Shireen: Wendy Phillips has over 20 years as a registered dietician working in adult and neonatal nutrition support and in inpatient, outpatient and rehab settings. She has worked for Morrison healthcare for 11 years in Clinical Nutrition director positions, and is now a regional vice president for Morrison. She is active in public policy, and has held multiple leadership positions in the Academy of Nutrition and Dietetics, and the American Society for parent Terrell and interroll nutrition. Welcome, Wendy, how are you doing today?

Wendy: I'm great. Thank you so much for having me.

Shireen: It's an absolute pleasure having you on. So Wendy, let's dive in. I want to start out by learning a little bit more about your background, and what really led you to work within nutrition, and really to focus on food insecurity.

Wendy: Thank you. So I have worked for my entire career to address the issues of chronic disease prevention and treatment through medical nutrition therapy. It was about seven years ago that I really started focusing on the issue of malnutrition, mostly because of some personal experiences with my mom and my sister suffering from malnutrition. And I saw how this disease can really be influenced by all other chronic diseases and can impact the recovery and diagnosis period for those chronic diseases, and it's much more prevalent than what people might be aware of. So once malnutrition is recognized and diagnosed, the most important step is to create evidence based interventions, which registered dietitians are great at doing. Malnutrition treatment is so multifactorial, and it will vary based on the care setting, and what the patient's real overall care goals are for themselves. And then of course, the underlying cause of malnutrition, whether it's acute, chronic or social, environmental related, really influenced what those for. Now, when you think about what the interventions are for malnutrition, often it involves things that have to happen outside of the hospital setting. Even before the COVID-19 pandemic, food insecurity was such a major concern in the United States and this pandemic is only worse than that problem. Food insecure individuals are much more likely to have malnutrition and poor health outcomes. So as I work on the issue of malnutrition, I just have to also evolve the food insecurity piece.

Shireen: Makes sense. So what does it mean to be malnourished and how does it impact our health?

Wendy: To be malnourished means that you have an imbalance of the nutrients that your body needs to function properly. So it could be a deficit of calories and protein that what we call macronutrients. It could also be in a deficit of micronutrients, vitamins and minerals. So that's why it can be really hard to tell from the outside if someone is malnourished. So some underlying causes for malnutrition include people who might not be able to eat enough, or when their body isn't able to process the foods that they are eating. Maybe there's malabsorption related to a GI condition. Other diseases like cancer and kidney disease really increase the metabolism and makes the lead much higher than what some people can eat. Malnutrition increases the risk of hospitalizations and complications. So patients are more likely to get infections and have a longer time leading to heal, and so really addressing malnutrition as the underlying disease factor can help to influence recovery time for other diseases.

Shireen: Now, what does it mean to be obese and and still be malnourished?

Wendy: That is such a common misconception that we see throughout the community and the health care facilities that someone cannot be both obese and malnourished. This often contributes to that delay in diagnosis and treatment, because a physician might see the patient coming in through the emergency room. And they're, they're doing a quick assessment, they're triage, what does this patient need in order to become stable, so they might document something like appears well nourished. And they're simply looking at their body habitus, and they're not looking at what a registered dietician might look at. So it's really important to be able to ask simple questions and get the patient referred to a registered dietitian, we then do what's called a nutrition focus, physical exam. And we take a look at things like weight loss, muscle mass, fat loss, and the science that they might have a micronutrient vitamin or mineral deficiency. So just a quick visual look and maybe calculating someone's body mass index, just doesn't tell you whether someone is malnourished and whether they have been eating and able to utilize the nutrients from our food over an extended period of time. People with obesity, they may have lost weight very rapidly and unintentionally. So even though they haven't, they still have an obese BMI or they appear to be overweight, that doesn't mean that they have lost muscle weight that's associated with that rapid weight loss, weight loss, and it could also be that they've lost vitamin stores.

Shireen: Now, how is malnutrition treated?

Wendy: Lots of different ways depending on what the cause is of the mount nutrition. It's treated, broad sense, you can say it's treated by providing good nutrition. A care plan has to be developed based on what the patient goals are for themselves and based on the underlying cause. We also talk, often talk to patients that say, “I know I've lost weight rapidly. It isn't a good thing, but I don't want to regain the weight, I'm happy that I've lost weight.” And so our message back to them is we won't help you gain back weight as far as fat, but we need to increase that muscle mass in order to have good health. So we can do this in multiple ways. We can offer foods that are high in calories, protein and appropriate nutrients. Sometimes that might also involve oral nutrition, supplements, whatever we can do in order to support getting enough nutrients. Then we also need to make sure that their GI, gastrointestinal tract, is functioning properly so that they're able to utilize those nutrients that they have coming in, in order to support good health and good nutrition. And lastly, there's some people who don't end up being able to eat by mouth, whether it's a stroke, an obstruction in their GI tract, many different ways that might cause the inability for them to eat foods by mouth and drink liquids. So that's when we would advance to enteral nutrition, which is also called tube feedings, or parenteral nutrition are TPN, which is when a patient is fed all of their nutrients that they need through an IV. So that's where I spent the first 15 years of my career is working with adults and infants who couldn't eat by mouth and we're feeding them either by a tube routine and helping to monitor electrolyte balances, muscle mass weight, all of the signs that contribute to having a healthy healthy nutrition status.

