Nutrition Education and Health Psychology

About the Program

The Nutritional Behavioral Health Program at People's Community Clinic is dedicated to working with patients as they develop the confidence to make changes that will improve their health. Many of the patients who participate in the program are newly-diagnosed diabetics.

The Program works through individual sessions and group classes. Each week our nutritionist and health psychologist hold classes on different subjects that are designed to give patients the tools they need to lead healthy lives. Weekly classes are offered in both English and Spanish and include topics such as:

Managing Diabetes
Newly Diagnosed Diabetes
Good Eating Class
Gestational Diabetes

Classes for children or parents are offered on an as-needed basis. All classes are small, ranging from just 3 to perhaps 10 people. They are open to all of our patients, and patients can sign up with their Medical Assistant during any visit.

Some of the diabetic patients at the Clinic work with Community Health Promoter Ruby Nino. The Community Health Promoters Program was designed to improve the health of the residents of East Austin using community health promoters recruited from and working in their own communities and neighborhoods.

Diabetic patients are also enrolled in the Clinic's Chronic Disease Management Program. The Clinic uses a Chronic Disease Registry database to enhance primary care and outcomes. A chronic disease nurse manages the program and works with healthcare providers to identify the patients who are most at risk and provide them with case management services.

Staff

The Nutritional Behavioral Health Program is currently staffed by our health psychologist Juli Furgeson, Ph.D. (biography) and nutritionist Rachel Head, RD (biography).

Diabetes Information

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

There are 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease.

One out of every five health care dollars is spent caring for someone with diagnosed diabetes, while one in ten health care dollars is attributed to diabetes. The total cost of diabetes for people in Congressional District 25 in 2006 is estimated at $359,600,000. This estimate includes excess medical costs of $231,000,000 attributed to diabetes, and lost productivity valued at $128,600,000. (Information from the American Diabetes Association.)

For more information:
American Diabetes Association
National Institutes of Health

Food, Folks and Fun - a conversation about the pleasures and challenges of health eating

The following article was taken from the November 2008 edition of the Voice - the People's Community Clinic email newsletter. Interview and article by Abby Williamson.

The arrival of a new nutritionist to the Nutritional Counseling program at PCC inspired a get-to-know-you interview of Rachel Head, RDE, and Juli Furgeson, Ph.D, by Abby Williamson. Rachel serves as the nutritionist at People's Community Clinic, teaching practical applications of food, nutrition, and cooking for low-income individuals suffering from chronic disease. Juli Furgeson, Ph.D. serves as Health Psychologist to People's Community Clinic, meeting with the patients both individually and as a group.

Tell me how each of you came to the field of nutritional counseling.

Rachel: Cooking is very important in my family, so that was an important base to start from. When I was in college, I was initially an English major but I happened to take a nutrition class and absolutely loved it. I talked with the counselor there and she told me what a nutritionist's job entailed and everything sounded tremendously fun. I also thought I had a better chance of getting a job with a nutrition degree than with an English one. Of course, my parents were supportive of that so I switched over and really did enjoy it and excelled. I also enjoy helping people so that's a good fit too. My eye is set on becoming a certified diabetes educator, gaining the practice and supervision hours to do that. Also, I'm about to sit for the registered dietician exams.

Juli: My path was much less direct. I moved to Austin in 2001 as a health psychologist. I had worked largely in pain management, and also with people in El Paso and Odessa who were depressed and/or anxious. One of the first things I did when I moved to Austin was volunteer with PCC. I began working with Susie Jastrow, who was the dietician then, and I've been here ever since.

Is there a difference between a nutritionist and a dietician?

Rachel: Yes there is. A nutritionist is not legally certified like a Registered Dietician. Also, an RD has worked over 900 supervised hours, completed the required course work and passed the licensing exam. My status right now is RDE, Registered Dietician Eligible.

Juli: The truth is, anyone can be a nutritionist because it's not a licensed or regulated term.

How do the two of you work together?

Juli: We blend nutrition and psychology. Nutrition is the information about what's healthy, what foods are beneficial for someone with diabetes, what diet is best for someone who is overweight. But we all know that information by itself doesn't lead to behavior change. By behavioral change, I mean changing what you eat, changing what you drink, increasing your level of exercise-changing your whole life, really. My area is the motivation piece of behavioral change.

Rachel: Juli also has a sense of the nutrition information and I have a sense of the motivation techniques, so we work tremendously well together. There is a lot of overlap in our roles.

In what ways is the Nutritional Counseling program changing with the arrival of a new nutritionist (Rachel)? What's on the horizon?

Juli: Rachel comes with new ideas and experience and enthusiasm. One of the things I really liked when I interviewed her was her experience in Fort Worth leading cooking classes...our patients were always asking me, "How do you cook vegetables so they taste good?" "Do you have any recipes for healthy vegetables?"

