and reminding them of that because a lot of times they've heard so much like, "Oh, I can't have that because it's bad or it's unhealthy even though it's a part of my culture." Focus on how you prepare things too. So I think a lot of people forget this is that you could take a food that's considered healthy or more nourishing or nutritious and then bread it and deep fry it. Do you know what I mean? So thinking about preparation methods and how we can balance some of those instead of eliminating the food completely is a great way to kind of look at it, staying flexible. Again, I love that word and just reminding ourselves that there are ways to kind of work with cultural and traditional foods and then use that fusion of how to make them a little bit more nourishing or cook them in a healthier way.

And again, patterns rather than rules, adapting to what the culture and access and preferences are for someone and what their values look like. And then also the piggyback off of this that I think is important that sometimes people don't tap into is then what is that individual person's health goals? And then how can you guys look at that full picture to try to accomplish some of those through process, but also keeping that honor of tradition and culture alive?

Jones: Yeah. You brought up a really good point earlier. We were talking about curiosity, but curiosity ties in here as well. And as you were leading us through that, it reminds me of dieticians are kind of like detectives, right? We're going and finding out about the person's culture because maybe as the dietician with that, you don't know about their culture and you're learning about it, but you're also learning about, okay, what do they like to eat in their culture and how can I help them continue to eat it, but maybe in a different way by tweaking a few things? And that's where the detective dietician skills come in, I think because you're curious and you're remaining curious and open to it rather than saying, "Okay, well, here's the food, here's the menu that you need to follow." And they're like, "What?”

Derocha: “I’m right, you’re wrong.” Yeah, exactly. “This is what you’re eating” and we know nothing about what they like.  

Jones: Yes. Well, thank you so much, Grace, for helping us figure out how to meet clients where they are and for sharing your insight, energy, and heart with us today. And thanks to our listeners for joining this episode of Nutrition411: The Podcast.