Tools for chiropractic health screening of patients

A brief health screening opens the door to talking about nutrition, its importance to musculoskeletal health, and wellness options

The American Heart Association (AHA) in August published a scientific statement calling it “critical” that health care practitioners assess and discuss diet quality with patients. Why such a statement?

Global, U.S. diet quality at an all-time low

The AHA’s statement, which was printed in Circulation: Cardiovascular Quality and Outcomes, reports that a poor diet has bypassed all of the other mortality risk factors known to exist today. As a result, it accounts for 11 million deaths globally and contributes to approximately one-half of all deaths due to cardiovascular disease.

At the same time, health care costs have continued to increase. These expenditures represent 17.9% of the 2016 gross domestic product and nearly have of them are due to conditions related to obesity.

Common barriers to health screening and counseling

There are multiple reasons health care professionals don’t typically assess a patient’s diet during a normal office visit, according to the AHA. Among them are:

• A lack of knowledge or training in dietary or health screening and counseling
• Not enough time to address diet during the appointment
• Diet is not a priority when compared with the other reasons for the appointment
• “Insufficient integration of nutrition services” within particular health care settings
• Reimbursement issues related to dietary counseling

What diet screening tells us

If doctors of chiropractic also decided to heed this calling, conducting dietary screenings on patients would offer several advantages.

One is that it opens the door to talking about nutrition and educating patients as to how the foods they eat are important to their musculoskeletal health. You are able to explain how consuming enough protein helps them protect their lean muscle mass and how eating foods high in calcium and vitamin D contribute to strong bones, and the dangers of processed foods.

Another benefit of health screening is that it can provide insight into other conditions the patient may have a higher risk of developing due to the foods they do and do not eat regularly. For example, a diet high in saturated fat has been linked to heart disease and stroke. A diet low in fruits and vegetables can contribute to vitamin and mineral deficiencies while also increasing one’s risk of heart disease, diabetes, and certain types of cancer according to the Centers for Disease Control and Prevention.

Assessing a patient’s dietary habits also tells you where their biggest nutritional obstacles lie. This enables you to provide suggestions more consistent with their lifestyle. If they typically eat a lot of fast food because they don’t like to cook, for example, providing tips for creating quick meals will be received better than sharing recipes that take hours to put together.

How to perform a thorough screening

In the AHA’s scientific statement, it provides a few tools for screening patient’s dietary habits. Ranked in order from those that require the least amount of time to those that require the most amount of time, they are:

• Powell and Greenberg Screening Tool – only consists of two questions, the first asks how many times per week they eat five or more servings of fruits and vegetables and the second asks how often they consume sugary foods and drinks;
• Starting the Conversation – a total of eight questions that ask the frequency (daily, weekly, or monthly) with which the patient consumes fast food meals or snacks, fruit, vegetables, sugary beverages, protein sources, snack chips or crackers, desserts and other sweets, and butter or meat fat;
• REAP-S (Rapid Eating Assessment for Participants – Shortened) – 16 questions that ask about the patient’s food-related behaviors, such as how often they skip breakfast or cook within the average week;
• MEDAS (Mediterranean Diet Adherence Screener) – asks the participant 14 questions, the answers of which are indicative of how well they adhere to a Mediterranean diet, such as how much olive oil they consume daily and how much wine they drink per week.

Offering dietary advice to chiropractic patients

Diet is not always an easy topic for patients to discuss. To make the conversation go more smoothly, the American Medical Association recommends that health care practitioners be both realistic and sympathetic when it comes to helping patients develop healthier eating habits.

Instead of having them completely overhaul their diet, start small. Come up with one or two things they can do to begin to make positive dietary changes. This enables patients to experience success early on, motivating them to continue. It also gets them used to a healthy and nutritious eating plan in a way that doesn’t overwhelm.