170 | What Does “Healthy” Actually Mean?

If I were to ask you to define the word healthy, what would you say? Welcome back to the Exam Room Nutrition Podcast. I'm your host, Colleen Sloan. I'm a PA and dietitian, and today we're dissecting that word, healthy. Because it sounds so simple, but it can mean so many different things. Now the World Health Organization defines health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. But I'm willing to bet that that's not exactly what your patients mean when they tell you, I just want to be healthy. So today I'm talking with registered dietitian Allison McKinney about how she helps patients figure out what healthy actually means to them and unpack their why behind it. So grab your coffee or drive safe and enjoy my conversation with Allison. Allison, I am so excited to chat with you today. Thank you so much for coming onto the podcast. Welcome to the show. Thank you, Colleen. Glad to be here. So this is one of my favorite topics. I guess it's like a pet peeve of language that we use in medicine, in nutrition, just kind of on social media. And it's this word healthy. I hear patients tell me all the time, well, I just want to be healthy, or I just want my kid to be healthy. So, like, how do you tease out what they actually mean when they're saying that?

Yeah, I get curious and I stay curious. And sometimes I can get it to it with one question, such as, tell me more about that, or what would that look like for you? When it comes to pediatrics, oftentimes, as I'm sure you're familiar, Colleen, the parents will come in with a list of goals for their child. And I've found that taking a moment to ask the child, what are some of your favorite things to do? has given me such some of the best entry points into ultimately getting at the health goals that perhaps the parent wants or the referring provider wants. But it could be that they love soccer. And so we talk about soccer. And honestly, I have them teach me about soccer, and then I can start to use their language about how foods can help them run faster or jump higher or kick harder. And, you know, they chuckle at my my uh poor use of soccer terminology, but that's kind of like the the bonding and connection that I've found is really important, especially when working with the younger patients.

You use my two favorite C-words. That's curiosity and connection. And I think those two things are vital for us as healthcare providers in order to help the patient see their goals maybe in a different way, right? And I'm curious as to why do you think it matters for the patient to define what they mean by health before we actually just jump into giving advice?

Well, as I'm I'm sure the vast majority, if not every person listening to this episode, can relate to that just telling people the what to do around health. Here's how you eat, here's how you move, here's how you sleep, is very rarely effective enough to support lasting change. Right. I have very few patients who are motivated by their A1C level or their cholesterol level, or, you know, the the numbers that we are dialing into as clinicians to indicate quote unquote health, but having them define it on their unique terms, I believe really helps with the long-term habit and behavior change so that they they have skin in the game, if you will, as opposed to my doctor or my dietitian or my PA doesn't want me to do XYZ, or they says I have to do XYZ. It's about, oh no, I'm doing this because. And then they fill in the blank with what their definition of health is.

Yeah, I think it's interesting because there can often be a mismatch between what you, as the clinician, has the definition in your own mind and what the patient sitting in front of you is actually defining. And I think of words like picky, right? Parents tell me all the time, my son is so picky. And that could mean 15 different things. And so I think healthy is one of those terminologies as well that we really do need to make sure we understand what the patient means when they say they want to be healthy. All right, let's talk a little bit about wellness culture. And, you know, social media makes it out to be like a certain body type, or right now I'm seeing all these crazy morning routines that are like 10 different steps to not be bloated and have perfect skin and all this, you know, nonsense. And it's not realistic for a lot of us who have to go to a nine to five. And I would just love to hear how have you seen that played out in a patient's expectation of actually what being quote healthy should look like.

Certainly. It's certainly something that I have to delicately navigate because as I know you've mentioned on the podcast before, the number of times that people come to me and want a meal plan or a calorie count, or kind of they they want to know what to do. And what I often stop to explain is that in my experience, just knowing what to do isn't enough. You have to have the why, which is where defining what healthy means for you comes in. The why can also refer to okay, why do certain foods interact with your blood sugar? Or why might you look at making this change to your sleep routine? So really understanding and then figuring out the how. I really do believe that by the time people get to me, they have tried and they want to be healthy. And they have tried their hardest. And the fact that they haven't obtained their definition of health or their doctor's definition of health is really to no fault of their own. And some of the ways that I have approached this is trying to get people into their bodies, meaning, oh, I read that I was supposed to eat or drink X, Y, Z thing. And I'll say, Oh, well, how do you feel after that? And they'll say, Oh, well, I feel bloated or I get a headache, or I get a, and it's remarkable to me how many people still want to do the thing because that's the should. And reminding them that the line I use is our bodies have a lot to tell us. Stopping to hear it is one thing, and then deciding if we want to do something about it is another thing. But just being open to how all of these options for how you show up in your day and for yourself can affect you. And just pick the ones that work and release the ones that don't.

