Food and Nutrition During COVID-19

September 29, 2020

COVID-19 has impacted nearly every aspect of our lives – from virtual classrooms to telecommuting to isolation and quarantine. While following public health measures is important to reduce the spread of the virus, we don’t know how long these safety measures will be in place.

But you can still take care of and protect and improve your health and that of your family – and good nutrition is one way, said Suzanne Henson, a registered dietitian at University Medical Center and assistant professor of family, internal, and rural medicine at The University of Alabama College of Community Health Sciences, which operates UMC.

Henson said food and nutrition during COVID-19 has provided another benefit – family mealtimes. Family might be mom and dad, it might be child and grandparent, it might be child and aunt, “but to sit and have a meal and actually talk to somebody is one of the most positive things you can do for building the best food habits long term,” she said.

Henson sat down recently with Dr. Tom Weida, UMC’s chief medical officer and professor of family medicine, to talk about food and nutrition during COVID-19.

TW: Tell us a little bit about yourself.

SH: I’ve been in the Tuscaloosa community and around it for longer than I care to admit but going on about 31 years. I am a registered dietitian and have served University Medical Center patients for five and a half years now. I’ve actually been a dietitian for 21 years. I started out as a reporter at our local Tuscaloosa News (newspaper) and that actually prompted my interest in food and nutrition and led me to where I am today. I was a reporter in the early 1990s when Food Network had just debuted, and I ended up doing food and health stories for the Tuscaloosa News, which was fantastic because it led to my interest in becoming a dietitian.

TW: What kind of training goes into being a registered dietitian?

SH: Just as other health-care professionals, registered dietitians have coursework they complete, as well as clinical training. For registered dietitians, they have been through a four-year program with a foundation in sciences, and then they go on to complete 1,200 hours of training in community nutrition – working in public health departments, in our schools and our school nutrition services, in the hospital setting and, as I work in, the out-patient setting. Effective in 2024, dietitians must have a master’s degree to enter the profession.

TW: You have LD behind your name. Can you explain what that is?

SH: We are fortunate in the state of Alabama that dietitians have to be licensed. We have a board of examiners for licensing dietitians. We believe it protects consumers because before a dietitian can talk to a patient, even though he or she has passed their boards, they must become licensed. A board reviews their application and approves them to be licensed to practice.

TW: Tell us about the board examinations.

SH: Just like physicians pass board exams, dietitians have to sit for the registration examination. And once they pass that they have to maintain continuing education.

TW: What does a dietitian do?

SH: Dietitians work in a variety of fields. I’ve been fortunate to work in the food publishing industry as well as in education and I’m now working as an outpatient dietitian. Other dietitians work at the hospital treating patients. We also have dietitians who work in public health departments, as well as in schools and with school food service operations.

TW: What is the need or demand for dietitians?

SH: There’s been a huge demand within the last decade from students wanting to enter the profession. We’re needed because we take a look at what physicians and other health-care professionals don’t have time to take a look at. The physicians I work with at University Medical Center, they may deliver that diagnosis of Type 2 diabetes, but I have the benefit of spending 30-45 minutes with that patient learning about what they drink, what they eat, what their lifestyle is like, how much they can afford for food, how well they know how to prepare food and to shop for food. We help fill in a gap, at least in the outpatient setting. In the hospital, what we call the inpatient setting, dietitians are screening those patients who are at greatest risk and also working with patients in the intensive care unit and helping to monitor their care.

TW: In the hospital, do dietitians prepare the menu selections for food prepared in the hospital?

SH: That would be one role, but direct patient care is what so many dietitians do. Dietitians also work in food service operations within hospitals and they’re looking at not just what food is served but how safely is it prepared and how safely is it served.

TW: During medical school training, we might get one lecture on nutrition. Your 1,200 hours is a lot better than that.

SH: And nutrition changes so much, the information changes so often. I remember when I was training in the mid-to-late 1990s, what we would recommend to someone is very different from what we would recommend today. As new science emerges, we can tailor our recommendations based on that new, emerging information.