Rachel: I worked with a national program called Operation Frontline. It was a nutrition from cooking class. We would offer six weeks of cooking classes all over town. I'd bring my pots and burners to wherever. We'd pair nutrition instruction with a cooking lesson, make it fun, make it group discussion-oriented, get them interested, then supply them with groceries to try the recipe at home, risk free. I feel this approach really empowers people to do the change you're asking them to make. It also encourages them that this change is actually possible. I like those elements and I'm eager to apply these concepts here at the Clinic. We're working with low income people, many of whom don't have cooking skills. Many people today come from a generation of convenience foods and eating out, they are not used to cooking at home but to eating their meals out. Making that one switch to cooking at home is essential to a healthier lifestyle. But if they don't have the skills or the interest, that's a difficult change. My goal is for the classes to show how to eat healthy, to make it taste good and to do it on a budget; all three are really important. (Get one of Rachel's health recipes: Veggie Confetti Quesadillas).

Juli: Right now we are piloting the cooking instruction with staff. We're learning important things, like one hour sessions are not enough time.

If you had to summarize your philosophy or approach to nutrition into one sentence, what would it be?

Rachel: I would say it has something to do with making realistic changes toward a healthier lifestyle.

Juli: Start with where the patient is and find out where they want to go.

Tell me about a typical PCC nutritional counseling patient?

Juli: Patients are referred to us by their provider, mainly for diabetes. We have separate classes for people with diabetes and one we call Good Eating for any patient who needs to change what they are eating and drinking. Examples of the types of conditions with strong links to diet include high blood pressure, impaired fasting glucose, hypertension, and obesity. We see people individually or in classes and classes are offered in English and Spanish. We may have anywhere from one to three or four patients in a class. Sometimes they bring their children, their partners, their mothers. We encourage that because we like patient support. It's nice to have everybody singing off the same sheet of music, you know? The patients who come-and not all referred patients come-are interested in learning. They care about their health, they're concerned about their children's health and they're interested in learning what they can do differently.

Our patients generally are not medically sophisticated. We have lots of visuals to show why high cholesterol is a problem, what diabetes is and what's happening inside the body of a person with diabetes, how different foods affect you, sample meal plans, portion sizes. What ninety percent of the patients say they want to learn is how to eat. It's not something the providers have time to discuss during a typical visit.

Rachel: Our patients reflect the general trends of the American public. The general trends are that obesity is becoming an epidemic, as is diabetes. People, whether they eat out in restaurants or at home, are eating too much fat.

Juli: Some of our patients may be less knowledgeable about nutrition than the general public who reads more or is more educated about health topics. Many are very trusting of marketing. They tell me, "Well, it says it's good on the package." Some really don't know that sodas aren't nutritious, for example.

Tell me about a nutritional counseling success you have experienced.

Rachel: It seems as though almost all the patients who have come for more than one session have some form of success.

Juli: We had one patient recently who was really struggling with her blood sugar, it was regularly in the 400 range. She was starting to notice the effects of certain foods, and even her angry moods, on her blood sugar levels. Just her increased awareness of these connections is a minor success.

Rachel: I'm very proud of the patients who come back and report that they no longer drink sodas. That's a big step in the right direction.

Juli: I think the key to this work is coming up with something small that someone can do. If they drink a lot of soda, that might mean moving from three to just one per day. Sometimes people come to us and they say things like, "I've been bad." It's not helpful to think of yourself as bad. I think it's most helpful when people can come back to us and get support. I say, "It's just food; you've not been bad."

Rachel: The short term solutions-the rapid 100 pound weight loss, the fad diets, the pills, the fad equipments-do not work over time.

Juli: We're not trying to get everyone into small sizes. We're just trying to get people eating healthy.

What most concerns you about American eating habits or trends?

Rachel: I think, as someone in the field of nutrition, obesity is our biggest nutritional challenge. It is such a huge risk factor for all these other issues, including diabetes. If we're able to switch some of the foods we eat to healthier versions, and be a little more physically active, we can lower the numbers of obese people and with that, lower the levels of chronic health issues.

Juli: I also think the obesity trend is key and I don't think there's much consensus or awareness about how to deal with it. There's a lot of biochemistry involved with obesity-maybe obese people don't know when they're full, maybe the enzymatic processes change with weight gain. Additionally, marketing has a strong impact. There's lots of interesting research that says we eat with our eyes and we clean our plate and we eat whether we're hungry or not. That's a problem as portion sizes continue to grow.

Rachel: Also, the economy allows for the least healthy food to be some of the cheapest. High fructose corn syrup is in many fast foods and it's very cheap. That's why candy, chips and sodas are so inexpensive. If you're on a tight budget, you're going to resort to these things.

Juli: And many Americans don't know that these foods are unhealthy. Many people drink 5-6 cans of soda a day because they taste so good. People don't realize that Gatorade is not exactly a healthy alternative to soda because it contains so much high fructose corn syrup.

Obesity is a national problem requiring all sorts of major solutions, but we're down here on a micro level working with one person at a time. We regularly say to people, "I know it says it's healthy on the box, but you have to read the label. The marketing description on the box is written by the company and they don't really care if you are healthy."

Rachel: It can be difficult to read a label. A big part of my training in nutrition was in reading product labels. We try to help our patients with just the basics. If you are someone with a chronic disease and we're telling you that you need to watch your carbohydrates, reading labels is crucial.

