Spotlight: Dietitian - Supporting Clients and Keeping on Top of Research

Jennifer with her daughter

Jennifer Baker Christman, Registered Dietitian and Licensed Dietitian/Nutritionist currently working at MediFast, shares with us her journey from hospital to corporate work in the nutrition field.  I was eager to find out what the day to day work is like for someone in her field as well as how she can stay on top of often conflicting research in order to pass along valid information to her clients.  

Additionally, the weight loss phase of the MediFast program she now supports is based on a very low-calorie (800-1000 calories/day) combination of five MediFast low-carb meal replacement products plus a single home-cooked meal each day.  I was curious how that rubbed her as someone who studied for a career in food and nutrition.  

Plus, she mentioned that Halloween is a big celebration in the MediFast office.  How and why does a diet company celebrate a holiday extolling candy and sweets?!  Read on to learn more.  Extra credit: what do eskimos have to do with all of this?

JB: Hi!  Thanks for rearranging our call – we have a holiday party and it got postponed due to the storm [Hurricane Sandy], and it got pushed to today and we all have to go.

ES: That’s interesting, because – what does a company like MediFast do for Halloween, a holiday that centers around candy?

JB: Well, it’s funny you ask that because the owner of our company met his wife at a Halloween party.  He actually passed away at the beginning of this year, but the holiday is still very important to the company.

ES: Well, that’s understandable.  It has special meaning to them.  So what do you guys do for your Halloween party?

JB: Everybody dresses up and each department has a theme and there’s a contest with voting, and they do a chili cook-off and a pumpkin apple dessert contest.  And then they have lunch for us, and it varies every year what it is.  This year happens to be pit turkey and pulled pork and pit beef.  I think we have some cole slaw in there.  So, some healthy choices and some not healthy choices.

ES: Well, it’s a party, so…

JB: Yeah, it’s really nice.  They do a very nice job celebrating the holidays here.  It’s a family oriented company.

ES: Right, and Halloween is one that’s not religious, it’s just fun and festive.

JB: Exactly.  And we also do a holiday party every year around Christmas and Hannukah and all of that, so that’s nice too.

ES: Well, Jennifer, tell me your position with the company etc.

JB: I am the Clinical Nutrition Manager at MediFast Inc.  I’ve been with the company for two and a half years.

ES: What’s your background?  How did you get into this?

JB: I’m a registered dietitian and licensed dietitian/nutritionist.  I became a registered dietitian in 2001 I believe, so I have ten years experience in healthcare as a registered dietitian.  I worked at a hospital in Baltimore, Greater Baltimore Medical Center, great hospital.  I loved that job.  Then I started a family.

I love nutrition – I love the wellness aspect of it – but I also loved management at GBMC.  I was in clinicals for about five years and then I did management for about five years.  I really liked that.  It was a lot of long hours, pretty high stress and a lot of time demands though.  And I had a family and I now have two small children, so I wanted to still utilize my skills and help people. 

One of the reasons that I am a dietitian is that I want to help people feel good and look good and be the best that they can through health and wellness and through diet.  I had made a lot of friends in the nutrition world and I actually knew someone who worked at MediFast, and she had an opening and asked if I’d come and interview.  I was looking for a change and I came and checked it out, and it’s a great job. 

At the time, the job consisted of helping customers through the phone, through email, with success on their weight loss and weight maintenance plans, helping them troubleshoot.  And then also too, it was reviewing a lot of content for information that goes out to customers, whether it’s on the web or guides that we create to help people with success.  At that time, that’s really what it was.

Then we got more involved and as the company grows and it continues to grow, we’ll serve as a personal registered dietitian to people that are in the media, that we have a relationship with through marketing and we ensure their success. 

For example, if there’s somebody that’s a blogger, that is very popular, MediFast might have a relationship with them where we’re providing them support and the food and the program, and we would be their personal registered dietitian to help them with success and then they would blog about it.

We’ve also supported DJ’s – people on the radio – with their success.  You might even hear it on your local radio.  One person that I am supporting right now is Jack Nolan – he is the announcer for Notre Dame football – and you might know him. 

ES: Do you tend to reach out to those people or do they reach out to you?  How does that work?

JB: Well, we don’t really do any of that – that’s marketing.  Marketing is in charge of figuring out who.  They’re the ones with the advertising and all of that.  As a registered dietitian, I’m here to support them on the program.  We don’t reach out to them, marketing will target a certain area in the country.  They do all their marketing analysis and I serve as more of a nutrition support.  