TW: Why do patients come to you for help?

SH: I love what I do because patients can come to me and I get the benefit of a little bit more time with them and knowing what questions to ask. I can take a look at what somebody’s lifestyle is like, who they live with, if anyone, who does the food shopping, or do they pick up food. Looking at all these factors I can help somebody, as any outpatient dietitian can, and really try to see where we can make some small changes that can help them achieve their health goals – maybe get off some medications and just feel better.

TW: Prior to COVID, you did grocery store tours. Tell us about that.

SH: That was a lot of fun and I’ve missed that these past six months during COVID. We would go to local stores and I would spend about an hour to an hour and a half taking our patients around the store looking at food labels – where is sugar lurking in foods that you wouldn’t expect. Those of us who remember the fat-free craze of the 1980s and the early 1990s might still have that mindset that fat-free ranch dressing is a good choice. Actually, it’s just loaded with sugar. So, we would go around the store and take a look at items. One of the things I’ve heard my entire career, and I know every dietitian has, is that it’s expensive to eat healthy. I really want to break away from that idea because you can spend as much as you want to on food, or as little as you want to, and I promise you can have a healthy diet. You can have great health and not spend a lot of money. That’s one thing on those grocery store tours that we focus on teaching our patients. We also show people who have certain conditions – for example, rheumatoid arthritis in your hands that makes it hurt to try and cut anything, or patients with diabetes who have neuropathy where they’ve lost sensation in their fingers – I can provide tips for how to choose foods, like frozen vegetables not in a sauce and pre-cut and that are inexpensive and perfectly healthy. I can show how we can put that together so that there is ease of preparation as well as an enjoyable meal that didn’t cost much.

TW: Are there diseases that might be associated with poor nutrition?

SH: We typically see that in a lot of our chronic diseases, for example, Type 2 diabetes and hypertension, or high blood pressure. Those are the two I see most commonly. We know that blood pressure for many people begins to rise as they age. So, if you’re somebody who chooses to do more fast food and takeout, where are you getting the majority of excess salt in your diet? What are some other choices we can make to help reduce that and help get that blood pressure down into a safe zone? Blood pressure is something you don’t feel until it’s almost too late. I have many patients who say to me, ‘I know my doctor said my blood pressure reads this, but I don’t feel it.’ And you probably won’t. But we don’t want to get it to the point that you do feel it because then it’s at a dangerous level.

TW: Can we catch COVID from food?

SH: No, we cannot catch COVID from food.

TW: Have you noticed with COVID that there’s been a change in patients’ nutrition and how they have been eating?

SH: Absolutely. I’ve noticed it certainly in our adult population and I’ve really noticed it in our children, in our pediatric population. Children were at home, some still are, and what does any person do when they’re at home all the time and they’re not out doing things? You tend to snack more, and you tend to eat things you wouldn’t normally eat. We’ve definitely seen some changes in children who’ve been gaining weight over the past six months as they were completing virtual schooling, or parents didn’t feel good about them meeting up with friends, and that’s been a concern. It’s been the same with adults. I’ve been at home, I’m snacking more, I’m eating more or I’m stress eating because everything is so unknown and unpredictable right now. Even a change in your occupation can have an impact. I have patients who were active on their jobs but when the stay-at-home order occurred, which we needed, and they were at home all the time and weren’t moving as much their blood sugar numbers that looked beautiful at the beginning of March were climbing. There’s definitely been an effect of all that’s happened with COVID on the nutrition of the patients I work with.

TW: I noticed early on that when I went to the grocery store, I couldn’t find any flour or yeast. Everybody was making bread.

SH: In January and February and every month prior, I had been trying to get people to cook simple meals. I don’t even use the word cook, it’s more like, ‘We’re going to throw it together.’ And I go to the grocery store myself and I’m like, ‘Why is everybody baking bread all of a sudden?’ We’ve seen some interesting food outcomes with COVID. One major food manufacturer who produces macaroni and cheese, which is typically thought of as a side dish for lunch or dinner, is rebranding the product to be a breakfast item because children were at home and parents weren’t grabbing cereal to get out the door and weren’t going through drive throughs for breakfast but, rather, they were eating leftovers. So, one food company is really capitalizing on that.