Shireen: As you mentioned earlier, sometimes it may not be evident that someone is malnourished. So how is one screening for it? Or how is it recognized by a loved one or a physician,

Wendy: This is such an important step. So there are validated nutrition screening tools, depending on the care setting. And hospitals, most facilities use the non nutrition screening tool or in community settings. There's the determined checklist. Those are just two of many resources that are available to implement nutrition screening. There's different levels of which ones are supposed to be that the most validated for use in that care setting and with the, with the patient population that you're working with. For me, it's most important to get something in place, monitor whether or not it's capturing the number of people that you need to and then making sure you have a referral to a registered dietician in place. Because if you're screening for malnutrition, but you don't then have a registered dietician or a plan in order to address the issues that are being involved with screening Tools if you're not doing what you need to do, but I also want to talk to listeners about what they can do personally when they're not in the healthcare setting. Because how I mentioned earlier, a lot of times the adequate treatment for malnutrition does not happen, happen at the hospital, especially as it's related to food insecurity, if not having enough food, or the right kind of food or the right quality of food, is what the underlying issue is. So I really ask people to pay attention to their loved ones, to neighbors, people at church, really pay attention to people who are self isolating, especially a pandemic time. Be on the lookout, talk to them, see if they're eating, see what they need, and also look for visual cues. Is their skin starting to droop a little bit? Do they appear to be dehydrated with that dry scaly skin? How are their clothes fitting, ask them those questions, so that you can then be ready to refer that to resources. Sometimes a phone call to their family physician is important. Also, we have some good resources on the Aspen website at nutrition care.org are on the Academy of Nutrition and Dietetics website for eat right.org. These are all public facing great information for consumers to use to help address the issue of non nutrition for themselves, or with their family or with their community. And then one other website I wanted to mention is the National Council on Aging, or Nicola. It's at www.coa.org. And they have a lot of great information for working with older adults about the issue of nutrition. The goal really is to prevent malnutrition before it it develops,

Shireen: So list the work that you were doing currently to address malnutrition and food insecurity.

Wendy: So like I mentioned, malnutrition became a really important issue with me when my sister was going through cancer and I saw the challenges that she had with nutrition. The topic of food insecurity has been near and dear to my heart really for my entire life, growing up in a small town and walking with my mom and my sister to the community park and standing in the line where the nicest people gave us a loaf of bread and a jar of peanut butter and a block of cheese every week. And at the time, I didn't realize it but we were standing in a commodity line and it was very important to our family. And so I've grown up being very mindful of what that is. So one thing that I'd really like people to understand is the definition of food insecurity and I'll make it quick. But there are three pillars associated with food insecurity. Its food availability, food access, and food utilization. So people really focus on the issue of food availability, which is great, very important. We also want to talk about food access or food deserts. I happen to live in Cleveland right now and I live in the middle of a food desert. And I live, live in a city area, so parking is not easy. So and I can walk to work. So I don't even have a car there and it's the first time that I've really truly understood what a food desert is. I don't have quick and easy access to healthy food I have right across the street and so when we're talking about food access and food insecurity, that's something that I really would want people to take a look when they're in their communities. And consider what would you do, if you didn't have a car and you didn't have the money to buy the food? What would you do? And think about that so that you can help to address that issue in your community. And then lastly, food utilization. I think if anything else that 2020 has taught us is that there is a lot more that really needs to come up to the surface as we're talking about our national conversation. And one of those is we're talking about food availability and food access. Food utilization really talks about the ability to exercise, exercise your own cultural food preferences, and how to use your food effectively within your household and your communities to guarantee equitable nutrition. So my work through Morrison healthcare is really to help hospitals and health care facilities figure out how to address this. Like I said, I live in Cleveland working on the issue specifically in Northeast Ohio, and then taking those lessons learned to work with Maurice and for other places throughout the country. We're really working to address the nutrition education component that goes along with increasing food access and availability. And then working on behavior change through food utilization. We are focusing on specific interventions within that broad topic. Medically tailored meals, food pharmacies, hospital discharge food boxes, providing cooking utensils, and equipped kitchen equipment in order to promote people to be able to prepare these foods at home in a healthy way. And then we're working to develop a culinary skills lab might also be known as a teaching Kitchen, where participants can come in work side by side with the chef to learn how to cook, and work with a registered dietician to learn the nutrition education that goes apart with that. So lots of broad work going on there with some specific information in between.

Shireen: And then how can we, when we're looking at this and addressing malnutrition? And you know, food insecurity? What does that mean to you know, work with perhaps local hospitals there? And even with Morrison.

Wendy: Yep. So I think the biggest thing is to first do an environmental scan of what you are seeing in your community. Every day in Cleveland, I learned about more people who are working to serve the needs of the community in different ways. So you don't want to overload what other people are doing. You want to learn how you can complement that work. So really getting to know other people in your community, other organizations. And when you're talking to those organizations, ask them, who else should I be talking to now? So I have to say, give a shout out. I love working for Morrison healthcare, we are always hiring new people, registered dietitian and other positions as well. So check out Morrison healthcare.com, forward slash careers, and we will be happy to talk to you about how to career with us to focus on these issues right alongside us.

Shireen: I love that. So that rounds us to the end of the episode. I do also want to comment when you, you know, you mentioned that food utilization and it really resonated with me because you're talking about that ability to really exercise cultural food preferences, you know, which is something that we value it you know what we do it younger. So it's so important to have that conversation within the context of care for that individual, rather than, you know, sort of providing them something that doesn't resonate with them and that the won't won't sustain them. So I love that, you know, you're you're sort of looking at it through that lens. But so coming back to this, I want listeners to learn more about your work and learn how they can really stay connected with you.

Wendy: Yes, thank you. And so feel free to email me at Wendy Phillips at I am Morrison comm or look me up on LinkedIn. I'm very responsive. I love to connect with people that have the same passions that I do about treating malnutrition and addressing food insecurity and chronic disease in their communities. So by all means, please do reach out and we can learn what we can work on together.

Shireen: That's lovely. Well thank you so much for your time. We really appreciate it. Thank you for coming on.

Wendy: Thank you.

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