Milwaukee VA Medical Center
Dietitians deliver despite COVID restrictions
(Note: This is one of two stories marking National Nutrition Month. You can read the other one here.)
Isolation brought on by the COVID-19 pandemic didn’t just produce anxiety, loneliness and depression; it also produced something else:
Much like the “freshman 15” – weight students sometimes gain when they go to college – COVID pounds started to add up for many people as the pandemic lengthened. Health clubs were shuttered, and many found themselves cut off from their favorite activities.
For the clinical nutrition team at the Milwaukee VA, COVID pounds were one of many things to grapple with as they worked to serve Veterans struggling with proper nutrition and wellness as the world turned upside down.
“Quarantining and isolating created a variety of issues … and with more people stuck at home, they were more likely to gain weight,” said Kristen Bertram, registered dietitian and coordinator of the MOVE program.
“Many Veterans felt isolated. They lost access to gym memberships and didn’t feel comfortable exercising in groups.”
But the effects went beyond that. The political and social unrest of 2020 played a part as well.
“There was so much working against people. I’ve seen firsthand what a mental toll this past year has taken on many of the Veterans I’ve worked with. It has affected levels of motivation, depression, anxiety and paranoia.Renae Briones, registered dietitian
“There was so much working against people. I’ve seen firsthand what a mental toll this past year has taken on many of the Veterans I’ve worked with,” said Renae Briones, Home Telehealth’s registered dietitian. “It has affected levels of motivation, depression, anxiety and paranoia.”
She further explained that during the pandemic, food can be a coping outlet for boredom, stress and other emotions.
In addition, Veterans who contracted COVID often lost their appetite and/or sense of taste or smell, said registered dietitian Anne Koth.
When prolonged, this discouraged some Veterans from eating and led to temporary unhealthy weight loss, often followed by a rebound weight gain, Briones said.
Delivering services virtually
Before COVID, the team members were accustomed to working one-on-one and face-to-face with Veterans. But hospital restrictions forced the suspension of all in-person programming, so the team had to pivot to virtual delivery of services.
“Seeing a person face-to-face is very, very helpful,” Koth said. “It’s not impossible over the phone, but it loses a ton in the translation. So this was a big adjustment for us, but we found a way to give the best possible care.”
The transition took some time, but eventually the team and the Veterans got the hang of this “new normal.”
MOVE classes took place over video. The popular Healthy Teaching Kitchen program also went virtual. Veterans accustomed to coming to the campus for classes learned to connect via telephone and computer.
“We had to get creative, and the Veterans had to branch out of their comfort zones and try new things,” Briones said.
Before long, some unexpected benefits began to emerge. The dietitians could see Veterans in their homes and point out ways to make their kitchens more safe and efficient. Veterans began taking advantage of apps and other technology that helped them track their progress and stay committed to their goals.
And Veterans who were isolated in their homes began to form virtual connections, Bertram said.
“It’s been amazing how many are connecting,” she said, noting they will offer each other encouragement, share emails and become virtual workout buddies.
“That’s been really encouraging. … They’re really building that camaraderie,” Bertram said.
And “It opened the door to a lot of online resources and apps – things that will help people long beyond the pandemic, like during the long, cold winters each year,” Briones said.
Julie Haase, program manager for nutrition and food service, agreed.
“It’s been fun to hear stories of the positive impact that it’s had,” she said. “A lot of people are learning and enjoying the video care.”
In fact, Bertram said MOVE has seen “robust demand” and now offers more programming than it did before the pandemic. Some of that may be related to Veterans looking to shed those COVID pounds, she said.
“We’re hearing from Veterans that they’re liking the virtual options,” she said. “It’s exciting that we have a bunch of different options. … Hopefully we can find something … that helps them meet their goals.”
And when it came to losing weight, the dietitians were happy to report success stories.
Bertram noted a group in Green Bay that, over the course of four months, lost 135 pounds among eight Veterans.
“That’s pretty darn good, considering all the things they have working against them during COVID,” she said.
And registered dietitian Nathan Nitka said he had a patient who lost 18.5 pounds – about 6% of his body weight – since August.
He said the accountability – having someone to help the patient stay on track – is key.
“It helps them to have someone to talk to,” he said. “It helps with motivation and achieving their goals.”
Going forward, the dietitians said they will continue to be flexible in order to meet Veterans’ needs, whether through virtual or in-person means.
“We want to maximize and explore all options,” Nitka said. “We want to utilize all resources available.”
(Read about two Veterans’ success stories by clicking here.)
(To see other MOVE success stories, click here.)
Ready to help
The Milwaukee VA Health System’s clinical nutrition team consists of 40 registered dietitians and six dietetic technicians whose services range from ICU/critical care to home-based aid.
They use evidenced-based nutritional therapies to help prevent, manage and improve a variety of conditions that affect our health and wellness. They can help Veterans:
- Optimize diet and lifestyle choices to improve overall health, energy and immune systems.
- Provide life-saving nutrition through a feeding tube or IV for those unable to eat by mouth (for example if seriously ill, unconscious or intubated.)
- Connect Veterans to food service and supplemental programs in the community to help during times of food insecurity (shortages/hunger).
- Help Veterans optimize blood sugars and/or reverse early diabetes or “pre-diabetes.”
- Guide Veterans through special elimination diets to help improve digestive or allergic symptoms.
- Provide nutritional strategies prior to, during and after surgery to help optimize outcomes.
- Assist with goal setting, education and motivational support and accountability to achieve long-term weight loss results.
They have also adapted to COVID pandemic restrictions and can offer:
- Specialized nutrition care and support for Veterans with COVID-19 found to be at-risk for malnutrition.
- Video-based appointments to connect with Veterans from home.
- Virtual MOVE! weight management, diabetes and Healthy Teaching cooking/group classes.
- Home Telehealth’s TeleMOVE! program to engage Veterans in their weight-loss goals.
To connect with a local VA Registered Dietitian and explore available programs and services, Veterans can contact their VA Primary Care Clinic to request an appointment.