ES: What style of program is MediFast?  Do you buy MediFast food or supply your own food?

JB: That’s a great question.  MediFast is a weight loss company with a basic “five and one” plan.  We sell meal replacements, which are about 100 calories apiece.  You eat five of those a day.  There is one meal that you prepare yourself, and we call this the “lean and green” meal.  That’s basically a protein like chicken/fish/turkey, and then vegetables that would be lower in carbohydrates, like broccoli, asparagus, lettuce, spinach, green peppers…  there’s a whole list.

ES: Got it – non-starchy veggies.

JB: Right.  So you’re eating our food from us five times a day, and you’re eating the lean and green meal that you prepare yourself.  So, it is lower in calories and it’s portion-controlled and it’s carbohydrate-controlled.  There’s a lot of research to back up meal replacements as a weight-loss option, and not only weight loss but weight maintenance as well.

ES: Okay – so this is something that’s intended to serve people long-term, not just short-term.

JB: Exactly – we have a complete transition program – so after you’ve reached your weight loss goals, then you transition to eating all the foods you weren’t eating before, and you can utilize the meal replacements in maintenance or you don’t have to.  You can just eat regular food.  But there is research to back up using the meal replacements to keep the weight off. 

We have a lot of people that just buy the food as snacks, and don’t use it for weight loss at all, because it’s fortified with vitamins and minerals, and it has good protein and fiber.  There’s really nothing like it on the market.

ES: What channels is it sold through?

JB: It’s direct to the consumer and you order your food either online or over the phone and it’s shipped directly to your house.  You can’t get it in the store.  You can also get it through your doctor’s office or a weight control center. 

Basically MediFast has four channels: a Doctors’ division, a “Take Shape For Life” division which is health coaches, a Weight Control Center division where you can go in and meet with a counselor, and then a Direct to Consumer model where you just order it and it comes directly to you, and you can utilize as much support as you would like, online or calling in to talk to a dietitian or a program specialist.

ES: Now, is this something you were open to from the beginning, or as a dietitian, did you feel a little skeptical of people eating somewhat processed meal replacements?

JB: That is a great question!  I think when I first became a dietitian, about twelve years ago, I was a little skeptical of these things, but it’s the health professional in me to really look at everything carefully and critique it. 

And I think looking at the research over time, and looking at the obesity epidemic and seeing what works and what doesn’t, really looking at the research, I think what really hit me is when I went to the American Dietetic Association, which is now called the Academy of Nutrition and Dietetics, a couple years ago I went and became certified in adult weight management. 

What really opened my eyes is here’s this group of dietitians, and they’re presenting research on different medications that were out at the time, different programs that were out at the time, bariatric surgery, and to see that all of these are different tools.  Not everything works for everyone – there’s not a one size fits all – but meal replacements are definitely a tool that can be effective to help people lose weight and keep it off, and become healthier and prevent chronic disease. 

So yes, I was skeptical in the beginning, and it wasn’t something I was looking to get into, but it did fit into my belief of getting people healthy and feeling their best and preventing disease.

ES: You said you also work on some of your in-house guides that you publish for clients incorporating research about nutrition.  How do you choose what research to incorporate and how do you stay on top of it, because it seems like every other day, a new study comes out contradicting the last one.

JB: It can get confusing.  We have an entire research and development team here at MediFast, and we actually have two dietitians who are dedicated to that, and we have a Scientific Advisory Board.  So, we have specialists and scientists from all over the country that specialize and are experts in their area advising the company, keeping us up to date on the research. 

We actually just had our Scientific Advisory Board meeting last Friday, and we had top experts in the country speaking on behavioral issues, on soy, on the Look AHEAD study – everything that’s out there that is reputable.  These great minds all get together in one room and help advise our leaders on what direction the company should go. 

The head of the scientific advisory board is Dr. Larry Cheskin, who is one of the top weight loss physicians in the country at Johns Hopkins.  So we try to stay on top of it that way and it is a big job just for one person, but you always have to be reading the internet, seeing what the customer is reading. 

You have to keep on top of Dr. Oz, because if something comes up on his screen, we get a million phone calls about that.  It used to be when Oprah was still on, we used to get phone calls about that.  But now it’s Dr. Oz.  It’s a big job, so it’s a big group of people staying on top of it.

ES: It sounds like a huge team devoted to this.

JB: Yeah, and you have to be, because there is something that comes out different every day and you have to be on top of that.  What I help do as well is, if something big does come out…  A few years ago, something came out about brown rice syrup, and we develop what we are going to say to the customer about that, because that is in some of our products.  So people are going to call up and ask questions about it.  So we’ll help marketing come up with the answers to those questions.

