NewFNP is hard pressed to identify anything that separates her from her patients more than does diet, culturally speaking.
One of newFNP's physical exam preventive health screening questions is: Do you eat fruits and vegetables every day? The answer is generally no. She also asks: Do you drink soda? This answer, in contrast, is generally yes.
But the answer is not so commonly yes to the tune of 60 liters of soda daily. Sixty liters seems, shall we say, excessive. That level of consumption constitutes approximately 2500 calories per day and 100% of them in nutrient-void carbohydrates. In addition, it's doubtful that all remaining calorie source were from broccoli and artichokes.
Her patient very earnestly told newFNP that she was uncomfortable with her weight and wanted to change her diet in order to drop some ell-bee's. Nutritional counseling was not so much of a challenge.
But newFNP wondered what happened to the off switch in someone who consumes that amount of soda. It might meet the DSM-V criteria for soda addiction. It is affecting her health, she continues to use soda despite suffering as a result, she has tried to stop but hasn't been able to yet. NewFNP didn't recommend any specific diet, but she did recommend complete cessation of soda consumption in addition to initiation of physical activity.
Can we incorporate infant and childhood nutrition into prenatal classes? Because this kind of whack diet needs to stop way the hell before it starts!
9 comments:
I just started my health promotion class - this week we're discussing the difference between disease prevention and health promotion. This is an interesting point to bring to the discussion table. At what point would soda consumption turn from health promotion to disease prevention? Probably when the patient is obese or experiencing metabolic changes. I'll have to add this to our discussion. Thanks for the idea.
Oh, and kids are wonderful chaos. We're about to have #2 while I'm still in school - I'm sure it will be crazy for a while but after many years minus kids I cannot remember life without them!
And you totally have your sh*t together - don't be so hard on yourself.
60 liters! Do you think she might have been confused about the quantity? A liter is 4 cups; 60 liters is 240 cups! Can someone really drink that much a day?! And still have time to commute to work, do her job, sleep, and shower?! It also means she would also have to urinate a little less than 60 liters a day. How can one find time to do that?! Her toilet must have very sturdy plumbing! :-)
60 liters of anything in a day=polydipsia, i would think...
Oh my God. This is why newFNP should not write after wine and while watching The Daily Show. Six liters. Six!! Not sixty. Who in the fuck could drink 60 liters?? NewFNP is appropriately ashamed of herself although she stands by her 2500 calorie calculation.
But, hey, six liters is still a lot.
Thanks for the clarification. The first think I thought after reading your post was, "wow, that's more than a 2-liter bottle every hour - even if you don't sleep." Figuring roughly 16 hours of awake time per day, that's almost two 2-liter bottles an hour.
I had a patient who was drinking 8 liters of Coke every day and some amount of coffee. She came in for treatment for a UTI and was being treated for anxiety. I don't think anyone had ever asked about her caffeine intake or her diet.
Wowser! I like the 6 liters number better, much better, though it is still atrocious. It sounds like she totally needs more of a support system, but I think it is firly commonplace that people drink such a freaky amount of soda. I have oft met folks who absolutely never drink water. Apparently it is not exciting enough flvor wise.
My favorite is after the question about fruits and vegetables (and the no that follows) is when I ask patients if they brush their teeth and they say no.
Mind you, I'm a PNP, and my patients are children, but the parents concur with their answers, usually saying to me, "well they don't like to brush their teeth"...
And they "don't like fruits and vegs"
Just pop and candy...
Another lesson in futility...
First of all, I love your blog. However, too much pop is why I'm against the public option. Why should I exercise an hour a day and get my 5-9 servings of fruits and vegetables just to pay for my neighbor to drink pop and eat chili candies? I think a good alternative to the expensive dilema our country has in the "treat everyone" policy would be to charge $200 for "non-emergency" visits to the emergency room. No more $8,000 stubbed toe bills for our taxpayers. Eh?
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