New Certificate Program Teaches Dietitians Skills to Elicit Change

Cornell University’s director of wellness, Beth McKinney, has developed an online certificate program for registered dietitian nutritionists. The Nutrition Counseling certificate provides RDNs with client-directed counseling techniques they can use to elicit clients’ best thinking and results. Each course in the program provides six Continuing Professional Education (CPE) units for a total of 24 CPEs.

McKinney, a certified health education specialist and RDN who teaches an undergraduate course called Nutrition Communications and Counseling to upper level dietetics majors, has distilled her experience, and social cognitive learning theory, into an online program that allows RDNs to systematically learn, practice and hone their counseling skills.

“There’s a gap between the nutrition knowledge we learn in school and our ability to help clients make real changes. Even if most RDNs learned client-directed counseling, many haven’t had sufficient opportunities to practice it. These courses provide not only the techniques to transform behavior, but also videos in which practitioners can see counseling in action,” said McKinney, MSEd, RDN, CHES.

The Nutrition Counseling certificate, offered through eCornell, is comprised of four online courses that can be completed in three to five hours per week:

  • Getting into the client-directed counseling mindset with tools to develop self-awareness.
  • Mastering new, empathic ways to respond to clients that elicit more information and uncover problems from their perspective.
  • Motivational goal setting techniques that bring out clients’ best thinking.
  • Translating nutrition information to diverse clientele, using your authentic voice.

The program is open only to RDNs in the U.S. Students who complete all courses receive a Nutrition Counseling certificate from Cornell’s Division of Nutritional Sciences.

Want to Lose Weight? Drop the Diet and Get One of These.

The world is in the grips of an obesity epidemic. The UN’s Food and Agriculture Organization warned last year that “adult obesity is rising everywhere at an accelerated pace.” Some 640 million adults worldwide are now considered obese, or roughly 13 percent of the global adult population.  

As part of our Expanding Nutrition Frontiers webcast series, eCornell’s Chris Wofford was joined by professor David Levitsky from the Division of Nutritional Sciences at Cornell University to discuss why so many of us are putting on extra weight and what can be done about it.

Wofford: David, we’ll get into the solutions later but let’s start by talking about the problem. What is age-related weight gain? What is happening physiologically?

Levitsky: Well, I think age-related weight gain is perhaps the most serious medical problem in our country and maybe the world. Age-related weight gain is weight gain that occurs after you stop growing vertically. So after about 18 years of age, you continue to gain weight without growing taller. That age-related weight and the rate at which you gain the weight are the best predictors of whether you’re going to suffer from diabetes, hypertension, heart disease, stroke and many kinds of cancers.

Wofford: I was doing a little bit of research before this and I read that our muscle fiber tissues begin to disappear to some degree and get replaced with fat. Is there a biological reason for that?

Levitsky: Well, the decrease in muscle mass really doesn’t occur until middle age, your 50s or 60s. And it’s not that the muscle is replaced by fat, we’re just adding fat. Most of that weight gain is due to the fact we consume more calories than we expend. Simple as that. Despite all the hundreds of diet books out there teaching all kinds of magic, it is simple energetics.

Now we can ask why we are consuming more calories than we expend… My colleagues and I agree that we live in an environment in which we are surrounded by signals that make it easy. In psychology, we call this priming. So if we see food, it actually makes us want to eat. And we have experimental data showing that if you see people eating, you want to eat. When we see a television commercial containing food, we’ll get up and go to the refrigerator to get something to eat. We are totally surrounded by these stimuli and what is referred to as an obesogenic environment.

It’s obesogenic because simply responding to all the stimuli in the environment causes us to gain weight. And that’s the reason we’re gaining weight as we get older. We’re subjected to more and more of these stimuli and we’re going to respond by eating just a little bit more than we expend.

Wofford: Let’s back up a little bit and talk about your experience as it relates to psychology and nutrition, and the experiment that you conducted several years ago related to weight gain and how it might be prevented.

Levitsky: Okay. This all started for me when I was sitting in my office and I had someone pop in and say that they wanted to study “the freshman 15”, which is the idea that college students gain around 15 pounds during their first year. It turns out it’s less than that – more like 5 pounds – but the problem is real. Nobody was really studying it so I said, “Okay, go ahead and look at it.”

So we gave freshmen scales at the beginning of the semester, had them weigh themselves at the beginning the semester and again at the end of the semester, and by then they had gained about 5 pounds here at Cornell. We didn’t really believe it was real, so I got very excited about these findings because it represented an opportunity to study techniques to try and prevent that weight gain.

