Shireen: In today’s episode, we welcome Cristina Badaraco. She discusses her mission to elevate the role of nutrition services in health care and to promote better health. better health through our food system. We discuss the importance of agriculture in promoting healthy diets, the need to better prevent and treat diet related conditions through food as medicine and other nutrition interventions and tactics for changing our healthcare system to better promote health for all Americans.

Stay tuned. Christina Badaracco is a healthcare consultant at Avalere Health focusing on evidence generation, quality measurement, and elevating the role of nutrition in health care. She also regularly writes, teaches, and presents about nutrition, culinary medicine, and sustainable agriculture. Welcome, Christina.

Christina Badaracco: Thank you so much for having me. 

Shireen: An absolute pleasure. Christina, I first want to start out by just asking you a little bit more about your background and just learning a little bit more about a few specific projects, initiatives that you have led to really improve the delivery of healthcare and health outcomes through nutrition and what your work has been like there.

Christina: Sure. So in my job with Avalere, I’ve worked on a wide variety of different types of projects and tactics to help improve the practice of healthcare and nutrition services, as well as increase access for patients over the last almost five years that I’ve been at Avalere. And so I’ll, I’ll talk about a few different types.

So I’ve worked on a couple of projects focused on strategies for medically tailored meal providers as part of this Growing Food is Medicine movement to help them expand their markets and help better reach all different types of patient populations. So we have conducted landscape assessments to look at different types of plan benefits.

We’ve also conducted. Interviews and surveys with executives of health plans across different markets to help provide strategic direction to these provider organizations. A big focus for me has also been leading a project called the Malnutrition Quality Improvement Initiative that we lead in partnership with the Academy of Nutrition and Dietetics.

And that is really focused on better identifying and addressing malnutrition in the inpatient setting and also elevating the role of dieticians roles in optimizing outcomes for those patients who are malnourished or at risk. And then reducing the downstream healthcare utilization and costs. And what’s pretty exciting about that project, we actually created the first nutrition focused quality measure in a payment program through CMS, which is our Centers for Medicare and Medicaid Services.

And we’re now working with hospitals across the country. to support them in reporting on this measure to CMS through the payment program that’s called the Hospital Inpatient Quality Reporting Program starting next year. I’ve also been on a Quality Improvement Initiative project, a different one that’s focused on diabetes, and how technology and the data generated through diabetes technology can best be used to support patient engagement and improve their outcomes.

We’re doing a really exciting project now focused on physical activity and what types of benefits are offered through providers and also payers and potential means to advance opportunities in the healthcare space, including through a concept of prescriptions, physical activity prescriptions, which is pretty exciting.

And then the last one I’ll mention, and then I’m. focused on wrapping up over the next few weeks, we’re conducting an assessment of different areas of overlap between federal nutrition assistance programs and food based interventions that are covered by Medicare and Medicaid to better understand possible ways to improve efficiency and effectiveness and improving nutrition security for the patients.

beneficiaries with highest need. And I’m going to be leading a roundtable on this topic at the American Public Health Association Conference next month, which I’m really looking forward to. 

Shireen: Lovely, like quite, quite a number of things that you’re working on, very important things. And I do definitely want to break some of these things down as well through our podcast episode here today.

First, I just want to take a step back and really learn a little bit about your journey and sort of what led you to this. Can you share a little bit more about that journey from studying ecology and evolutionary biology and environmental studies to then working in public health, becoming a registered dietitian, and then eventually in healthcare consulting?

Christina: Sure, and it’s, it’s definitely an unconventional path, I’ll say, for somebody in, in any of these fields. So, I’ve always been really interested in studying plants and animals and understanding the natural world. And that goes back to me as a young child, and my mom still reminds me I used to love to go out, outside and count the petals and look at all the different colors on different types of flowers that were growing in the yard.