Juli: Yes, we spend a lot of time discussing nutrition labels and serving size. A can of soup is not a single serving, for example. This info may not matter as much to a healthy person without chronic illness, but for a diabetic or person with cardiac disease, knowing portion sizes and reading labels is essential.

Rachel: And that's another reason why cooking at home is so important. You can control what goes into your food because you make it. It's not hard to see if a food is healthy or not if you're the one making it.

Juli: For those who really rely on fast food, we work with them to identify menu choices that are better than others: it might mean that if you go to McDonalds, the salad with chicken is a better choice than the chicken tenders. I don't change all my habits even when I know I should, so we get excited about small, incremental changes.

Rachel: I think fast food has a time and a place, mostly on road trips. Something I might do in a cooking class is, if I know you regularly stop for sausage and egg biscuit at McDonald's in the morning, I'll teach you how to make a sausage and egg biscuit sandwich at home and how to do it cheaply and quickly. It might mean you make ten at a time and freeze a few to warm later in the week.

What are you most looking forward to in your Thanksgiving meal?

Juli: I am most looking forward to the sides: sweet potatoes, pumpkin pie.

Rachel: This is the first year that I'll be coming back home from living on my own so I plan to interrupt my family's comfort food fest! Perhaps I'll even prepare one of the recipes I've cooked in the healthy cooking classes. I may not tell them it's healthy and hopefully I can start influencing my family in positive ways. I have a recipe for pumpkin muffins that I add all sorts of fruits and nuts to, for example.

Improv Class

The following article was taken from the December 2007 edition of The Voice - the People's Community Clinic email newsletter.

The Nutritional Behavioral Health Program at People's Community Clinic is an organic program - it was created as a result of two people, Susie Jastrow, RD LD and Juli Furgeson, Ph.D., coming together with different, but complementary backgrounds. It succeeded because of their dedication, because there was a need for their contribution, and because it had the fertile soil of the Clinic to take root in. This program is a perfect example of the elements that make the Clinic what it is: unique, innovative and compassionate.

The foundation of the Nutritional Behavioral Health Program

In the late 1990s Susie Jastrow (right) became a volunteer dietician at the Clinic. She saw referrals from the providers - whoever seemed to need help with their diet. The Clinic had never worked with a nutritionist before, but before too long people began to notice that what Susie was doing really worked for the patients who came to see her. It's no surprise that her efforts paid off - after all, good nutrition is a crucial part of being healthy.

The Clinic believes in adopting programs that work for patients, and brought Susie on staff to continue the work she was doing. The Clinic strives to quickly recognize and adopt ideas like Susie's that make the most sense for our patients. This is how the Nutritional Behavioral Health program was born.

A new approach...

In 2002 a new volunteer started work at the Clinic, a health psychologist named Dr. Juli Furgeson (right). Susie brought Juli into her own fledgling program. In this way a unique and innovative partnership was born. Juli's talents added to Susie's mean that we approach patients with information in a new way. We ask the patients what they're going through and what they want to know, and give them the information they are interested in.

Juli and Susie use the empowerment model to approach their students - they know that telling people what to do doesn't usually work when it comes to changing negative behavior. People are able to make decisions on their own about how to live their lives. Juli and Susie just want to help them have all the information they need to make positive decisions for themselves.

Improv Class

The Nutritional Behavioral Health program reaches patients because the patients themselves decide the content of the classes. There is no lesson plan, no outline to follow. Instead, Susie and Juli do a kind of improv each time. They are both very knowledgable about their subjects, and are prepared to answer whatever questions their patients come to them with. Are they curious about what cholesterol is? Do they want to know more about exercise? Perhaps they want to know about blood sugar? Juli and Susie are prepared to help them with what they need to know most, whatever that might be.

End of an Era

After almost a decade, Susie Jastrow has decided to retire and will be leaving the Clinic. [Update: Ms. Jastrow's last month at the Clinic was December 2007]. We will all miss her. She is one of the unique, thoughtful, compassionate people that make the Clinic what it is. She has given of her time and expertise to hundreds over the years, and she has given her fellow staff members encouragement and enthusiasm.

We remain grateful to her for the program she began and the ideas she has fostered. We thank her for everything she has done for the patients and for us.

"Susie brought more than nutrition services to People's. She brought with her a real dedication to listening to what our patients have to say and to building lasting relationships with the patients. With Juli Furgeson, Susie has built a nutrition program that puts patients at the center of the care. Susie's work at the Clinic is a wonderful example of the fundamental importance of patient engagement and empowerment. Patient engagement was an important part of the Clinic's founding, and Susie's work echoes that spirit. We and our patients will miss her greatly!" -- Medical Director Louis Appel, M.D.

"Susie Jastrow is an example of the kind of people the Clinic attracts. She has been a dedicated employee whose work on nutrition for diabetics was published in the medical literature. She not only did brilliant work here but she is one of those people whose sunny disposition is a sure cure if you are having a tough day. We all will miss her and we wish her and [husband] Ken a wonderful retirement." --Board member Frank Bash, Ph.D.