The most logical way to lose weight is to say, “I’m just going to reduce my calories by 200 per day.” Diets have been around forever, and forever they’ve shown that they don’t work for the vast majority of people.

They’re still responding to the stimuli in their environment and it gets more and more difficult the more weight you lose. So the traditional way of concentrating on caloric intake fails.

Wofford: Nothing new there. Okay, so you’re doing this study and discover that the freshman 15 – or maybe the freshman 5 – is real. What’s next?

Levitsky: My training is in psychology and it’s in a certain kind of psychology called behaviorism, which is a discipline that’s simply dedicated to your behavior in certain situations. In order to change behavior, you have to have some monitor of that behavior. When it comes to weight, that monitor can simply be stepping on a scale.

So the first thing we tried was to give freshmen scales and ask them to weigh themselves every day and keep a graph of their weight. We found that those who followed through and weighed themselves did not gain weight while those who didn’t follow through gained two and a half kilos. I did not believe it the first time we did the experiment so we replicated it the following year and the results were very clear: those who weighed themselves every day and had a record of their weight in the form of a graph do not gain weight.

But of course, college students do not represent the population so we then used older people at a health center for a two-year study and again, those who continually monitored themselves actually lost weight.

Now we have a project that we’ve just started here at Cornell, working with the staff because neither students nor people who belong to a health club are representative of the population. We’ve recruited staff from the groundskeepers to the police force here — wherever we could find real people who are more representative of the population — and half of them have scales and half of them do not. We weigh everybody at the beginning and we weigh everybody at the end. Our hypothesis is that people who weigh themselves regularly won’t see a weight gain. We’ll have to wait and see how it turns out.

Wofford: What is happening from a behavioral psychology standpoint? When they look at this weight graph, what is happening in their minds? How does that affect what they do?

Levitsky: Well, there are actually three hypotheses that we have been entertaining as to how this works. The first is that it is simply having the information. They look at the scale and say, “Oh, 155 pounds is too much for me.”

A second possibility is that it works as reinforcement. If you see yourself losing weight, you say, “Oh wow, that makes me feel good” and then you are going to reinforce those behaviors that made you lose weight. That is also a possibility but I’m not holding my breath that either one of these two hypotheses will work.

I prefer to consider the third hypothesis, which is based on priming. Just like when you see food and it makes you want to eat that food, we are working on a priming idea where just stepping on a scale is a primer for all the health information that you already know. You know what to eat, you know how you should behave but you need something to stimulate you. I think that is what happens on the scale.

We have done a number of studies in our laboratory where we bring people in for a focus group. Well, we tell them it is a focus group, but it’s not really. We put snack food in front of them and then sometimes we show them advertisements for cars or how beautiful it here is in the Finger Lakes and sometimes we show them food commercials. When we show them the food commercials, they consume considerably more than if we show them a food-neutral stimulus.

But when you have them weigh themselves just before they go in – we don’t tell them anything about why we’re weighing them, we just get their weight – they consumed considerably less.

Wofford: Even though they’re exposed to the same amount of stimuli.

Levitsky: Right, the stimuli is the same but stepping on that scale changes the way you react to things.

Wofford: I’d like to turn to the audience and get them involved. We have a question here from Christine, who says, “I have been stepping on the scale every day for years and I run three to four miles three times per week and yet I have gained at least 10 pounds.” Is this where we get into the issue of the quality of the calories?

Levitsky: Well, stepping on the scale does not produce magic. It should be a means of informing you of where you are. If she’s gained ten pounds over a few years, she can reverse it by making changes to her eating. You have to change something. If you can live without desserts, without snacks or with smaller portions, these are all good techniques to cause that negative energy balance to get you to lose weight. The only thing I would warn her is try not to lose that ten pounds overnight. She has to think of it in terms of a slow return back to her weight and she can do it. I mean, running 10 to 15 miles is no small thing.

Wofford: I’ve got a question here from Marsha. She says, “I weigh myself every day and work out at the gym every day but I could also use a calorie counter app on my phone. I feel like keeping track of the calories is the most influential in my weight control.”

Levitsky: Calorie trackers work but the problem with the trackers, whether it’s movement trackers or diet trackers, is that most people can’t keep that up for long periods of time. People don’t have room for extra things in their lives and inputting that information is an extra thing. That’s why I tell people in our studies to put their scale right by their bed. You get out of bed and step right on that scale and it takes two seconds to get a measurement, but it’s nothing extra you have to add into your life.

Wofford: Erica asks: “Do you believe that weight loss is about 80 percent of what you put in your mouth and 20 percent physical activities?” Is this a common metric?