And that continues to this day, so. I studied environmental science in, focused in environmental science in my, Biology program and in college, and I was really interested initially in pursuing a career in environmental policy and law was even starting to study for the LSAT, the law school entrance exam, and I think my, at the time, was really passionate about pursuing a career in in environmental regulation, working at the Environmental Protection Agency, which was my first full time job after college.

And I think over my couple of years there, my interest in working from a regulatory approach in the food system lessened a bit. As I became myself excuse me, I found myself more interested and inspired by meeting and learning from other leaders. who are working in the community and working to address food system issues in ways that promoted both environmental and human health.

And I think getting to meet people and volunteer with different people really opened my eyes to different career opportunities and ways to make positive impact on these issues that I cared about. So I decided to go back to graduate school, focus in public health, and especially in nutrition. And also to become a registered dietitian, to get that RD credential, so that I could really obtain that clinical expertise and credential.

I think another motivating factor for me was really my own personal journey, after having grown up significantly overweight, and certainly experience being teased about that as a child. And it really took, I think, the couple or few years. After graduating from college and living on my own to learn about eating mindfully and being more considerate of a balance and Getting more excited about cooking for myself.

I will say as a side note. I did grow up eating wonderful food. You know, my mom is a wonderful cook and I so appreciate everything I learned from her. But I think I never really understood again those concepts of sort of mindful eating intuitive eating and you know I don’t necessarily have to Go back for seconds or eat my whole plate.

It’s okay to save leftovers, you know, come, come back for those another time. And so I was really passionate about wanting to share my experiences and my learnings with others to try to make a positive impact on the huge and growing burden of obesity in our country among children as well as adults. And to do so in a way that promotes enjoyment of food and also understanding of how it’s grown and why that matters.

So I never really intended to work clinically as a dietitian, really rather I think have an aim to make broader positive changes in our food system. I don’t think, even probably as of the morning I first, I had never heard about the company where I now work. I had never heard of healthcare consulting.

I don’t think most dietitians have. And I won’t take a lot of time describing this today, but it was really kind of an uncanny meeting at a conference here in DC, literally the day I moved to DC that ended up leading to my current, my current role. And so in healthcare consulting over the last five years, I’m certainly learning so much new information, new skills on the job every day.

And I really appreciate the opportunity to work in. This unique space and continue to seek ways to prioritize nutrition among the decision making groups and audiences in the healthcare community. As I’m thinking about different ways we can focus more on nutrition and also environmental health as well.

Thinking about issues related to air pollution, water pollution, etc. and how stakeholders in the healthcare community can take action and have positive influence. 

Shireen: You know, one of the, one of the key things, and even when we’re talking about some of the recent things that you’re working on, help me understand a little bit, especially when you mentioned the environmental piece here, tell us a little bit more about your involvement with children’s gardens, farmer’s markets, and then just organic farms.

How do these grassroots experiences really tie into sort of this broader goal of improving health through nutrition? 

Christina: Sure. Yeah. And so I think, of course, A few of those examples you’re mentioning are opportunities I’ve had to volunteer thus far, I think over the past decade, maybe even beginning in college a little before that, leading pre orientation trips for incoming freshmen, and then volunteering in my local farmer’s market network in DC and other things like that.

And So I think that desire to work in that space stems from knowing that the way we grow and process and cook our food is really fundamental to the health of humans and to our planet. And so I’ve really valued so many of these experiences throughout my career to work with organizations and volunteer at events like this focused on growing healthy food and empowering people of all backgrounds to be able to access and enjoy.

seasonal and wholesome food that also helps to keep dollars in their own community and support local farmers. And then I think also kind of tying into what I do in my profession, these individual opportunities have also given me great sight into a lot of the challenges and opportunities for. What I am also teaching about and advocating for related to food and agriculture policy, especially the farm bill in this country.

So we certainly can’t all live on farms. Although as a side note, I think someday I would really love to. But I think it’s important that we know, as consumers, that we can buy food in ways that minimizes the distance that it needs to travel from where it’s grown, maximizes value to small family farms.

