Nutrition Counseling: Wellness Chiropractor, Dr. Alexander Jimenez takes a look at discussing nutrition with patients in a clinical setting.
How Clinicians Can Do Better
Despite overwhelming evidence that relatively small dietary changes can significantly improve health, clinicians seldom discuss nutrition with their patients. Poor nutritional intake and nutrition-related health conditions, such as cardiovascular disease (CVD), diabetes, obesity, hypertension, and many cancers, are highly prevalent in the United States,1 yet only 12% of office visits include counseling about diet.2 Even among high- risk patients with CVD, diabetes, or hyperlipidemia, only 1 in 5 receive nutrition counseling.2 It is likely that many patients receive most of their nutrition information from other, and often unreliable, sources.
These data may reflect the minimal training, time, and reimbursement allocated to nutrition counseling (and preventive services in general) in clinical practice.3 Most physicians and other health care professionals receive limited education on nutrition in medical school (or other professional schools) or in postgraduate training. Just 25% of medical schools offer a dedicated nutrition course, a decline since the status of nutrition education in US medical schools was first assessed in 1985, and few medical schools achieve the 30 hours of nutrition education recommended by the National Academy of Sciences.4 As a result, physicians report inadequate nutrition knowledge and low self-efficacy for counseling patients about diet.3 In addition, time pressures, especially in primary care, limit opportunities to counsel on nutrition or address preventive issues beyond patients’ acute complaints. Lack of time is frequently cited as the greatest barrier to counseling on nutrition and obesity.3
Moreover, nutrition and behavioral counseling have traditionally been non-reimbursed services. Few state Medicaid programs cover nutrition or obesity counseling, and before 2012, Medicare explicitly excluded coverage for obesity counseling; although now a reimbursed service for Medicare beneficiaries, just 1% of eligible Medicare beneficiaries receive this counseling.5 Dietitian counseling is also excluded by Medicare, unless patients have diabetes or renal disease. Although the Affordable Care Act mandates coverage for services graded A or B by the US Preventive Services Task Force, including nutrition counseling for patients with CVD risk factors and obesity counseling for patients with a body mass index of 30 or greater, existing private health insurance benefits are in- consistent, and the covered services are often unclear to both clinicians and patients, thereby limiting use.
Furthermore, health behavior change counseling is often frustrating given the current food environment, in which less nutritious foods tend to be less expensive, larger portioned, more easily accessible, and more heavily marketed than healthier options, making patient adherence 6 to nutrition advice challenging. Conflicting and confusing nutrition messages from popular books, blogs, and other media further complicate patient decision making.
Special Clinic News & Events
Despite these unfavorable trends, there has been progress in this area. The evidence base supporting the benefits of nutrition intervention and behavioral counseling is expanding. Renewed focus on nutrition education in health care professional training is being driven by both student demand and the health care system. Although time pressures and reimbursement remain impediments, incentives and reimbursement options for nutrition and behavioral counseling are growing, and value-based care and health care team approaches hold promise to better align time demands and incentives for long-term care management. Initiatives to integrate clinical care and community resources offer opportunities to leverage resources that alleviate the clinician’s time commitment. There is evidence of some success; for instance, the amount of sugar-sweetened beverages consumed by individuals in the United States has declined substantially over the past 10 years.7
Clinicians Can Take The Following Reasonable Steps To Include Nutrition Counseling Into The Flow Of Daily Practice:
1. Start the conversation. Several short, validated screen- ing questionnaires are available to quickly assess need for nutrition counseling, such as the Starting the Conversation tool8 (Table). This approach can be efficiently used prior to seeing the patient at an appointment, either delivered by medical assistants as part of vital sign assessment or as prescreening paperwork for patients to complete online or in the waiting room.
2. Structure the encounter. Using methods such as the “5 A’s” (assess, advise, agree, assist, arrange), which has been adapted from tobacco counseling. Motivational interviewing, which has documented efficacy in numerous behavior change settings, is particularly helpful to engage patients who are not yet committed or are hesitant to consider behavioral change.
3. Focus on small steps. Changing lifelong nutrition behaviors can seem overwhelming, but even exceedingly small shifts can have an effect (Table). For example, in- creasing fruit intake by just 1 serving per day has the estimated potential to reduce cardiovascular mortality risk by 8%, the equivalent of 60 000 fewer deaths annually in the United States and 1.6 million deaths globally.9 Other examples include reducing intake of sugar-sweetened beverages, fast food meals, processed meats, and sweets, while increasing vegetables, legumes, nuts, and whole grains. Emphasize to patients that every food choice is an opportunity to accrue benefits, and even small ones add up. Small substitutions still allow for “treats,” such as replacing potato chips and cheese dip with tortilla chips and salsa, the latter lowering trans fats and saturated fat and increasing whole grain and vegetable intake (Table).