Levitsky: There are a lot of reasons why people should exercise. However, and I hate to tell you this, exercise has very little effect on what you weigh. The reason is that the body is so efficient that when you go out and spend that energy and then come back and rest, your metabolic rate after you rest actually goes down lower than it would have had you not exercised. So, exercise doesn’t benefit your weight. It does, however, benefit your risk of heart disease, the prevention of diabetes, and the prevention of stroke and cancers.

Wofford: OK, so exercise isn’t going to get you there. It’s all about what you eat?

Levitsky: I strongly recommend that if you try to lose weight, it should be done very slowly. You should lose weight probably at no greater than one percent decrements. So you see what your weight is and then set a goal for a weight at no more than one percent lower than that for whatever time period you need. You need to take it one step at a time. Some people could do it immediately, while for others it will take them a while to figure out that maybe they can’t live without that afternoon snack. And that’s fine. You just try something else like lowering your portion sizes or skipping dessert. You figure out what works for you and then you try to get to that lower value. Once you discover you can live with whatever change you made, then you make another change. You go down another one percent.

I don’t recommend that anybody get below 10 percent weight loss. At 10 percent, you can reverse things like diabetes and lower blood pressure. All of the beneficial effects of weight loss occur at a maximum of about 10 percent weight loss. That’s all you need in order to improve your health. Now, if you want to lose it for other reasons, aesthetic reasons or whatever, that’s another matter.

Wofford: Another question from the audience focuses on so-called good calories versus bad ones. Do you have any thoughts on this?

Levitsky: Healthy food will do the most to reduce your caloric intake. Low fat foods will clearly decrease your caloric intake. If you reduce the portion size, you’ll be satisfied with less food. If you can do without the potatoes, without the the carbs, fine. Are there good carbs, bad carbs or good calories? It makes a great title for a book, but the nutritional science says that a calorie is a calorie.

Wofford: We’ve discussed weight solutions for individuals but is there anything we can do as a society to address this problem?

Levitsky: I think the scale is the most healthy tool that you can use, so why not give out scales? Let the government give out scales to those who want one. It will be cheap for them. It would cost them probably about $50 a scale and they could save millions if they could prevent you from getting diabetes or hypertension.

A number of my colleagues believe that the government should step in and curb food commercials, particularly ones targeting children. I mean, it sounds reasonable but I am very skeptical because the food industry is perhaps one of the most powerful lobbies in Washington.

Wofford: What’s next for you? Are there any new weight-related research projects you’re working on?

Levitsky: My dream experiment that I’ve been trying to do for a while is to work with obese children. We know that if you don’t do anything to help a pre-adolescent obese child, they will become an obese adolescent. We also know that if you do nothing once you’ve become an obese adolescent, you are going to maintain that obesity throughout your life. The chances aren’t just extremely high, it is almost a certainty.

So what I want to do is take these pre-obese children and give them and their family scales and see if we can we get these children to grow at a slightly reduced rate by watching their weight. Could that get them into their adolescence in a non-obese state? That’s where I would like to go but I’m still trying to get funds.

Wofford: That’s a noble cause. Isn’t the obesity rate among children something shocking – like over 20 percent?

Levitsky: It is and what is more shocking is the rate at which it’s increasing. The actual rate of child obesity is lower than adult obesity but the rate at which they’re getting fatter is what’s really threatening. And that’s what I want to prevent.

Wofford: We all wish you the best of luck with that. I want to thank the audience for coming today. And thank you David, this has been illuminating for me. I’ve learned a lot today in the short time that we’ve been together.

Levitsky: My pleasure. Thank you.

 

Want to hear more? This interview is based on David Levitsky’s live eCornell WebSeries event, The Only Weigh to Prevent Age-Related Weight GainSubscribe now to gain access to a recording of this event and other Expanding Nutrition Frontiers topics. 

Does Your Environment Impact What You Eat?

How to Improve Healthy Eating and Active Living in Rural Communities

America is in the grips of an obesity epidemic. While it may be tempting to lay the blame on personal choices, the reality is much more complicated. It’s hard to live healthily when you have limited nutritious food options nearby or if your community does not provide the types of environmental features that promote physical activity.

As part of our Expanding Nutrition Frontiers WebCast series, Chris Wofford was joined by Rebecca Seguin, an associate professor in Cornell University’s College of Human Ecology, to discuss healthy living in rural communities.

Wofford: Rebecca, what is the current state of affairs when it comes to healthy eating and active living? Why is this something we should be concerned about?

Seguin: I think everybody knows that we have a major problem with the number of overweight and obese Americans. Two out of three adults are overweight, and that is certainly problematic in and of itself. But it also carries all of these additional risks like cardiovascular disease, diabetes, and some types of cancer.