And I think our healthcare system. So often pays It’s a little heed to these sorts of upstream drivers of poor health, but I do think it’s really exciting to see a lot of growing initiatives to bring healthier, more sustainable food into hospitals. As an example, programs like farmers markets at hospitals, produce prescriptions, you know, that are connecting patients and low income beneficiaries, even sometimes healthcare providers themselves with truly nourishing food.

sometimes even healthcare institutions that grow their own food and teach patients how to do so. And so even in my healthcare consulting role, I’m really excited about finding ways to help elevate and expand opportunities to spread such initiatives further throughout our country.

Shireen: You know, you mentioned the Farm Bill.

I know you serve on the board for Slow Food D. C. and the Academy of Nutrition and Dietetics Farm Bill Task Force, among other leadership roles you have. How do these roles really contribute to improving access to healthy and sustainable food? And then do you see these roles as connecting with sort of your own work in healthcare transformation?

Christina: Sure, I am involved in several organizations that, in various ways, are aiming to improve health through food and nutrition in the D. C. area, but also across the country. Another role, I am the president elect of D. C. MAND, which is the D. C. affiliate of the Academy of Nutrition and Dietetics. And through that role, I’m also seeking to connect and empower dieticians.

in this area as we’re learning and collaborating to optimize our impact. Also involved with the D. C. Food Policy Council’s Nutrition Education Subcommittee, working on different ways to enhance access to nutrition education, including from registered dietitians across the district. And then the couple of specific examples that you gave, one role is with the local board for the, actually international organization called Slow Food.

So I work with a really inspiring team to promote and celebrate Local, seasonal, sustainable food sources that are also working to preserve culinary traditions of the diverse populations throughout the DMV region and then really support the right to enjoy clean and fair food for everyone. And then in My role with the Farm Bill Task Force, you know, as, as one area, I think I focus in related to the Farm Bill.

I’ve been applying my expertise in the Farm Bill and its myriad different influences on nutrition, as well as an advocacy and strategic planning to help develop the Academy’s strategic priorities for the Farm Bill, which was. I think, due to be signed, reauthorized this year, although it looks like it’s probably going to be happening next year due to various delays this year.

Why the Farm Bill is so important to the health of patients served by dieticians across the country, and then suggestions about what we can do about it, regardless of our area of work. You know, I certainly work in a very non-traditional setting as a dietician, and, and dieticians can work in any area, and I think it’s so important that we all know our work is.

Affected by the food system and can positively affect the food system, whatever, whatever it is that we do. And so I think while a lot of these different roles are not necessarily directly related to my full time job in healthcare consulting. I’m always eagerly looking for ways to find areas of overlap and then think strategically about ways to bring them together for the betterment of our country.

And I think one example is what I mentioned several years ago, preparing for this round table at the American Public Health Association, looking at the overlaps between our federal nutrition assistance programs and the benefits provided through our public insurance plans. You know, the largest program by far funded through the Farm Bill is SNAP, more formally known as food stamps.

And there’s a lot of attention from different sides of the aisle on ways we can make that program more effective and more efficient. And so I think it is, it is really important to kind of think strategically about. Ways to optimize that program and think about what are other programs serving similar populations and how can we best optimize nutrition in terms of access and also outcomes for People are receiving these benefits 

Shireen: truly and you know to some of the work that you also spoke about I’m curious to even understand and get your take on this because we know so what we know at the core of Where things stand today is that nutrition security for instance is a is a big issue It’s not only about foods, but it’s about like nutrient dense foods, for instance.

How did we sort of get to where we are, I think is a bigger question in my mind, to where we’re even looking at all of these different policies that need to happen, that need to sort of be implemented. And I know the Dietetics Association is also doing some work in that, in that space. But help us understand the state of affairs today in that this advocacy work is needed to even begin with.

Where are some of those sort of core gaps that you see that still exist? 