I think giving patients that permission to release the things that don't work for you is huge. Like that's so freeing because you know, they're bombarded with so many messages online from credentialed individuals and likely uncredentialed individuals, but they're being sold something that they want so desperately and at what cost? And so I really love that you get to the why and you really ask about how that makes you feel. I think patients don't reflect on those things enough, and that can be very, very powerful.

I I had a dear friend one time say something kind of very just like in in passing, and she goes, Yeah, I've learned to listen to my body when it whispers so it doesn't have to yell. And that was such a profound statement for her to say, but I have really echoed that sentiment in lots of different scenarios where, you know, oftentimes we're doing our best intellectually and we're missing a lot that our body has to direct us in terms of physically and and and how we feel.

That is so insightful. I love that so much. Listen to the whisper. That's incredible because our bodies do, they communicate to us for years, you know. And I'm working with kids and their bodies are communicating things for them. They might not actually hear the yell until they're in their 30s or 40s, but you can bet things were being whispered in their you know, teens and young adult life. And if we can help them listen to it, I think that could be massively helpful. Thank you for sharing that story with me.

And if I can just add, working with children and their families has is some of the most fun that I have on visits because there is still kind of the playfulness. And what I've learned about working with kids and also having kids of my own, that they they have a wisdom and kind of a connection to feeling that I think a lot of us of adults have lost. And so I ask them the questions. I ask them the questions in age-appropriate ways that I ask most of my adult patients. And oftentimes the kids are the ones that are quicker to be able to come up with how they feel about, you know, whether I'm asking about digestion or how foods make them feel in terms of energy or or what have you than adults. Because again, as we get older, we're just so cut off into the shoulds from that we each need something different. And it's not anybody else's routine that's gonna work for us.

I share your sentiment. I personally think kids are the best. They're my favorite population to work with. Obviously, that's why I'm in pediatrics, but they are so insightful and often very in tune with their bodies. And it's just like in infancy, right? I teach new parents your baby knows when they're hungry and they know when they're full. You can trust that. It's not until later on in life that that is blunted. And it's usually because an adult taught them to not trust their body. So I love that you pointed out about kids. All right, Alison, you've developed a really cool framework. And I would love if you could walk us through some of the different areas and how they maybe influence one another.

Yeah, certainly. Colleen, I'll give you some links so folks can look at the visual. I'm very much a visual person. And so the framework that I have put together through my years of practice and just realizing that I can, in some ways, teach how I think about working through various patient situations. And it once you look at the visual, you'll see that it's really a giant circle. And on the outside of the circle, there are four words. And these four words are what I consider to be the four big buckets of health. The first word is physical health. And I describe this as most consistent with what I think people think about when they go to the doctor. This includes things like understanding your disease process, getting screening, taking your medications, asking the questions, getting the support you need. The next word on the outside of the circle is functional health. And this one I describe as can your body do what you want it to do? Now, in pediatrics, I imagine you see less of this, but as again, I work with individuals throughout the lifespan. Um, I will have older individuals dealing with pain or surgeries or illnesses or what have you. And it may not be their goal to be an athlete at that stage, but it may be a goal to get on the floor and play with their grandkids. Or for a parent, they want to be able to play tag without getting out of breath at the park with their kids. And so functional health is not performance health, but it's very, very individualized to how do you want your body to be able to show up so that you can live and lead the life that you want to. Cognitive health is the third bucket and third word around the outside of this framework circle. And this relates to what most people are familiar with. We know that lifestyle interventions, especially the earlier that you start implementing them, can really prevent or slow cognitive decline. Um, and I think that that's just such an exciting area of research in my generation as both an individual and a clinician, because I imagine many people are like me, where they've had very close family members affected by Alzheimer's disease and other dementias. And then finally, emotional health. And when I talk about emotional health, I am always very the first to say that number one, this is not my area of expertise. And I'm very still much a student of this. So, how can you find moments of joy and purpose and meaning? And it's kind of the least tangible, but some would argue the most important aspect of health. And in each one of those buckets of health, if you will, again, physical, functional, cognitive, and emotional, this is where I will have people explore what their why is. And the why is very, very specific, or I encourage folks to get very, very specific. It's one thing to say, oh, I yeah, I don't want to get Alzheimer's disease. It's another to say, and this is speaking from personal experience, playing cards is like a rite of passage in my family. And I want to be able to keep up with the card games as long as possible. And that I, you know, I got chills saying that, and it gives the why behind the health goal just that much more oomph to say, okay, I I really do want this instead of some kind of distant, undefinable, quote unquote healthy.