We also have a major epidemic of child obesity, with one in three children being overweight or obese and about one in five children qualifying as actually obese. We know that if individuals are overweight as children, they are more likely to be overweight or obese as adults and that will then carry through all these additional health risks. If current trends continue, the next generation will be the first to die younger and sicker than their parents.

We know that while individuals make their own decisions about what they eat and what they do, they are part of social and physical environments that influence them both negatively and positively. So we need to better understand the features of those environments so we can help guide people towards making healthier living choices.

We can also influence policy at the local, state, and federal levels in terms of policies and guidelines that can help people make better choices and live healthier lives.

Wofford: Can you give us an example of how the physical environment in rural communities affects healthy living?

Seguin: There’s a town in Pennsylvania that we’ve worked with that’s fascinating. There’s a sort of a triangle in the middle of these two state highways and the community center and school are sandwiched in between. You have residential communities on each side of the highways and the children all get driven to school even though they only live a 16th of a mile away.

They have to be driven because there’s no safe way for them to get from their residences to the school or to the other side to the library, which is really the heart of this community. I myself took a walk through this area and it really felt dangerous. There weren’t sidewalks, there weren’t crosswalks. Cars were not looking for pedestrians at all.

So the question becomes whether you could build some structures and start changing social norms that would enable the kids to actually be more active in their daily lives. That’s what we really need. We don’t necessarily need people to be more active by going to gyms. They need ways to become more active in their daily routines.

Wofford: What’s the solution?

Seguin: A local policy might be to organize “walking school buses.” Parents could sign up to take one day a week in which they would help the kids safely walk to school. That’s an example of a residential policy initiative that could really help kids get active in their day-to-day lives.

Wofford: So that ties in to what’s known as the “built environment” concept, right? And doesn’t the same concept apply to things like the availability of healthy food?

Seguin: Absolutely. Something we have to think about, particularly in rural environments, are the small businesses. Small store owners, for instance, are often barely staying in business. So while you might want there to be healthier choices for people in those small town retail environments, in some cases healthier food choices are going to spoil because people aren’t buying enough of them. A local initiative that might actually help drive business would be to use local marketing to highlight some of these healthy options. If you can create enough demand within these small stores, the owners wouldn’t lose money and then they could stock more variety and higher quality products.

Wofford: As you said, the obesity epidemic is a national problem, not something that is confined to rural communities. What are some of the factors behind it?

Seguin: This is really simple stuff but I think it’s important to remind people that when we talk about obesity it is about energy in and energy out. What we want is for people to maintain an energy balance. Even if you are overweight, staying weight stable is a benefit compared to continuing to gain weight. And if you’re obese or overweight and want to lose weight, that means you have to expend a bit more energy and eat a bit less. If you just make those tiny shifts over time, you’ll get closer to a healthier body weight.

A lot of this has to do with sedentary behavior. We’ve built all of this efficiency into our lives and that efficiency has actually caused us to hold onto extra weight and not be as physically active or physically fit.

Two out of three people are not getting any daily physical activity. And at our schools, this number is a little out of date, but around 90 percent of children have no physical education classes. We need people to be more active. We want them to engage in vigorous physical activity. We want them to do a range of leisure activities and to simply sit less.

We’re all sitting down a lot but there are little things you can do to help: just getting up and moving around, parking a couple blocks away when you’re running errands, taking the stairs, that sort of thing. Those little bits of activity really add up throughout the day.

Wofford: Activity is one thing, but what about what people eat?

Seguin: We really need to see a shift in eating patterns, like eating more whole grains and having fruits and vegetables take up a much bigger bit of real estate on your plate, as well as having a variety of protein sources.

Let’s look at what Americans are eating. Too much in the way of refined grains, not enough in the way of whole grains. Too much in the way of added sugars and sodium. I don’t think people realize all of the foods that have added sugar. Bread and cereal are good examples. Both can have quite a lot of added sugar—more than people might realize.

Part of this is individual decision-making but part of it is also the social environment. And part of it is the built environment—financial access and physical access.

Wofford: Can you tell us about some of these environmental factors?

Seguin: When it comes to health in rural communities, there is a list of questions you need to look at. Is there a sidewalk? Are there crosswalks? Is there a restaurant there? Is it a fast food restaurant? Is there a grocery store? Is the only food store in town the gas station that sells convenience food? The built environment matters.

When people think about the environment, they think about things in nature but when we talk about the built environment, these are man-made features: streets, playgrounds, sidewalks, community centers, et cetera.