4. Use available resources. Numerous extracurricular resources are readily available for clinicians. The Nutrition in Medicine program offers online, evidence-based nutrition education and tutorials for clinicians and an online, core nutrition curriculum for medical students. The Dietary Guidelines for Americans offers evidence- based and freely available nutrition guidance, tutorials, and tools for clinicians and patients alike. A companion website, Choose My Plate, offers nutrition and counseling advice for clinicians and handy resources for patients, including recently added videos with useful examples of small substitutions that patients will appreciate.
5. Do not do it all at once. Expecting to create long-term behavioral change during a single episode of care is a recipe for frustration and failure, for both the patient and clinician. Empowering and sup- porting patients is an ongoing process, not a 1-time curative event. Use a few minutes at the close of a patient visit to identify opportunities for future counseling, offer to serve as a resource, and be- gin a discussion and support that can be reinforced over time. Take solace in knowing that small initial steps can quickly improve health; for example, reducing trans fats at a single meal (eg, replacing baked goods with fruit or nuts or fried foods with non-fried alternatives) promptly improves endothelial function.10
6. Do not do it all alone. The primary care physician need not be the sole clinician who provides nutrition counseling. Proactive use of physician extenders (eg, physician assistants, nurses, medical assistants, and health coaches) and referrals can alleviate much of the burden for the busy clinician. Receptionists can distribute assessment and screening questionnaires for patients to complete in the waiting room; medical assistants can document behavioral change progress while assessing vital signs; administrative staff can identify and con- tact patients who are overdue for interaction. Large practices may benefit from including nutrition or health coaches on staff. Referring to clinical specialists and community-based support programs can significantly extend the clinician’s reach.7 In addition to registered dietitians, numerous clinical and community resources are available and often covered by insurance plans. Board-certified obesity medicine specialists, certified diabetes educators, and physician nutrition specialists are available as referrals in many areas. Diabetes Prevention Program group counseling sessions are now covered by Medicare and available throughout communities, such as in many YMCA sites, and electronically.
Although there is no conclusive evidence that these steps will improve diet and health outcomes for patients, there is virtually no harm in counseling and the potential gains, especially at the population level, are substantial. Nutrition and health behavior change must become a core competency for virtually all physicians and any other health professionals working with patients who have or are at risk for nutrition-related chronic disease.
A Healthier You
Scott Kahan, MD, MPH Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and George Washington University School of Medicine, Washington, DC.
JoAnn E. Manson, MD, DrPH Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; and Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Published Online: September 7, 2017. doi:10.1001/jama.2017.10434 Conflict of Interest Disclosures: All authors have
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
1. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:E62.
2. Office of Disease Prevention and Health Promotion. Healthy People 2020. https://www.healthypeople.gov/2020/data-search/Search-the-Data#srch=nutrition. Accessed January 23, 2017.
3. Kolasa KM, Rickett K. Barriers to providing nutrition counseling cited by physicians. Nutr Clin Pract. 2010;25(5):502-509.
4. Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010;85(9):1537-1542.
5. Batsis JA, Bynum JPW. Uptake of the Centers for Medicare and Medicaid obesity benefit: 2012-2013. Obesity (Silver Spring). 2016;24(9):1983-1988.
6. Kahan S, Cheskin LJ. Obesity and eating behaviors and behavior change. In: Kahan S, Gielen AC, Fagan PJ, Green LW, eds. Health Behavior Change in Populations. Baltimore, MD: Johns Hopkins University Press; 2014:chap 13.
7. Rehm CD, Peñalvo JL, Afshin A, Mozaffarian D. Dietary intake among US adults, 1999-2012.JAMA. 2016;315(23):2542-2553.
8. Paxton AE, Strycker LA, Toobert DJ, Ammerman AS, Glasgow RE. Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med. 2011;40(1):67-71.
9. Mozaffarian D, Capewell S. United Nations’ dietary policies to prevent cardiovascular disease. BMJ. 2011;343:d5747.
10. Williams MJA, Sutherland WHF, McCormick MP, de Jong SA, Walker RJ, Wilkins GT. Impaired endothelial function following a meal rich in used cooking fat.J Am Coll Cardiol. 1999;33(4):1050-1055
MEET THE STAFF
These canons of professional ethics are based upon fundamental principles of moral and professional behavior and recommended for all doctors of chiropractic and chiropractic assistants. The following basic principles should be guiding factors in the practice of chiropractic and upheld at all times:
Consider the well-being of the patient. The primary effort and ultimate goal is for the greatest good of our patients.