Christina: Sure, so I think to kind of, I guess, offer a big picture, our health care system and our food system provides so few incentives for healthy diets and other behaviors that optimize good health. The agricultural subsidies that are, were funding and structures in our health care system, as I mentioned before, are not really designed to address upstream causes of poor health and unfortunately in many ways I think kind of make it easier to and less costly in the short term.

I mean, for consumers and patients to be able to access, buy, consume unhealthy foods, and then to unfortunately need to be treated for many of the poor health outcomes that result. And so I think it’s very important that we need more comprehensive care. from different types of healthcare providers who are speaking in similar language, you know, held to similar standards, having similar goals, prioritizing similar concepts to show our patients that we’re on the same page and we can work with them to make real lifestyle changes that can prevent them from experiencing what might even seem inevitable.

And then also, I think there’s, there’s also room for improvement in, I guess, sort of setting a good example in terms of the, the behaviors, the practices by healthcare providers in terms of, you know, what, what they’re doing in their own lives. Also, what is served and promoted in healthcare settings. I mentioned before some exciting work happening.

getting healthier food into healthcare settings. And so I, I think again, sort of alignment across these different types of healthcare providers. I think there’s a bit more we can do in terms of sort of practicing what we preach, setting more norms around healthy eating, not making it seem like nutrition and healthy eating are kind of a punishment, but rather something exciting, something to be embraced.

And then I guess. Maybe on sort of a related topic as well. I think when we start to do more of that, it will also be important and helpful. For patients and consumers to ask for more healthy food and when they buy healthy food in farmers markets and grocery stores That will show market demand and help to their therefore sort of present opportunities to increase supply I think also seeking opportunities like healthy cooking classes.

You mentioned before I work in the culinary medicine space. So though I think such opportunities are increasing again, expressing interest, asking for classes and, and showing up and registering at clinics, markets, workplaces, and more because that will show big food companies and payers and farmers, even our government, that there is really this motivation and desire for more services to be offered and covered.

And this will just kind of create kind of a positive feedback loop. And so that’s something I think is also an opportunity to help. bring about some more of this positive change.

Shireen: I love that approach around empowerment and, and sort of the individual sort of making a case for themselves of like why they need the food, the good quality foods, for instance, that they need.

It also seems on the flip side that the system is just really not set up in that way, which is so unfortunate, and I think you hit it right on, you hit the nail right on the head. What can healthcare professionals do? I know you mentioned a couple of things. But, you know, how can healthcare professionals really be able to help in this transformation that is needed to prioritize nutrition?

Christina: Yeah, absolutely. So I guess, first of all, I can mention that registered dietitians are, you know, the experts in this space and nutrition. And so I think there is a lot of exciting work sometimes involving professional associations and sometimes through kind of grass efforts. But, I would say not all dietitians are necessarily engaged in efforts, whether it be in sort of policy advocacy or collaborative efforts to advance our profession and profession, excuse me.

So I think sort of posing a call to action to dietitians to make sure that we are. Speaking up for our area of expertise, making sure that we have a seat at the table, whether it’s within our own institutions, whether it’s on local boards, leadership roles to really showcase our expertise and show the positive outcomes that we can have in our institutions and in society.

And then also. Kind of to what I was saying before, showing that we’re not here to be the food police. We’re not here to, you know, wag our fingers and make people feel guilty about, you know, eating an occasional treat or something like that. But that we love what we do. We’re here to help patients live their healthiest, longest lives, help them to enjoy food, give them the tools to do so.

And we’re here to be their… their partners in that transformational change. As for other types of healthcare providers, I think this is another area I’m passionate about is educating and empowering other types of health care providers to work in this space as well and really be a part of inner, interprofessional teams.

And so I’m actually next week going to the Obesity Medicine Association Conference and leading a culinary medicine workshop. And most of the folks that come to that will be physicians, but I know we have a few other types of providers, some nurse practitioners, pharmacists, and others, and so I think for those other types of providers who don’t necessarily know as much about nutrition, looking to, to learn more about Nutrition and science itself, but also what are tangible tools and tactics to be able to reach patients and how can they best partner with dieticians?