Wofford: So, making a community more walkable can help with obesity?

Seguin: Yes, but it really depends on a variety of factors. Part of it depends on how far people actually live from where they’re walking. There are also factors related to low-income neighborhoods and minority neighborhoods and there are safety and transportation factors. There’s not a clear answer but in general, community features that we consider to promote active living are associated with lower obesity rates.

Wofford: You mentioned earlier trying to walk a few blocks when out running errands, but in some rural communities the nearest market might be ten or more miles away.

Seguin: That’s right. For a lot of people the closest market is far from home and in a lot of cases it’s not even a good market in terms of healthy choices. That’s what people are faced with. They are basically forced to drive.

We did some work in rural Montana and, in some cases, people out there only shop once every three weeks or more because they are driving 100 miles to a mega-superstore and getting all this food.

Wofford: You hear a lot about “food deserts.” When it comes to access to food, what are we talking about?

Seguin: I think people will often hear the term “food access” and they just think maybe there isn’t a store there. But it’s actually more than that. It’s proximity to the store—can you get there? There are many people, including a lot of the older adults whom I work with, who don’t have access to consistent or reliable transportation. And so, that Dollar Store or the local convenience store becomes their only food access point because they don’t have any other options.

Wofford: A big part of your work has been dealing with the local community members, whether that be in Pennsylvania or Montana or wherever. How did you get people engaged and did you meet with any resistance?

Seguin: We absolutely faced resistance. In food environments, the big issues are working in schools. There are huge barriers involved, like the food that the schools have access to, and time factors for the workers involved.

When it comes to the built environment and a focus on increasing physical activity, the biggest resistance is cost. How do you pay for all of this? It might sound great to build a bridge over those two busy roads to get the kids from the library to the school and then home again. But who’s going to pay for it?

There’s also the capacity issue. People have limited capacity and they’re busy, so how do you keep them engaged over time? That’s an ongoing challenge.

However, through some of the community work that we do, we can see that one of the key motivators for residents in the projects that we run is that they’re incredibly concerned about their children, their grandchildren, and future generations. That motivates them to get involved in changing community environments, because they want their grandchildren to be healthier.

Wofford: We’ve covered a lot of ground here today. Rebecca, thank you for joining us.

Seguin: Thank you, this has been great.

 

Want to hear more? This interview is based on Rebecca Seguin’s live eCornell WebSeries event, Improving Healthy Eating and Active Living in Rural Communities Through Citizen ScienceSubscribe now to gain access to a recording of this event and other Expanding Nutrition Frontiers topics. 

Learn How and Why to Eat a Plant-Based Diet

The Government Office of Disease Prevention and Health Promotion, the nation’s top nutritional panel, released a 571-page report with their dietary guidelines for Americans. Their top finding? That Americans need to consider the environment when planning out their diet.

According to the group, two-thirds of American adults are overweight or obese. About half of American adults, or roughly 117 million people, have preventable chronic diseases related to poor diet and physical inactivity. They best way to combat this is a diet rich in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts.

Converting to a diet that limits or cuts out meat seems daunting. However, eCornell’s Plant-Based Nutrition certificate can walk you through how and why to make this transition.

eCornell partnered with the T. Colin Campbell Center for Nutrition Studies to create this certificate program. In it, you’ll learn about nutrition science and the role diet plays in maintaining health or creating disease.  Explore some of the ways a “wholistic” approach to nutrition might inform our approach to scientific and medical practice, healthcare in general, and even education and the environment. Interact with students from around the world, get great recipes and learn how to optimize your nutritional health for a long and healthy life.

Learn about our Plant-Based Nutrition program here or check out our downloadable flyer.

Giving the Gift of Good Health

eCornell’s online Plant-based Nutrition Certificate was offered in VegNews’ Holiday Gift Guide for 2011.

No matter the time of year, good health is always in season. In addition to the Certificate in Plant Based Nutrition from the T. Colin Campbell Foundation and eCornell, healthcare practitioners and nutritionists may receive CME, CEU or CECH credits upon completion of the certificate program.

Students in the T. Colin Campbell online courses create Yahoo Group

A new Yahoo group is available for students who have taken the online courses in plant-based nutrition as an informal way to continue to keep in touch after the completion of coursework.

The Certificate in Plant-Based Nutrition offered through the T. Colin Campbell Foundation and eCornell is an innovative online three-course program designed to help understand the role of diet in healing and managing disease. It expands upon the ground-breaking book The China Study, by T.Colin Campbell with each course providing approximately six hours of learning based on the lectures and research of Dr. Campbell along with a variety of other experts in the nutrition and medical fields.