- Dr. Alexander D. Jimenez D.C., C.C.S.TChief Clinical DirectorPhone: 9155408444Email: email@example.com
Specializing in Severe Pain: Sciatica, Neck-Back Pain, Whiplash, Headaches, Knee Injuries, Sport Injuries, Dizziness, Poor Sleep, Arthritis. We use advanced proven therapies focused on optimal mobility, health, fitness, and structural conditioning. We use Patient Focused Diet Plans, Specialized Chiropractic Techniques, Mobility-Agility Training, Cross-Fit Protocols and the "PUSH System" to treat patients suffering from various injuries and health problems.
Message from: Dr. Alex Jimenez D.C., C.C.S.T
( Biography and my promise to you )
My name is Dr. Alex Jimenez, I am Chiropractic Doctor specializing in advanced therapies focused on total joint health, strength training and complete fitness conditioning. We use patient Focused Diet Plans, Advanced Chiropractic Techniques, Agility Training, Cross-Fit and the PUSH System to treat patients suffering from various injuries and health problems. Our goal too is to help your body heal itself naturally. When your body is truly healthy, you will arrive at your fitness level and proper weight efforlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25+ years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs...
My goal too is to help the body heal itself naturally. When your body is truly healthy and balanced, you will move pain free and ultimatly arrive at your optimal fitness levels and proper weight effortlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25 years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs. These programs are natural, and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life.
The focus on spinal and skeletal adjustments is what makes doctors of chiropractic unique in their approach to treating patients with spinal complaints. This hallmark chiropractic adjustment, however, is not the only procedure a chiropractor may employ in managing a patient's care. I am very proud to bring my patients a variety of treatment options beyond the typical scope of care. With the advances in physical therapies and modalities we bring El Paso option that better aid in the rehabilitation process. Tissue healing is a wonderful process that begins the moment an injury occurs. How the injury is managed determine the final outcome in terms of healing. It is critical we implement immediate procedures as soon as we can in order to gain optimal recovery. The old day of let it rest until it gets better is not the only option.
Letting it rest may even be an irresponsible approach considering what we now know. The implementation of active and movement based treatments have clearly shown increased and improved outcomes in many instances.
As a doctors focused on the greater good for a patient, we must assess each patient individually and apply the appropriate protocols. It is also very important to denote, that El Paso has fine doctors in many specialties of healing and repair. The direct relationship we have with specialist of these disciplines is clearly what allows us to bring the highest quality of care to our patients.
My promise to my patients is clear for all to read here. I, with Gods help, will do what ever it takes to assist you in your recovery. I too will draw upon all the specialist in this town to find you the collaborative care that is required with the disorders being tended to.
With Great Regards to you.Read moreRead lessEducation:
Affiliations and Certifications:
- Texas Chiropractic Association
- Chiropractic Care
- Physical Therapy
- Strength Training
- Crossfit Doctor
- Return to Competition Rehabilitation
- Truide TorresExecutive Director / Patient LiasonPhone: 9152526149Email: firstname.lastname@example.org
Director: Patient Relations Advocate Dept.
Truide has been working for the past 20 years in claims resolutions. She works hand in hand with patients and is availible to resolve dispute resolutions.
Truide Torres (Bio)
Driven by the passion of doing what is in the best interest of the patient, I wake up every morning with the drive to help those in need. The claims process for health care is full of pits, valleys and difficult obstacles designed to strike fear in those in need. My duty is to do what is within the confines of the law, "what ever it takes" to get those involved to pay attention to those who need help. That is what I am honored to do for our patients.
Personally, I have seen great injustices transpire on those that do NOT have a voice. Whether, a language barrier or just not knowing the rules. My job is to find out how I can help. If I personally can not help, I will find the right sources to open the possibilities. I get the job done.
As a wife and mother of 2 children, 3 dogs and 2 Cats. My passion is for God, Family and the mission of serving my fellow man.
