An Interview with Smitha Suresh, a Clinical Dietician (Part 2)

How much of an impact do you think nutrition has on a person?

I think nutrition has a huge impact. There is a saying that says, “you are what you eat,” so pretty much if you are not eating a well-balanced diet, you can see the symptoms of malnutrition. If you are limiting certain food groups, you can see that you are deficient in certain things. Nutrition is very important. People who are eating a lot of fast food and things like that, you can they don’t have long-term energy and are at high risk for diseases. So nutrition makes it or breaks it for you. If you eat healthily and have a healthy lifestyle, you can live a very long life. But if you don’t take care of yourself by not making good eating choices then you are at risk for developing a lot of diseases.

As a dietician, what signs do you look out for in your patient if they have unhealthy eating habits, how do you identify those?

So, we have a lot of sugar criteria. For example, when the patient comes into the hospital, we look at their height and weight. We also look at their skin, if they have any muscle wasting, fat wasting, or malnourished nutrition. We also look at their paleness or if they’re deficient in iron. There are a lot of other signs and symptoms of vitamin deficiencies that we look out for. It all depends on the height and weight and the DMI of the patient. If they look well-nourished, then we do an assessment based on that. We ask the patient what their eating habits are, and we do something called a 24-hour recall, which is like a food questionnaire of how their day-to-day eating habits are. Then, we ask them about their weight status has been, if they eat out a lot, and how much water they drink. So there are a series of questions that we usually ask a patient before we do an assessment. Many patients have wounds, pressure ulcers, skin breakdowns, eating problems, or swallowing problems, soo those are all conditions that may cause your intakes to vary. If they have issues with swallowing, they’re not able to eat as much, so that is a high risk for us. If they have skin deficiency or skin breakdowns, they need more protein and vitamins to heal. There are a lot of different criteria we look at, but typically when you do an assessment, you start with their height and weight and a food questionnaire or a 24-hour recall.

When do you think it is most beneficial to go to a dietician after a doctor recommends you do, or on your account?

You can go for different reasons to a dietician. You can always go to a dietician if you’re diagnosed with acute illnesses, as a doctor may recommend that you go to a dietician. I have also seen patients who ask the doctor for a referral to go to a dietician because they want to know what they should be eating or how to eat a balanced diet. Dieticians also work closely with different populations like neonates and the neonatal unit. We work a lot with kids who have difficulty eating or swallowing and things like that. So there are different reasons why you would go to a dietician, mostly it’s through a doctor’s referral.

With COVID-19, has there been a change with the diets you recommend now?

A lot of patients, because of the pandemic, have very low appetites. That’s one of the things we have seen with COVID. People lose their sense of smell, taste, and appetite, so people are not eating when they’re battling the disease. Therefore, we try to focus on if they are eating a healthy, well-balanced diet. Many patients, if they have respiratory distress and incubated, then they are not able to eat. Because of that, they are on tube feeding, and that optimal nutrition early on is very important for any healing process, whether it be trauma or a pandemic. So our focus has been to feed the patient at the right time, so they get the benefit of being able to fight the infection with optimal nutrition.

Has any patient come to you with an eating disorder? If so, how did you address it or change their diet plan? Or has anyone come to you to change their diet plan to fit beauty standards, specifically?

Since I work in a hospital, patients are there already because they have a psych disease. So, eating disorders are not as much of an eating problem, it is more of a psychiatric disease. It is psycho-social. I have not seen patients who come to me in person since I work in a hospital. They are admitted there automatically, but when I talk to them, they have questions about their body image. So it’s significant as a dietician that I gain their trust, first of all, in identifying that they have a psychiatric issue and not penalizing them for doing anything wrong. I start with the basics and educate them on the significance of nutrition and why eating a healthy diet is significant. In our patient setting, you will have patients come to you asking those things. But in a hospital scenario, I’ve not had anybody that comes to me specifically for that. However, in discussion with them, I have talked about these things.

Do you have any recommendations for patients with eating disorders and how do you give them a diet plan that helps them with their disease and eating disorder at the same time? 

So, with an eating disorder, it’s not an eating problem, per se. I usually only recommend a healthy, balanced diet. I go down with every food category. First of all, there’s something called a food pyramid, where you have different food groups. So I start with every food group and explain the benefits of that food group. For example, you need fiber and grains for your gut health and protein for your muscle. So I go down every food group and explain the importance of that, but again with eating disorders, it’s not just diet, it’s also the psychiatric treatment that’s necessary. So they have to be treated in an incubation setting with psychotropic medication.

Do you have any final thoughts about nutrition or anything you want to share?

All I have to say as a dietician again is that it is not just right now that you have to worry about, it is long term. So, you may fit current beauty standards now, but those implications of you not eating healthy will cause a major effect on you when you become 40 or 50. You will have nutrition deficiencies and ailments that may decrease your quality of life when you get older or now. Those things and those decisions you make can have a long-term effect on your health. So be careful about that.