Monday, August 31, 2015: My main preceptor is on vacation all week, so I had to do a little switching around of my schedule this week. I didn’t have anywhere to go today, so I spent a good portion of the day working on restructuring a COPD nutritional handout, reading through some academic articles, and sorting through/reviewing disorders and such. 
Tuesday, September 1, 2015: I got placed at a Weight Management Clinic Tues.-Thurs. of this week and today was my first day. If you saw my instagram post about it, then you know that I LOVED it. Seriously, it was such a great environment. The RDs (there are 2 full time, 1 part time) and the rest of the interdisciplinary team (the MD, PA, social worker, psychologist, RNs, and MAs) were all very warm and welcoming. It also helped that the RD went to UGA for her undergrad, AND did her internship through WCU, too! Seriously, finding another UGA grad in Asheville is like finding water in a desert. We bonded immediately after that, not to mention that she was already super personable in the first place. As for the patients, they were nothing like I expected. But before I get to that, let me give a little background…
The Weight Management Clinic focuses on both medical and surgical weight loss, so either medical meal replacement programs, or bariatric surgery (aka gastric bypass or the sleeve). Patients must be referred to the clinic by their primary care provider. There are a few contraindications to beginning either program. In terms of the medical meal replacement program for instance, age, certain health conditions and disorders may serve as a risk factor that needs to be addressed prior to beginning the program. In terms of the surgical options, being younger than 18 or older than 70, having a BMI >65, and having other comorbidities or disorders can serve as risk factors to be addressed.
Okay, so back to the patients. When I say they were nothing like I expected, I mean that they were absolutely amazing, and truly inspiring. Every single one that I got to see, either in patient interviews or classes, displayed such high levels of motivation and determination that I couldn’t stop smiling. They are continually working so hard to lose weight, stick to their meal plan, engage in physical activity, and address the other social, environmental, and behavioral factors that go into successful weight loss and a healthy relationship with food.
In general, I feel like many people hold a negative view towards “shakes” or “meal replacements”. Why would a dietitian “prescribe” these to a patient? Don’t we always tout and encourage consumption of real, whole foods?? Yes. Yes, that is usually the case, but not always. For some people, food has become more than just a source of nutrients and energy to allow for the body to function. For some, food has become a drug, a crutch, a reward. So much so, that they no longer hold a realistic and “healthy” view of it. In these instances, these “shakes” or “meal replacement” products can be substituted in for food and meals, either entirely, or partially. The products offered through the medical weight management program differ from the products you might find over the counter in that the products in the program supply all the vitamins, minerals and nutrients that our bodies need to survive. Over the counter products are more of a supplement, whereas these are a true replacement.
Patients in the medical weight management program will consume 5-6 products daily, for 12 weeks, until slowly reintroducing real, whole foods back into their diet. Within the 12 weeks, they are focusing more of their attention on the psychosocial, environmental, and behavioral factors that have an effect on the way they eat. The 12 week period is referred to as Active Weight Loss, while the 5 weeks after, where foods are reintroduced, is deemed Transition. Maintenance (deemed MEDAL) is the last step, and is available for as long as patients desire follow up. I’ll stop here before I write a novel that is probably boring most of y’all to tears, but it truly was such a great experience that even opened my eyes as well.
Wednesday, September 2, 2015: Another long 10+ hour day at the Weight Management Clinic today, but it flew by! I got to sit in on more patient appointments, counseling sessions, and group meetings for both medical and surgical weight loss patients. These sessions ranged from post-op follow up, free information sessions, initial medical and surgical sessions, monthly MEDAL one on one meetings (required for first 6 months after program is complete), Active Weight Loss weekly meetings, as well as weekly Transition meetings.
Thursday, September 3, 2015: My last day with Weight Management š They were actually short on staff today, so I got to assist in the weekly weight checks for the medical weight loss patients! I had such a wonderful experience these last 3 days. I saw close to 15 different individual patient counseling sessions, and learned something new during each one. I became more aware of my own eating habits and how my emotions and environment can stimulate my appetite, even when I’m not hungry. I loved how this rotation with weight management relied so much on interdisciplinary work between the RDs and the rest of the clinicians. It seems as if more people are realizing that weight issues are complex, and don’t just stem from one cause. I felt more comfortable in the outpatient setting here, as I loved getting to know patients on an individual basis and being able to follow them over an extended period of time. Some patients have been coming to the monthly MEDAL meetings for over 5 years! I was sad to leave at the end of the day, but am certain many other awesome rotations will come my way soon enough.
Friday, September 4, 2015: Having worked 10-12 hour days Tuesday-Thursday, and working close to 6 on Monday, I only had around 2 hours of independent work to do today to fulfill my 40 hours. I did some research on some additional weight management and bariatric information, as well as searched through the Nutrition Care Manual and its seemingly 1000 sections. Talk about information overload!
This wasn’t exactly a traditional week of rotations, but I feel like I gained so much knowledge and insight in an area of the field I had never really considered. I will be back at the hospital working mainly inpatient next week, where I hope to gain the comfort and confidence I had in outpatient this week. Second week on my internship, DONE!