Let it be clearly stated... I am here to help. My phone 915-850-0900Read moreRead less
- Daniel AlvaradoExercise PhysiologistPhone: 9152038122Email: email@example.com
Daniel Alvarado is the owner and the top trainer at PUSHasRx® CrossFit Fitness Facility. Since becoming a Trainer Daniel has kept up to date on many continuing educational classes, ensuring that his clients receive the most comprehensive and advanced training. Working directly with the Doctors, he develops and collaborates on care plans that are patient specific. No patient ever gets the same clinical protocol. His expert clinical kinesiology experience spans over 2 decades. He has trained injured patients and NCAA National Champion Athletes. His technical ability to create programs that are clinically sound and second to none. He too has used his physical therapy and recovery experience to take broken top tier athletes into strict recovery protocols assisting them to achieve highly competitive national championships. He certainly will not admit it but, he is a top national champion trainer. Daniel, also develops youth programs that are sport specific to aid young athletes achieve great success. His mastery of clinical recovery is applied applied to all patients and top tier athletes alike. All patient programs are specifically designed with patient focused recovery priorities. He is happily married to beautiful Victoria Alvarado has one child. He enjoys strength training, movies, singing, conducting, writing poetry and being a CrossFit champion. Just a way cool dude. We think you will agree.Read moreRead less
- Dennise AcostaHead Office ManagerPhone: 915-850-0900Email: firstname.lastname@example.org
Dennise has been at Injury Medical & Chiropractic Clinic for four years. Known as the master multi-tasker. Dennise, handles patient care from the moment you walk in the door. She is akin to the air traffic controller. She will assist you in matter requiring clinical preparation and effective inter-office communication. She unifies all department and clinical providers making sure all important information reaches all clinicians in a timely manner. She also loves to work out, stay in shape, watch movies and help people.Read moreRead less
- Sandra MartinezHead Clinical TherapistPhone: 915-850-0900Email: email@example.com
Sandra has been working at Injury Medical & Chiropractic Clinic for over 5 years. As the head Licensed Massage Therapist, she manages and directs critical aspect of clinical care. The patients love her ability to make you laugh while removing those pesky trigger points causing pain. She is able to relax and bring comfort to all she touches. There just simply is no patient that escapes her talented touch. Trained in advance myofascial techniques, she is an integral part of patient recovery. You will never see anything but a kind smile and resolute persona ready to correct your condition and aid in your recovery. She definitely enjoys helping people, has 1 dog and loves movies. She loves flowers too.Read moreRead less
- AlejandraBilling AgentPhone: 915-850-0900Email: firstname.lastname@example.org
Alejandra works in accounts & billing. She is the radar of the bunch. Nothing appears to escape her mind. Highly intelligent and appears not to need a computer for recall of facts. She provides information retrieval for patients and clinical staff. She has been at Injury Medical & Chiropractic Clinic for three years and ready for any task at hand. She performs interoffice communications with attorneys and medical director of ancillary offices. She loves her family and places know how to prioritize well.Read moreRead less
- Mike ContrerasPersonal TrainerPhone: 915-203-8122
Big Mike was born and raised in El Paso and is an excellent personal trainer and CrossFit coach. Mike works hand in hand with each patient’s clinical care plan in order to achieve optimal outcomes. A trusted clinical representative of the PUSHasRx System along with his advance protocols. Mike not only trains the injured and recovering. Mike is a sincere human that has great talent of brining out the best in every individual he works with. He will never admit it, but we will share with you a secret. He with his God given talents trains the greatest athletes and champions in El Paso. Many champions in our community know of his commitment. As a youth, he also played football (wide receiver), basketball, and track at Bel Air High School. Educated in Clinical Human Kinesiology at UTEP and loves playing football and basketball with his little nephews in his free time. Mike has three sisters and one brother, most of which live nearby in El Paso. When he’s not watching the Cowboys or Spurs play, he’s usually lifting, sleeping or watching movies. We are blessed to have this soul on our team.Read moreRead less
- Alexander Isaiah JimenezCollegiate Athletic Consultant & NCAA Wrestling ChampionPhone: 915-820-9443Email: email@example.com
Alexander Isaiah Jimenez leads the power and agility education programs for the high school athletes. While still studying for his medical degree he provides physical performance testing in order to collaborate with clinicians. He is gifted in creating physical performance programs no matter what the clinical presentation is. As national fitness champion and collegiate wrestler, he too understands what performing at high levels entails. He too has had to recover from debilitating injuries only to return better then before an win national titles. He understand how the recovery process is different for clients, patients and extreme athletes. We are blessed to have his counsel.Read moreRead less
- Ethan PadillaPersonal Trainer & Strength CoachPhone: 915-203-8122