What are the evidence based care models? Understanding what are the different incentives that are offered in our healthcare system to be able to bring in these different types of experts, cover provide and cover these evidence based nutrition services to patients. So, I think that those are a few different items.

I think learning about, at least to a basic level, the latest nutrition science and evidence itself, looking for ways to bring in the nutrition experts to provide that most effective care, and then really understanding the most effective means of delivering the education and empowering patients to really prioritize nutrition.

Shireen: This also Christian ties back into and my next question is really deep diving into this. So in an ideal world, what are your visions for the future of healthcare, particularly in terms of how it incorporates nutrition services and addresses issues really related to access and consumption, which is what you mentioned of healthy and sustainable foods?

What does that ideal world look like? 

Christina: I would love to see that people of all different backgrounds would have access to nutrition education. I think both beginning in their homes as Children, you know, learning from families, but also in their broader communities in their schools, you know, their places of worship, their places of play from a young age so that diet related diseases would ideally be a much smaller problem in our country.

I would love to see that dieticians would be firmly embedded throughout our system of primary care. And, you know, to even back up another step, I’d say I would love to see that more medical students would choose to go into primary care. In our current healthcare system, you know, we have a shortage of primary care providers in this country.

And I think there are, there are a variety of reasons for that. One of which is working in other areas of practice is often more lucrative. So that our healthcare system would find ways to better incentivize and motivate providers to go into primary care. And… With that more of a focus on, you know, maybe lifestyle medicine and prevention, sort of moving upstream, everyone at risk of a chronic condition could receive the necessary care and then also find a community to learn and adopt sustainable lifestyle changes to embark on a path to good health.

And then even when we think about the acute care setting and hospitals, I would love to see that dietitians would no longer be relegated to the basement level and then called in to see a patient at the last minute, but would rather have a seat at the table when care teams are discussing, discussing nearly any patient.

And for that to happen, all providers and administrators. We’d really need to understand the immense value that nutrition experts, dieticians can offer in delivering patient centered, evidence based, and cost effective health care. 

Shireen: Well, with that, Christina, it’s been an absolutely great episode. Thank you so much for your time.

It really provided us a lot of bigger picture and a better perspective around nutrition and the state of where things are in our country. And thank you for the incredible work that you are doing and sort of moving that from a policy and even from the advocacy standpoint. At this point, I would love for our listeners to To learn more about how they can connect with you and learn more about your work.

Christina: Absolutely. So they are welcome to visit my website, Christina batteraco. com. And I’m also happy to connect on LinkedIn. I do live in the DC area. If anyone is in this area and wants to connect. I also list on my website a few different conferences that I’ll be attending soon. So certainly if any listeners are going to be there, I’d love to be able to connect with anyone in person.

Information about the book that I wrote about the Farm Bill is also available online. I think you might be able to provide that in show notes. Yes, listeners are also welcome to read more about some of the other writing that I’ve done in the past. So I would love opportunities to connect for anyone passionate about these areas.

Shireen: Awesome. And we will link, by the way, absolutely, we will link some of these things up in the show notes. So, you know, just scroll down and you can find there and everything should be linked up for you. Christina, with that, thank you so very much for your time. To our listeners, thank you for joining us on another episode of the Yumlish podcast.

You know what time it is. Head over to our Facebook. Book our Instagram. Find this podcast post. Comment below to tell us “How can you take a more proactive role in improving your own health through nutrition?” Again, head over to Facebook, head over to our Instagram page, find this podcast post. Comment below the podcast post, and tell us again “How can you take a more proactive role in improving your own health through nutrition?”

We’ll continue the conversation there. With that, Christina, thank you so much for your time. 

Christina: All right. Thank you so much. Have a great day.

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