Saint Louis University

Author: Hannah Cole
Published: Monday, November 7, 2011

It’s no surprise that dietitians are met with resistance by many of their patients and clients. Not only do people not like being told what to do, but they also don’t like hearing that what they have been doing in the past is wrong. That’s why it doesn’t surprise me when patients say things like, “Oh no, don’t take away my favorite foods,” or “ya I know I know, I just don’t like vegetables as much as I like fettuccine alfredo.” These patients may not respond well to an education, but in general, they admit their mistakes, and recognize the truths of what we say. However, in my cardiovascular rotation I worked with a client that not only did not want to hear my educations, but believed the entire field of nutrition science is “a poppycock science invented in the 1970’s by doctors from hippie towns in California.”

Mr. V is a 61-year-old man with a BMI of 32, although his height of 6’1” helped him to not appear obese. He came to the emergency room with chest pain and shortness of breath and was admitted for testing and for placement of a pacemaker. He was found to have cardiovascular disease, along with other co-morbidities such as a triglyceride level of 516 (4 times the recommended level) and an HDL of 27 (a bit more than half the recommended level). Needless to say, this patient was a prime candidate for nutrition education.

MR. V was very friendly towards me, and the idea of a nutrition consult. He stated that his hospitalization had scared him enough to be ready for some serious life changes. I was excited to work with a patient that actually wanted to work with me! However, I quickly realized he was only ready to say that he is ready to make changes, and not to actually hear about or consider what changes those may be.

As soon as I began discussing avoiding saturated fats and cholesterol I learned that MR. V is from the south and an avid consumer of red meat, whole milk, gravies of all kinds and as many as a dozen eggs in one sitting. I explained to MR. V that his previous diet was certainly a cause of his current condition, but that there were numerous very simple changes he could make that would allow him to lead a similar lifestyle but improve his health. He then said something along the lines of “No, what I’m saying is I’m from the south, I’ve been eating that way for 60 years and I’m going to continue to do so. My father is 80 years old and has never been hospitalized.” Before this encounter I hadn’t realized that people from the south believe they have uncloggable arteries!

I began discussing with MR. V that diet can affect patients differently particularly with different lifestyle choices, which would explain why his father, a hardworking farmer his whole life, had not seen as many repercussions from his diet choices. MR. V was kind and allowed me to continue reviewing the heart health handout we provide to all cardiac patients. MR. V looked down at the list of foods he was suggested to avoid and responded with “If you showed this list to my family in The south they would shoot you before you got out the word ‘vegetable’.

By this time it was clear I had overstayed my welcome. I told him to look over the handout, and think about 1 or 2 changes he would be able to make, and that if he had any questions to tell his nurse to contact me and I would return. He mentioned that he had a question right now; “ I don’t mean to degrade all of the work you have put in to your education, but none of this nutrition stuff is true. Why on earth would you choose to study food for the rest of your life? 30 years ago your profession didn’t exist. People have been eating the same way for hundreds of years, they get old, their hearts give out, and they die. What you eat doesn’t matter, how much you exercise doesn’t matter, and whether I drink whole or 2% milk especially doesn’t matter.”

A million responses went through my mind. Thousands of journal articles that have proven the various effects of eating right, the increasing rates of heart disease and obesity in America, the fact that dietitians have been around for well over 30 years, as well as a few other choice phrases that I should not publish on the world wide web. But, using all of the restraint I could muster in my body I simply stood up, smiled, and said, “Well I hope you enjoy your stay at the hospital. I’ll see you again soon” and walked out.

He was discharged that day, and readmitted 3 days later for worsening chest pain.