Ethan was born and raised in El Paso and is one of our most outgoing and friendly coaches. Ethan earned his nickname “rampage Ethan” from his years at El Dorado High School, where he played inside linebacker. He has placed twice in the Strongman Competition and also recently competed in the Desert Games with his fellow PUSH Athletes as a team and placed 4th overall! Ethan is currently pursuing his Bachelor’s Degree in Kinesiology at UTEP. His focus on clients is obvious to all. Ethan is able to manage very large groups of individuals like no other. His awareness of the dangers while exercising is his greatest concern. When he’s not coaching or studying for class, he likes to spend time with his family (who are here in El Paso) or with his weimaraner puppy. Fun fact: Ethan loves any food with sprinkles (especially donuts with sprinkles) and is a diehard Seattle Seahawks fan.Read moreRead less
- AndresRecovery & Nutrition
Andres has been at PUSHasRx for two years. He brought his company Recovery and became the official juicer. Andy will fix you right up. Andres, will make sure that your nutritional recovery programs fits within your standards. Also, there is great care in making sure the nutritional requirement are clinically met. Patients and high performance athletes depend on high performance nutritions. Upon your completion of the physical medicine portion of therapy you will be offered specialized organic recovery drinks and supplementation to help aid in your recovery. You will be confident that from your pushing to recovery, you will be taken care of.Read moreRead less
- Iylene AvalosPUSHasRx TrainerPhone: 915-203-8122
ylene has been working with us for over 4 years. In her spare time she enjoys working out and running. She has 2 dogs and loves movies. Iylene is extremely aware of body mechanics and mindfully watches rehabilitation movements. She is always standing ready to assist and respond to client needs. Her commanding voice is always clear to all, no matter what floor you are on. Iylene is always ready and willing to answer any question you may have regarding fitness and recovery.Read moreRead less
- Rick CanoPersonal Trainier Level VPhone: 915-203-8122
Most early-rising PUSHasRx members know Rick well as a fantastic coach who focuses strongly on form and will always make you laugh. He was born and raised in El Paso and loves to train his athletes and coach CrossFit. Rick is a very diligent, kind and considerate trainer. He is always mindful of client techniques and aware of client goals. When he’s not coaching, Rick loves to work on cars, especially his ’69 Chevelle (his next car will hopefully be a ’69 Charger). He not only became a certified Automotive Mechanic at 17, but while working on his certification at EPCC, he won 1st place in a bench competition when he was 16 (approx. 56 reps at 155#). His favorite movements are clean & jerks and snatches. He loves oreos (eats them every night), loves watching the CrossFit games, and loves his three bulldogs. He spent one year full-time personal training before he started coaching CrossFit two years ago. He is CrossFit Level 1 Certified and hopes to get his Level 2 Certification soon. Rick has competed in several competitions, including WOD for Toys in 2014, where his team placed 1st.Read moreRead less
- Astrid OrnelasBlogger/Research/CuratorPhone: 915-850-0900
Astrid has been at Injury Medical & Chiropractic Clinic for about three years. Astrid has taken her love for writing to an new level. She is a gifted and talented copywriter able to create amazing storylines. She creates content for patient consumption. She is able to bring words to life in a way that perplexes even the elite authors of the day. She loves nutrition and the healing power of clean eating. A naturalist at heart you will never see her eating processed foods that would be contra to clean living. She enjoys movies and creating storylines for Anime.Read moreRead less
- AdamVideographer & Graphics SpecialistPhone: 915-850-0900
Adam has been at Injury Medical & Chiropractic Clinic for about a year. He enjoys designing and various forms of art. A story teller by trade he can see things people don’t see until his masterpieces are revealed. Adam is a director of many medias using the top graphics, audio and video medias to tell the story of our patient. Modest to the core, you would never know what he is about to create. We are blessed to have his talents telling the world about Chiropractic using any and all medias available.Read moreRead less
- Our PassionsEmail: firstname.lastname@example.org
We Welcome You 👊🏻.
Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, functional strength training and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.
We use Specialized Chiropractic Techniques, Balanced Diet Plans, Agility Training programs, Cross-Fit techniques, the PUSH-Rx Rehabilitation System and a highly specialized program for our Veterans.
We've been blessed to use our methods with thousand of El Pasoans over the last 27 years. This has allowed us to improve health and restore true fitness through researched non-surgical methods and wellness programs. These programs are natural and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and informed on how to maintain this way of life.
As an extension to dynamic rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high performance exercises and advanced agility options. We are very proud to have teamed up with the cities premier therapist and trainers in order to provide high level competitive athletes the option to push themselves to their highest abilities within our facility.
Come learn how to improve your health for yourself and your loved ones.
With a bit of work, we can achieve optimal health together, no matter the age or disability.
Its all about: LIVING, LOVING & MATTERING! 🍎
2 CONVENIENT LOCATIONS:
(LOCATION#1) CENTRAL ELPASO:
6440 Gateway East, Suite B
(LOCATION#2) EAST SIDE ELPASO:
11860 Vista Del Sol, Suite 128
PHONE: 915-850-0900 ✔️Read moreRead less