ES: So what is your day like?  What are your day to day responsibilities?

JB: Well normally, right now, I support the DJs and bloggers.  We support members in our weight control centers.  A lot of what I do is over the phone or online, with technology, because the company is really all across the US.  So really, I don’t do a lot of face-to-face with customers.  A lot of what I do is phone and online support.

One thing we do is helping with budget and trying to get our name out there, so we find different conferences that would target different groups of people.  For example, we went to the Academy of Nutrition and Dietetics Conference just last month.  It was 12,000 dietitians in Philadelphia, and we have an exhibit booth there.  So, I would go there and talk to other dietitians.  Three of us went.  So, trying to find out what is the best return on investment for that, what will get our name out there to the groups we want to target.  I’m looking at another conference that we’re going to in March. 

We do a lot of trainings.  I help develop those.  So we’ll train employees on new things that are coming out or any health and wellness topics.  Our employees can have a free consultation with a dietitian anytime they want to.  We have a gym here at MediFast too that employees can use.

I do a lot of review of material.  Anytime that Marketing wants to put something out, like a flyer or anything, regarding the program, it has to go through us and legal just to make sure that what they’re saying is correct.  We don’t want to say anything like “lose 20 pounds in one week.”  We’re making sure that we’re sending out accurate information.  If it’s a very science-based piece that they want to send out to health professionals like doctors or something, that will go through or Research and Development team just to make sure it’s cited appropriately.  But otherwise, we can do regular program and product information.  That’s what I do a lot, every day, all day.

I do a lot of organizing – I supervise a behavioral specialist and we have two other dietitians that are under me and also an intern.  We’re constantly working on projects.  Updating, updating, updating.

ES: When you were working at GBMC in the hospital role…  I have a couple friends who were dietitians at hospitals here and it was kind of eye opening to me to hear what they were doing.  They were designing nutritional plans for patients, and I never really thought about it.  I just thought when you’re in the hospital, you get hospital food – jello and whatever – but I never thought about patients who needed a specific plan.  When you were at the hospital, is that what you were doing?  And is that what you thought you’d be doing when you were getting your degree?

JB: Well, actually, the first couple years I was working, I was actually working in the Intensive Care Unit.  So, in that setting, I was really providing nutritional plans for people that couldn’t eat.  So, tube feedings for people who were hooked up to breathing machines – I was calculating out their nutritional information. 

And then people that couldn’t be fed through tubes, who had bowel resections or cancer of the stomach, they had to get fed through their veins.  It’s called total parenteral nutrition.  It’s like getting fed through an I.V.  I was doing a lot of that.  A lot of math is involved and I like math.  That was pretty challenging. 

I would go on rounds with the doctors every day and if somebody needed tube feeding, or they weren’t eating well, I would try to figure out ways to get them to eat better.  So I was doing a little bit of that as they were recovering from whatever ailment they had. 

And then the last five years, I was actually more managing – I was the administrator of the computer system that printed out the room service tickets for patients.  So if a patient was hungry, they would call up and order their food.  Then the person would enter it in the computer just like in a restaurant and it would spit out an order for what they wanted in the kitchen, and then it would get made and  their tray would go out of the kitchen. 

So I was making sure that if you were on a clear liquid diet and you tried to order a hamburger, it wouldn’t let you do that.  It’s a little more complicated than a restaurant.  Like, if you were on the heart-healthy diet, it wouldn’t let you order five pats of butter.  The computer system constantly needed monitoring and I was the manager for them and the dietitians.  It was challenging – if the computer went down on a Sunday evening, they would call me.  It was time consuming.  If the computer’s down, none of the patients can eat.  Because the hospital’s open 24/7.

ES: Right, it’s not like the hospital closes.

JB: It’s a constant hustle and bustle in a hospital setting, and it can be very rewarding; it can be very challenging.  What have your friends told you about it?

ES: Well, I just know it’s probably not what they dreamed of doing when they got into school to be nutritionist.  Usually you think of food as this tangible thing, not nutrients in a bag.  So I think the hospital setting might have been a little bit of a letdown for them but I’m not 100% sure.  Obviously there’s a huge need for people to do this in hospitals across the country, but I’m just not sure it’s what you go into the field thinking of doing.

JB: And when you’re working at a hospital, you’re really dealing with sick people.  You’re not preventing anything; you’re trying to get them better, back to baseline.  So a lot of times when you’re doing any time of diet education in that setting, the people are not feeling well.  They’re sick in their hospital bed, and they really don’t want to listen to you. 

