It’s no secret that food and nutrition can have an impact on health in countless ways. The idea of “food as medicine” is quickly being accepted by practitioners, but understanding nutrition from multiple angles is becoming more important than ever. Jerica Berge, PhD, MPH, LMFT, analyzes nutrition and behavioral patterns in three different realms: in the clinic, as a researcher and through medical education.
“Eating behaviors and other weight-related behaviors such as physical activity, are a common thread that run across all kinds of health conditions that contribute to better or worse health, so paying attention to food and nutrition is key when it comes to overall health,” Dr. Berge said.
Dr. Berge’s clinical work emphasizes an “integrative care” model, where dietitians, behavioral medicine providers, pharmacologists, residents, MDs and DOs all collaborate in the same location–typically a family medicine clinic. This collaborative environment ensures that people with varying expertise come together to intervene in a holistic way, and it allows the team to address multiple issues in the moment.
“It’s really important that we’re thinking about ‘food as medicine’ in all of the ways in which we deliver care to our patients. The common thread across many health conditions revolves around weight, weight-related behaviors and the food choices that we make,” Dr. Berge said. As a medical educator, Dr. Berge emphasizes that residents being trained in family medicine and primary care clinics need to be able to understand and treat all behaviors that impact health.
“A lot of what we teach in the clinic involves interpersonal relationships, because so much of eating behaviors and food choices are about this, especially in parent-child relationships. For example, my research focuses on the feeding relationship between the parent and child, and we have found that more controlling feeding practices such as restricting or pressuring the child to eat often results in unintended consequences such as higher weight status or disordered eating behaviors. Interprofessional clinicians provide the right context to really help a parent in navigating this relationship with their child,” Dr. Berge said.
As a researcher, Dr. Berge studies how family relationships, parent feeding practices and the bi-directional relationships in the family context affect food intake through innovative mobile health technology. One important factor that can impact these relationships is stress. Dr. Berge’s research has shown that higher stress levels are predictive of controlling feeding practices and less healthy behaviors like consuming fast food or pre-prepared foods and serving them to their family.
“We’re really aiming to lower overall stress levels of parents in order to help them be able to engage in feeding practices that are better for their kids. Some of those are behaviors within their control, while some are very structural. We're also digging into the larger system of food insecurity that can drive a parent’s ability to provide healthy foods to their children. We’re really trying to understand all the levels at play in a family’s context to really provide change that will be sustainable and impactful on health. You can’t just intervene at the behavioral level, it’s not enough,” Dr. Berge said.
Unfortunately, eating healthy isn’t always possible for some, and this isn’t by choice. 10.5 percent (13.7 million) of U.S. households were food insecure at some time during 2019, demonstrating that structural factors also play a significant role in nutrition.
“Now, in medicine and public health, we are looking at systemic and structural barriers to accessing healthy food and how that can impact nutrition. It’s a really fast moving field right now. We’re trying to put all of the important pieces together because there are individual level factors, relational and familial factors, and community and structural factors that all play into someone’s food choices and eating behaviors,” Dr. Berge said.
Poor nutrition, especially for those who are food insecure, often begins at a young age. Data demonstrates that childhood obesity regularly continues throughout adolescence and cements itself in adulthood, making early clinical interventions crucial to mitigate the later effects of poor nutrition.
Nutrition plays a central role in health outcomes and will be a point of emphasis for many people across the spectrum of medicine and public health. Experts at the University of Minnesota will continue to be at the forefront of innovative research and clinical care in this realm, particularly in using real-time technology to understand obesity and interventions.