Expert Q & A: How do I incorporate healthy-eating components into my program?

Karen Trainoff is a registered dietitian and the founder of Pathways to Health and Wellness, a consulting firm providing counselling and education on nutrition and health promotion. With her background in nutrition and mental health, Karen enjoys exploring the connection between food and mood. She has developed an innovative health-promotion program series, “Food and Mood… the Mind-Body DIS-connection,” that has empowered many participants to adopt healthier behaviours around food. She represents Dietitians of Canada on the Ontario Chronic Disease Prevention Alliance's Mental Health Workgroup and is also a member of the College of Dietitians of Ontario, the Canadian Obesity Network and the Ontario College of Social Workers and Social Service Workers.

1. What made you decide to be a dietitian?
I had worked in community mental health for about 15 years and always had a strong interest in nutrition, healthy eating and healthy lifestyles. I noticed anecdotally in my work that nutrition was of interest to others as well. Consumers and family members talked about how nutrition and diet had an impact on mental health and wellness. They wanted to discuss how food affects mood and how, in return, our mood has an impact on what we eat and how we eat it. People were talking about research and bringing in researchers to talk to us about it. Colleagues, as in any work environment, also wanted to talk about food and the relationship between their mood and their food intake. People everywhere seem to be interested in food and its relationship to health — mental as well as physical.

My sister-in-law, a dietitian, said to me, “You should really consider becoming a dietitian; what a great combination … to combine your background in community mental health and your interest in nutrition.” I was at a crossroads in my life and looking for some change, so that’s exactly what I did. I went back to school to get my degree in food and nutrition and did my clinical training at Mount Sinai Hospital in Toronto.

2. How did you incorporate healthy eating into programming when you were working in the community mental health sector?
Beyond educational speakers and discussions, we started to look at what types of snacks we were providing to the group and connecting with other programs going on in the community. Many, many years ago, there wasn’t much concern or thought about snacks, as long as they were easy and inexpensive (for example, cookies or juice). Over time there was more interest in types of snacks and how we could incorporate healthier snack items — or, looking at programs, how to prepare meals on a budget that integrate the health component.

3. Did you see changes in the eating patterns of program participants, or receive feedback?
Once you are able to raise the issue in different environments, the conversation comes after it. Any type of change will often cause discussion. Change is not always comfortable for people. Whenever there is opportunity for conversation or education, there is opportunity for learning from each other. The feedback [was] that something is different: often people liked it, and there were some hesitations. Even learning why people were hesitating let us know how we could approach things differently.

4. What types of hesitations did you hear?
General things like “I wouldn’t like that”; ”What is that?”; “That’s not something I normally would eat”; ”What difference does it make? I can’t eat in a healthier way.” Sometimes the hesitations would help us to back up, slow down and help people figure out what change or changes they were ready for.

5. Did the programs involve dietitians?
No, I had not worked with a dietitian.

6. Do you think it is important to incorporate dietitians in the planning of programs?
I think dietitians can be a really helpful addition to planning program content, based on their expertise in the science of nutrition. Dietitians take a 4-year science degree followed by a year of clinical training.

7. Now that you have a dietitian’s perspective in addition to that of having worked in community mental health, what topics do you think would be important to cover in a program for mental health consumers?
There are a few different areas that are important. There are the issues of shopping and preparing food in a healthy way, taking into consideration budget constraints and the need to be culturally sensitive.

Another issue in mental health for a lot of people is weight gain, which may be related to a specific illness or medication — to be aware of that and be able to offer strategies for weight management and disease prevention. Excess weight may contribute to diabetes and heart disease. Schizophrenia is now [also] seen as a risk factor for diabetes. That understanding is needed so that one can help prevent, or reduce the high risk of developing, diabetes.

A third area — and I work with this in my private practice — is the emotional part of all this: helping people to understand the connection between your mental health state and the food behaviours you might have, and how those are interconnected for a great number of people. You can work on it in the community as well, helping people develop strategies to deal with these connections in a healthy way.

In general nutrition, we talk often about the need for planning so that you know what you are going to eat. And that may not be realistic for people with mental illness, because if you are not well it can be very difficult to plan ahead and to have that routine in place. It is important to have that awareness, so that you can plan for when you are unwell and have a strategy in place for those times.

8. Do you see peer-leadership opportunities?
Definitely. Any one of us can be a healthy-eating ambassador. Peer pressure for positive change works for adults as well as it does for children, even as far as adopting healthier attitudes towards food and nutrition. In addition, from a community programming perspective, there are definitely roles for peer mentors, peer educators, and peer support workers. With proper training and support, there are tremendous opportunities.

9. It seems to me there is opportunity to share the food skills from a variety of cultural backgrounds.
Absolutely. Food, for anybody, is a personal thing. We all eat, but my relationship with food is not the same as anyone else’s. Our relationship is unique to each of us. And to that uniqueness we bring tremendous skill and passion.

10. What about barriers that program leaders may face when incorporating healthy eating into their programs?
Program planners should make sure there is buy-in and interest from the group. They would also benefit from having access to the right level of knowledge through educational supports, as people may have questions that [program leaders] may not be able to answer right away. Access to physical space [is needed] for food preparation — making sure you have adequate space that allows for safe handling and food safety.

11. Can you describe possible partnerships in the community to help overcome these barriers?
Mental health groups can certainly look at having the right resources and information, including access to professionals (like dietitians). Partnering with other agencies that focus on chronic disease (e.g., local chapters of the Canadian Diabetes Association, Heart and Stroke Foundation, or Cancer Society) can help with this. These organizations may have information resources already developed that they may be willing to share.

Local community centres, universities and colleges may have hospitality, nutrition or related educational programs. They may be able to provide a volunteer base with a specific skill set that you might not have in-house. Individuals will be looking for opportunities to work in the community to gain hands-on experience. They may also have access to cooking facilities to share with your group.

Dietitians of Canada provides access to a roster of people who are interested in doing work in this area through its online member directory.

The Nutrition Resource Centre can guide you to Community Food Advisor programs, which are generally affiliated with local health units.

12. Is there a main tip you would recommend to help someone start changing their diet to be healthier?
The first tip I would recommend is to journal: it captures where you eat, what you eat and who you are eating with. I would ask people to rate their hunger before they eat, to help identify if they are eating because they are hungry or for other reasons. And then I would ask them to identify their mood before and after eating. This type of journal helps to identify patterns that you might not otherwise be aware of. From there, people can help to adjust their own behaviours into a more healthy pattern, perhaps by changing when or where you eat — because it is not always just about changing what you are eating.

13. What are you having for lunch?
I am hungry, so I’m going to have leftovers. I made a vegetable, lentil and potato soup.

14. Are you a proponent of cooking from scratch vs. buying store-bought?
When possible, yes; but I’m realistic enough to know that this is not always possible. There are healthy options to be bought in stores as well.

If you have further questions, you can contact Karen Trainoff directly at karen [at] pathwaysrd [dot] ca. Her website is