So the doctor will write a consult for you to come in and do diebetic education for a patient that came in with uncontrolled diabetes.  Well, they’re not feeling well; they’re trying to recover, and you sitting there trying to talk to them about their diet is not the ideal setting. 

Sometimes dietitians can get out from that, especially working in that clinical setting.  Usually they’re doing it right out of an internship.  I happened to really like the ICU because it was different every day, it was challenging.  And you get to see some improvement and you get to play around with nutrition and different formulas, see if it can affect things.  But it can get a little daunting.  I’ve really enjoyed the change into more of the wellness aspect, and not a lot of dietitians have the opportunity to do what I’m doing.

ES: It’s nice because I’m sure some people think, “it would be nice to be in a practice where people come in and want to lose weight,” but how many jobs are there out there like that?  There are a lot more jobs in hospitals that have benefits and pay the bills.

JB: Right, and if you’re in private practice, people have to come through the doors and want to lose weight.  It can work as well.

Part of our company, MediFast, we have a Take Shape for Life division and you can be a health coach and sell the food to your patients – it doesn’t cost the patient any more that way – and you can make a commission.  So we have a lot of dietitians who are health coaches and they incorporate the MediFast program into their practice and get the commission.  And there are doctors who do that as well.

ES: So, getting back to what you’re doing now – you were mentioning Jack Nolan and the other celebrities.  Does he talk about MediFast on the radio?

JB: Yes, you know when you hear DJ’s talk about, “I’ve been on, MediFast for the past three months and I’ve lost x amount of weight.”  Certain celebrities will be more free about it – it just depends on the program.  But Jack has been very free with it.  He’s done very well and he talks freely about it.  And he’ll go to parties, and people will see that he’s lost weight, and it raises awareness of the program.

 I have one DJ on Yahoo Sports Radio – his wife has done really well and lost weight on MediFast.  And I have this blogger, the Turnip Farmer (Kelly Brown) – she’s lost 100 lbs.  We actually met and ran a 5K together.  We became friends because we talk every week.  When you talk to somebody every week, you start to know them.  She’s done really well. 

It’s really rewarding to see others lose weight, get healthy.  And they feel good about themselves and reduce their risk for disease.  The real test is having them maintain it.  They lose weight, and then I feel like as a dietitian, that’s where I can really bring in my expertise and help them maintain weight.

ES: Right – getting to your expertise, I know you say you have these phone calls with clients and you “support” them.  What types of questions do you have.  What kind of things are they asking.

JB: Well, we talk about the plan: how to pick the five MediFast meals and how to make the lean and green meal.  Any struggles they’re having – like, if they’re going to a party and there’s going to be a lot of food there, we talk about strategies.

ES: Right – what are some strategies for that?

JB: It’s a lot of motivational interviewing and open-ended questions.  There are a lot of techniques to use.  It’s basically behavioral counseling because a lot of it is in your head.  “So, you’re going to go to the party.  What’s your plan?”  I’d ask them that, and let them come up with something.  Because I could come up with a plan for them, but it may not work. 

I let them come up with good ideas, and I might give some suggestions as well if they want them, but I’ll ask them “what’s your plan?” and we talk through it.  A lot of times having that touchpoint of somebody that you’re accountable to helps people with success.  Usually we set up calls every week, so you can imagine my schedule is pretty booked.

We also talk with members in the centers, on their maintenance plans.  We talk to a lot of people, all day long, about any struggles they’re facing, any questions they have.  They might ask, can I have a certain food on the program.  You know, “can I have apples?”  “Well no, you can’t have apples because they’re too high in carbohydrates.  But you can have them in transition and maintenance.”  So, you know, questions like that. 

People have the most questions when they just get started on the plan.  So the first three weeks require the most support, and then it can taper off.  Then it gets more intense when they start ending the program and transitioning into their maintenance.  They’re afraid, because they’ve been eating five MediFast meals and their lean and green meal, and that’s like a safety net.  They’ve had success, and now they’re introducing all the regular foods back in.  It’s scary because some people have lost 50-100 lbs., and they don’t want to go back.

ES: It’s got to be really nice to have someone to be accountable to because it’s so easy to let things creep back in.  I know I’ve done low-carb, and it works really really well for me personally, but it’s just  hard to keep track.  If you’re not keeping track religiously, which I’ve chosen not to do for my entire life, and there’s no food that I’m going to rule out ever putting in my mouth…  I kind of have to say, I’m going to stick to it 95% of the time, but if things aren’t black and white, it gets really hard to keep track.