How do you get that why out of patients? I feel like that can be a struggle for some clinicians. You know, you might ask, like, oh, why is this important to you? And, you know, how do you know when you've really gotten to that thing that gives them the goosebumps rather than just a surface level answer?

Well, I often, when I'm meeting a patient for the first time, they will want to jump directly to, okay, what to do? What should I eat? How should I sleep, as I mentioned. And so I gently encourage us together to step back. And let's think about like why we're doing that. And sometimes people are able to pretty quickly get them themselves. You know, they're referred for a diagnosis of prediabetes, and they watched a parent or a great grandparent have a really, really difficult course of the disease. And that's motivation enough. Other people, it takes much more conversation. I'll ask things, what do you enjoy doing? What makes you happy? What would you love to do in your free time? And slowly those things present themselves. And again, sometimes the person can grab it, and sometimes it's a matter of reflecting. Ah, you've mentioned your grandkids a couple times. Imagine that you really like being able to have them at your house. Or, oh, your dog is a really big part of your life. And imagine that being able to walk them is important to you. And I know it when I've hit on it because I get kind of that, oh, or you know, the light up, that aha moment. And the other thing to keep in mind is these health goals are fluid. Someone's definition of health might change throughout the day, the week, the years, and just being open as an individual listening to this, but also as a clinician, to it's so tempting when we are all so busy to just jump into, okay, how's it going? What questions do you have? Here's my next education topic, and taking just a few minutes to ask about like what's new or what's what's been happening since I saw last saw you in May. Or uh, Colleen, you mentioned this on one of your recent podcasts about jotting down, like trying out for soccer, following up. Hey, how'd those soccer tryouts ago? I mean, that does such amazing things for the connection, but then also for the clinician to be aware if someone's health-wise is shifting. They may have say, like, no, I decided not to do the soccer tryouts because I found this other thing and it's theater, and I'm, you know, and they light up and then we we pivot.

Does your strategy change at all when you work with families? Because there's a different dynamic there. Depending on the age of the child, you know, obviously you are working with the child, but sometimes the parent is the one who maybe puts on certain goals on the child. And I imagine some diet culture can be brought up, you know, especially if it's a millennial parent and they're concerned about a child in a larger body, for example. How do you, you know, address both goals, especially if maybe they're different?

Absolutely. And these are some of the most, the trickiest for me, anyway, conversations to navigate because you know, the parent and the child are often in the room. And so sometimes I find it can be helpful to talk to the parents separately to not, I don't want to call them ground rules, but kind of set the stage for here's how I recommend approaching this. And it often includes, you know, the following it includes we really want to take emotion out of food, whether that's, oh my gosh, he ate the broccoli and or the nagging at the table and you can't leave until you've had this bite or whatever. Um, and so making kind of uh meal times as neutral as possible. I encourage parents and caregivers to focus on here's what we're gonna do instead of here's what we're gonna stop doing. Um, and then also explaining how food fits in with that greater picture of health. I recently had a real small intimate class, and someone was asking about added sugars and how do you navigate that, and it's so tricky. And I said, well, I want you to picture two scenarios. I want you to picture a scenario in which it's late at night, you had a really rough day, you grab the ice cream, and you're just like eating it in front of your favorite show, like barely tasting it, which we've all experienced. Or you have the ice cream with your niece, and you go together, and then you sit at the park and you laugh and you make a memory. And and so I explain that food is so much more than food, and it's often the context in which it is held that I think is more important in terms of how it affects health, as opposed to the rules that wellness and diet culture has led us to believe we need to follow.