TW: Is it better to eat at home, or better to get takeout?

SH: It depends, and I say this COVID or not, on what your lifestyle is like, what you feel comfortable doing. If you don’t enjoy cooking, then let’s look at other options for how we can put meals together, how we can simplify things. If you’re someone who has been going to work a good bit during COVID and maybe you’re taking on extra duties that you didn’t have pre-mid-March, then takeout might be a better option for you on some days. I think it just depends on the situation and what’s the best for you or your family depending on who you’re putting meals together for.

TW: How do you balance teaching a child who is at home, trying to do your job and now you’ve got to cook to?

SH: I’ve had colleagues tell me, ‘I’ve become a short-order cook, I’ve become a teaching assistant and I’m also trying to do my full-time job.’ I have friends in my field who are doing more batch cooking, things they could have a lot of and space it out either into multiple meals or use it for different meals. I encourage my patients, as well as friends and colleagues and myself – give yourself some grace. For me, Friday night is always pizza night. I pick up an individual pizza, take it home, maybe through some extra veggies and cheese on it and put it in the oven. I don’t have to cook, and I’m somebody who loves to cook and cooks most nights, but Friday night, that’s my pizza night.

TW: So, cooking in batches means leftovers. How do you disguise the leftovers?

SH: Maybe you make a whole chicken. One night, you have chicken with a side of rice and some microwave vegetables. The next night you do skillet or sheet pan nachos. Take some tortilla chips, shred that chicken over it, add some cheese, it would be great to throw on some extra veggies, grab a jar of salsa and you have dinner.

TW: What about children? Does it help to have them on a structure for their meals if they’re at home all day, or let them eat whenever they’re hungry?

SH: Again, I would say COVID or no COVID, children really do well with structure. That’s been a challenge and I appreciate what parents have been through because, depending on their situation, many are trying to help children with virtual school and trying to do their own jobs. But giving children structure works so well for them. So, have a structured breakfast time before when school starts. I would ask my pediatric patients and their families, ‘When would have been your lunch time? Then let’s plan to have lunch at that time. Did you have a snack time? Let’s plan that so you have a dedicated snack time.’ Then it’s not a situation where you step away from the computer and run into the kitchen.

TW: With COVID, are there any nutritional tips to either help treat COVID or to prevent getting COVID?

SH: Continue what you have been doing, which is to try and have the best habits possible as much of the week as possible because it’s what you do most consistently that makes the biggest difference. Take a look at what you’re doing. Has that changed? Because we are all wearing face masks, how well are you hydrating? Are you drinking water? I had to make a point, when I realized I was getting dehydrated, of drinking larger bottles of water when I was home or when I wasn’t needing to wear the mask, in the car for example. These things will help you feel better, keep your immune system up and give you a greater sense of wellness.

TW: Do you think that COVID-19 has affected the overall nutritional health of our community? Has it been better, worse?

SH: I think COVID has impacted all aspects of our lives. From the nutritional, absolutely, because all of a sudden people were at home and are at home, as well as to the mental health effects of being in isolation. Even patients I work with who live in a residential community and who were accustomed to going out to eat once a week with others in their setting couldn’t do that any longer. That sense of isolation also had a great impact for our older adult patients who could not visit with relatives or see grandchildren. I think we’re all trying to find what is the new normal and then work through that. I had some very positive comments from patients and from students I worked with in the spring and they said, ‘We’ve found that as a family, we were eating together for the first time, that we were actually having a family meal and talking to each other.’ I think that’s one of the best things that has come out of this. We know one of the best things for children, and research has repeatedly shown this, is to have mealtime with family. Family might not be mom and dad, it might be child and grandparent, it might be child and aunt. But to sit and have a meal, screens off and away and actually talk to somebody, is one of the most positive things you can do for building the best food habits long term.