“Twenty years ago when I practiced, I had implemented a program for clients who had 50 or more pounds to lose. Now, 20 years later, it’s not unusual for me to see clients with 100 or even 200 pounds or more to lose with BMIs over 40, some as high as 60.” - Susan Harrow Rago, MS, RD, LDN
It is my good fortune to have had the opportunity to conduct a question-and-answer session with Susan Harrow Rago, a Registered Dietician and Licensed Dietician-Nutritionist. I would now like to share that good fortune with my readers who, I am sure, will be as appreciative as I am for both the time and instruction that Susan has given.
Susan has been involved for 25 years in the areas of healthcare programming. These areas focus on establishing and enhancing healthy lifestyles to prevent and manage disease. Among her many credentials, Susan is a Nutrition Consultant. She is experienced as a Consulting Dietitian and practices medical nutrition therapy with client referrals from cardiologists, endocrinologists, gastroenterologists, and gerontologists. She was a consultant for an in-house addictions program and along with behavioral health staff, developed a weight management program for members who were 50 pounds or more overweight.
I began the interview by asking Susan a few questions about nutritional counseling for weight loss.
My Bariatric Life: Do you classify obesity as a disease? If so, is it a physical or psychological-based disease?
Susan Rago: I don’t think it really matters whether we classify obesity as a disease or not, except for insurance reimbursement purposes. And I do think that insurance should cover, at least in part, coverage for the treatment of obesity, especially nutrition counseling by registered dietitian nutritionists. The important thing is that millions of people are struggling with obesity. There are most likely both physical and psychological manifestations, many of which are not well understood, which is why treatment for obesity is so frustrating for all involved.
MBL: Please give us a profile of the typical person that comes to you for nutritional counseling.Susan: It’s really alarming to me the extent to which obesity has become a problem. Twenty years ago when I practiced, I had implemented a program for clients who had 50 or more pounds to lose. Now, 20 years later, it’s not unusual for me to see clients with 100 or even 200 pounds or more to lose with BMIs over 40, some as high as 60. The age ranges go from teenagers to mature adults; men and women. I see blue collar workers, professionals and stay-at-home parents. Obesity effects everyone. One common thread is usually the person is so busy with life, work family, etc. that they are not taking the time to take care of themselves. Many people I see are now suffering the consequences of their poor lifestyle habits throughout many years and now have diabetes, heart disease, kidney disease, and a myriad of other chronic conditions related to obesity.
MBL: How do you approach nutrition counseling for individuals with obesity who want to achieve permanent significant weight loss?
Susan: My first question is, “Why do you want to do this now?” Making permanent lifestyle changes necessary to achieve permanent weight loss is hard. Unless clients have a compelling reason for making changes that is going to carry them through all the challenges and obstacles to making the necessary changes, their likelihood of success is dismal. One of my clients wanted to lose weight and be more limber because she buys a season pass to Great Adventure and rides the roller coasters with her grandchildren. My second question is, “How do you think I can best help you?” My approach is individualized for each person. Based on his/her eating history, we’ll develop goals based identifying changes the client is willing and able to make.
MBL: What can a person expect from nutritional counseling in terms of what happens during the consult, how long will they work with you, what sort of support tools do you provide, and things like that?
Susan: Our first session together is usually an hour long. That first session gives us a chance to get to know each other. I’ll obtain a diet history, review medical history and medications, weight history and then we’ll set some preliminary goals. It’s really helpful if I can obtain some records from the client’s physician including most recent labs so any comorbid conditions with nutritional implications can also be addressed.
Clients are encouraged to contact me via email, text, or phone if they have any questions between sessions. Since my practice is primarily insurance based, insurance often dictates how often we follow up. For instance, the local Blue Cross plan covers 6 visits per calendar year for nutrition counseling. I have some clients who I have been seeing for 3 years using that benefit. Typically I see clients on a monthly basis. I have a FaceBook page on which I often post timely articles relevant to my clients.
MBL: How can a person best prepare for her first session of nutritional counseling?
Susan: First, I would make sure that the registered dietitian nutritionist is a good fit for you. Before your session, ask what will happen in the session and what is usual follow up. Ask if he/she has a website you can review. Bring copies of your last labs to your visit. It would be helpful to keep a food record, either paper or electronic for a week before your visit to share with the dietitian nutritionist. Also bring a list of all of your medications and supplements as well as the dosages. Have the name, phone number, and fax number of your physician with you. Know and understand what your insurance will cover as far as nutrition counseling.
**MBL: Where can people find reputable referral sources to get nutritional counseling for obesity?**Susan: To find a registered dietitian nutritionists people can go to the ** Academy of Nutrition and Dietetics website and use their free find a dietitian service**. Also, people might want to call their health insurance customer service center to find a dietitian nutritionists who is in-network with their insurance.
**MBL: What advice would you give the person who cannot, for whatever reason, undergo nutritional counseling?**Susan: Talk to their primary care physician about local resources. Think about joining a Weight Watcher’s Group or ** Weight Watchers online** or other online program. It’s very difficult to do this on your own.
You also may enjoy my series of interviews with Lori Rosenthal, MS, RD, CDN, a bariatric dietitian. Read more:** Keep the Weight Off for Life**
Cheryl Ann Borne, writing as My Bariatric Life, is a contributing writer and Paleo recipe developer for HealthCentral’s Obesity Community. Cheryl is an award-winning healthcare communications professional and obesity health advocate who has overcome super obesity and it’s related diseases. She publishes the website MyBariatricLife.org and microblogs on Facebook, Twitter, and Pinterest. Cheryl also is writing her first book and working on a second website. Watch her transformational video on Vimeo.