Yeah, I agree with you that it's important to separate out parent and child given the age. But honestly, kids are really smart. Like we talked, they're insightful. So I do think setting that expectation or that tone for how the visit will go if the patient is the child, I think can be very beneficial. So you're not arguing in front of the child of like, hey, we're not gonna talk about her weight or we're not gonna label foods good or bad, sort of wasting precious time with in front of the child. So I agree with you and I understand sometimes it's not possible for timing-wise, but especially if you're a dietitian and you maybe have 45 minutes or more, consider you know, separating or maybe sending some information to the parent first. So there are some expectations that are set up.

I agree that once I can kind of encourage or explain my approach with the parent or caregiver, and then I very much engage with with the patient, with the child patient. And we we build the lists of foods, you know, growing foods, which I call protein, energy foods, which I call carb, um, helper foods, which were things like vegetables and fruits and you know, things like that. We build that list together. And it has been so enlightening and funny at times. I mean, I had one parent, for example, come in and say, ah, you know, so and so, they just like won't eat any protein. And so I I turned to the to the patient who's a child and says, Well, let's look. at all the protein things that provide your body that with those growing protein foods and and he goes well I love lobster and so it was it was just like a mismatch of of expectations where it's okay if you don't like chicken it's it's it's it's more about let's grow the list and the options that you enjoy or want to try as opposed to dwelling on the what isn't happening which I think just is not helpful.

I love that and you're right it goes back to a mismatch this time it's not a mismatch of definition but it's often a mismatch of expectations and between parent child diad that's very very often and so I think that's important to you know ask the patient like you said have a list of stuff and they're like oh yeah no I love beans and I love you know almonds or whatever it is and sometimes the parent just needs to kind of have someone else you know ask a question. You know, you we're usually so used to giving that child the same five foods that's normal for our family that we don't sometimes think outside the box. So that can be very helpful. Alison my last question really revolves around something that's very real for families and unfortunately health advice online especially social media and influencers can sound very elitist and you can feel like you're not healthy because you might not be able to afford or have access to the things that they are recommending. So I would love to hear how do you like bring that conversation in maybe whether it's about finances or access to food, maybe inability to cook or lack of time do those realities change the recommendations you give and how so it's such a great and timely question, Colleen certainly something that I inquire about from the very first visit.

You know, I've I've often said that I all the information that I have to offer in the world is useless if families are facing food insecurity and don't know where their next meal is coming from. And so I have really familiarized myself with the resources within the state of California to address food insecurity before perhaps any education is given. Validating that acknowledging that I think goes a really long way so that it can take the shame and kind of the secrecy and the embarrassment around that. And then working with the patient to explore that there's not really one right way of eating. I don't like I said give I give calculations I don't give meal plans I don't even give recipes. I really take it as a kind of build your own adventure approach. I I help them see within the context of what their goals are and perhaps what their diagnoses are, how different nutrients may interact with that. But then really help them see that there's lots of ways to include a protein a carbon in a meal cost aside whether it's you mentioned beans, whether it's frozen veg, I've gotten myself oriented with the resources from food pantries that are available so I can help individuals know what to do with this stuff once they get it home. Kind of trying to get away from that stigma that if something's not prepared from scratch every meal of every day, then you can't be healthy and it's embracing the microwave, it's embracing leftovers. And so just trying to normalize that being healthy can look a lot of different ways and that health does not have to be dependent on financial status.

Alison thank you so much for helping us understand what healthy means. And honestly we've just scratched the surface but you've given my listeners so many different things to think about so many different questions that they can discuss with their patients to really give you better advice. And that's really at the end of the day I believe that we all want to truly help our patients and it's really important to meet them where they are. So thank you so much for the gift of your time and sharing all of your wisdom today.

If people want to connect with you online or learn more from you where can we send them absolutely it was a great conversation Colleen and everyone can uh go to AllisonMckinnie.com that's my website that has links to every everywhere else that I'm online I have a Substack publication um I have a podcast I'm on my local community radio and do uh plenty of in person presentations and community discussions in my neck of the woods.

So again allisonmakinny.com well what an honor to have you on the podcast again thank you so much for the gift of your time and for being here thank you so much. All right guys thank you so much for carving out some time for nutrition today and I will see you next week.