JB: And sometimes we don’t have a set topic for our phone calls.  It might start out with me asking, “What’s going on?  How are things going?”  And they might say, “Oh, it’s been a really hard week.”  You know, just talking about what happened and what they might do differently next time – it’s that counseling, being that touchpoint, staying engaged helps keep you focused.

ES: I’m sure people must ask about how you compare to other weight loss systems.  I know there was a big flare-up when Weight Watchers recalibrated their points system and began allowing unlimited fruit or something like that.  What was your reaction to that?

JB: Well, I think Weight Watchers is a great program.  I think Nutrisystem has its place; I think Jenny Craig has its place.  People have to choose what works for them.  Our program is totally different than any of them because it’s meal replacements and it’s 800-1000 calories.

ES: Yeah, it’s very low calorie!

JB: Yes, it’s low calorie but it’s also low-carbohydrate.  It’s not that one pound per week weight loss; you’re probably going to lose more than that.  It’s 2-5 lbs. the first two weeks and 1-2 thereafter.  Weight loss can vary obviously, but it is quicker than those other programs because it is low carbohydrate and calorie-controlled. 

As a registered dietitian, people might ask me, “how can you say not to eat fruit?!”  I tell them, “I’m not saying not to eat fruit ever again.  I’m just saying  temporarily, to get you where you need to be, this is a tool.”  I mean, it works, it’s nutritious.  All of our meals are fortified with vitamins and minerals so you’re not missing anything. 

I most certainly want you to eat fruits, I want you to eat grains, I want you to eat dairy.  All of those things are good for you.  But when you’re trying to lose weight, sometimes it takes that little bit extra to get you where you need to be.  But in the long term, most definitely incorporate all those foods. 

As far as the other programs, they’re good programs, and if people can have success with those, I’d say go ahead and do it.  But I’ve heard so many times from customers that this is the only program that’s worked for them.

ES: Do you still recommend exercising with that low calorie intake?

JB: We do, but the first two or three weeks, we recommend to wait to allow your body to adjust.  Because you are eating lower calories and carbohydrate controlled.  After that, we recommend up to 45 minutes a day because we don’t want you to exercise too much.  Because if you create too much of a caloric deficit between the calories you’re taking in and the calories you’re burning, it can impede your weight loss.  We want people to feel good.  Most people, when they follow lower carbs, they feel more energized.

ES: Yes, but there’s definitely a transition phase.

JB: Yeah, a few days, and then a few weeks with the exercise.  But most certainly, we do recommend it because there are so many benefits to exercise besides weight loss.  And absolutely in transition and maintenance, you can ramp it up a little bit for overall health.

ES: Low carb has been around a long time.  It’s interesting the amount of controversy there is around it in the mainstream media.  Our parents and grandparents wouldn’t have thought it was strange to hear of someone avoiding starch if they were on a diet, but somehow that common knowledge got lost and overshadowed by the low-fat mantra.

JB: It is controversial, but I think that there’s more research coming out on the low carbohydrate approach, even with athletes – elite athletes – using them.  Dietitians coming out of school now in general are more open to those types of things because the research is coming out.  But if you’re cutting out foods like dairy for example, you have to be sure you’re getting the nutrients like calcium from other foods.  And you can do that, most definitely, with other foods.  So, it’s not an issue for me.

ES: It’s interesting – thinking back on what I’ve read by Gary Taubes, patients who are on low calorie/low-carb tend to be much more satisfied than people on low calorie/high-carb.  So you can sustain it longer.

JB: Well, people who are on low-carb tend to go into ketosis, which naturally suppresses appetite.  So you don’t have the cravings.

ES: Is your system recommended for people who are severely overweight?

JB: We do recommend that you have at least 15 lbs. to lose.  A lot of our customers have like30, 50 lbs.  If you don’t have the fat stores, then going into a state of ketosis, you might not feel as good.  And your body adjusts to ketosis over time, so if you’re someone who does low carb all the time, your body is often in ketosis and you feel best doing that. 

If you think of, Eskimos, they are in ketosis all the time.  They don’t eat grains or anything.  Their diet consists mainly of fish.  Our bodies naturally go into ketosis overnight because we don’t eat overnight.  It’s a natural part of metabolism, and your body does adjust to it over time.

ES: It’s great to hear that your system promotes this.  I’ll let you get back to your clients now, but thanks for being so generous with your time in speaking with me.