(originally posted 4/18/2016. libbysfitnutrition.com)
Eating Disorders are expensive to treat! Acting early can save time, health, and money, but many insurance companies do not deem it "medically necessary." See my other insurance posts for more info.
Here is a list of resources to gain knowledge from in the fight towards individual and nation-wide coverage (some of these are repeats from my previous posts).
(originally posted 2/16/2016. libbysfitnutrition.com)
Treatment of eating disorders is costly - no two ways about it. Residential treatment can cost $100's to over $1000/day! And a lot of insurance companies are denying coverage for treatment. Here are some tips I found to help with getting insurance coverage, or the cost of treatment if not through insurance:
"If your insurer balks at your requests for coverage, ask to be assigned a case manager...A case manager can often (though not always) help you get access to additional care. Insurers normally do not cover nutritional counseling, for example, but a case manager authorized six visits to a [dietitian] for one of Dr. Herrin’s patients.
If the case manager cannot help you, you will have to take a route familiar to almost anyone who has tangled with an insurer. Get in touch with your employer’s human resources department, and ask them to go to bat on your behalf. If your employer and your insurer will not budge, make a formal appeal to your insurer. If your appeal is denied or not answered, contact your state’s insurance commissioner or even your representative in Congress.
Extreme though that may sound, it has been known to work. Susan M. was able to get her daughter’s lengthy residential treatment covered by enlisting the help of her senator’s office. An aide called the Department of Labor, and after several more steps, the insurer ultimately agreed to cover the treatment.
You might consider contacting a lawyer for advice on your rights and legal precedents in your state, as well." - New York Times (2010). Treating Eating Disorders and Paying for It, By Lesley Alderman.
Remind your insurance company that eating disorders are a medical illness. The most likely medical complications from an eating disorder are cardiovascular events (heart failure), growth failure, irreversible osteopenia, and sudden death. Suicide rates are also high among people with eating disorders. Nutrition counseling for prevention or treatment of an eating disorder is cost-effective for the insurance company.
Some specific insurance company nutrition policies:
CenCal Health (I am a provider):
Requires a Physician referral (RAF form), for any nutrition counseling, then covers 2 hours/month (as of Feb 2016).
Anthem Blue Cross: https://www.anthem.com/medicalpolicies/guidelines/gl_pw_c164431.htm
(originally posted 1/10/2016. libbysfitnutrition.com)
By Adrianna Calabro
What are the challenges that come with packing a lunch for a school or work day? For some, it may be the time and effort needed to create something they actually want to eat. For others, it can be the planning and organizing that overwhelms them. Let me first admit, I am not an exception to this rule. I often find myself “too tired” or “too lazy” to make something for tomorrow. However recently, being unemployed, I can no longer afford to eat out everyday, especially being a college student.
My name is Adrianna. I was born in New York and have come to the west coast to learn about nutrition. As a Cal Poly student graduating in the spring, these past few years in San Luis Obispo have been a great learning experience for me in relation to food and other things. Living on my own has been challenging but I promised myself I would not quit, pushing myself to not give up. Everyone has their own obstacles, and I understand that, but we must find ways around them, otherwise we will get stuck in a sticky rut.
Before I continue to ramble on, here are 5 tips I have that can make a difference on how you pack your lunch and snacks for your week!
1. The expense of eating out. Let’s say you spend at least $8.00 on lunch a day. If you buy lunch 5 times a week, that is $40.00 a week spent on lunch. In comparison, if you go grocery shopping every 2 weeks, and spend $80.00 per time, you will be able to buy all of your meals for the equivalent price of just buying lunch five days a week. If that doesn’t make sense to you, here is the math!
Every 2 weeks (14 days) = spend $80.00 on groceries = that would be...
80 x 26 (52/2=26) = $2080.00/year ( 52 weeks divided by 2 for every other week)
But at this rate, your getting breakfast, lunch, dinner, snacks and deserts – all your meals for 2 whole weeks
Buying lunch 5 days a week = spend $40.00 a week = that would be…
40 x 52 = $2080.00/year
But at this rate, you are only getting lunch! You will have to spend even more money on your other meals!
Essentially, you are getting more bang for your buck if you go grocery shopping and prepare a lunch in advance. Being prepared pays off.
2. Pick a day of the week that you will designate as your “food- prep” day! For some, Sundays are often nice to prepare meals because its close to the start of the week! Or choose the middle of the week, maybe Wednesday, if your work pattern is different! Try to go food shopping in the morning with a planned grocery list that includes fruits, vegetables, foods high in fiber while also avoiding sugary foods. Then, by mid afternoon, start cooking! Play some music, burn some incense, put on a movie, anything that will keep you calm and relaxed- it should be fun!
3. After you are done preparing everything, package into small containers or plastic baggies so that you are ready for the week. For example, if you like eggs, make a dozen hard boiled to leave in the refrigerator – this way, each morning you’ll have a snack you can grab quickly! Or if you like grapes, for example, rinse all of them, then separate into small bunches and place in the refrigerator. They will taste nice and fresh when you are ready to eat! Use Tupperware to avoid wasting too much plastic if possible or buy reusable Ziploc containers that you can find at any grocery store! Also, if you want to focus more on making meals, try some of these to make in “bulk”: fried rice, hot or cold pasta, quiches or salads (don’t add the dressing until your ready to eat it!).
4. If you work in an office, drive a car to school, or have a locker where you can store things, try buying a small sized cooler to leave your meals in so that they stay as fresh as possible.
5. Find a friend! If you think you might not be motivated, ask a friend to join you in your “food- prep” day and help keep each other motivated! You can share the food, as well as the cost and can make a whole Sunday out of it (maybe buy a bottle of wine or beer too! Just an option!)
I hope these tips are helpful. The new year often brings about resolutions and ideas that sometimes we don’t keep, but this is totally feasible and possible if you just set your mind to it! One more note, convenience foods and pre- packaged meals bought from the store often are higher in sodium in comparison to foods we make at home which can lead to issues like high blood pressure. So put some tender love and care into what you eat and the rewards will be numerous. Live to be mindful and life’s stresses may seem a little bit easier each day!
(originally posted 12/25/2015. libbysfitnutrition.com)
Have you been looking at my (or other RD's) websites and brochures and not sure what to expect? Nutrition counseling is a very individualized service just like with traditional psychotherapy. Some dietitians create specific meal plans, analyze intake with nutrient analysis software, help you manage diabetes medications, learn what food do in your body, and so much more.
Make sure whoever you choose to go to for nutrition services has a "R.D." or "R.D.N." credential. This is a indicator of education level and national standards of practice. As with any profession, we hope everyone is ethical in their business practice, but trust your gut, and never be afraid of getting 2nd opinions.
What do I do, specifically?
"The primary goal of nutrition counseling is behavior change."
Herrin & Larkin, Nutrition Counseling in the Treatment of Eating Disorders, 2013.
Here is a list of services that one may experience when working with me.
-Diet "check-ups": I go over your food journals to see what you are eating on a regular basis and what is working for you or areas that need improvement.
-Medical Nutrition Therapy (or "MNT): This is what separates dietitians from "nutritionists" "health coaches" and "health educators." Medical nutrition therapy is something only RDs are legally allowed to do (and medical doctors, but they don't have our training) going over complex medical diagnoses that have nutrition related care and intervention. This goes beyond "eat vegetables" that nutritionists can cover. This is also why RDs are only licensed in specific states like MDs are.
-Nutrition education: What does food do in the human body? This is the R.D.'s expertise. We study anatomy, physiology, biochemistry, metabolism, nutrition for specif diseases, and many other sciences involving the human body and food. This is what I studied in college for 7 years, plus a year of internship, and continue to learn about. I love helping people understand how proteins, carbohydrates, fats, and micro-nutrients interact in the body and keep it healthy.
-Individual needs: How many calories do you need? How does your exercise affect how much you need to eat? What proportion of carbohydrates/ protein/ fat do you need? What about supplements?
-Have an eating disorder?: This is my specialty area, figuring out what someone needs to be eating to recover. By working on slowly changing unhealthy habits, I strive to create a safe space using positive body-image talk, intuitive eating principles, and a mindset of health at every size, while educating on what is occurring in the body and mind while in the disordered behavioral mind-set.
-Contact with your other medical professionals: If allowed, I will work with your other health professionals to create a united team approach for your best health.
-Go over lab values: Bring lab results from your doctor and we can look at what might be going on and if there is nutritional deficiencies or medical dietary interventions (note: only RD/RDNs are qualified to make medical diet plans - "MNT").
-Meal outings/ snack challenges: Optional, but helpful for normalizing eating socially for those with restrictive eating.
-Referrals: To appropriate therapists, doctors, websites, apps, books, etc.
-Exercise planning: Though I don't actively train anymore, I use my experience as a personal trainer, fitness instructor, distance runner, and dancer to help you come up with an exercise plan, check form on moves, discern how much exercise you should be doing, and optimal nutrition for your sport.
-Weighing: Need to keep up with weights for your doctor or therapist? Need someone to keep track of weights (blind weighing) or keep you accountable?
-Safe plan for weight loss or gain as needed: Fad diets don't work! Safe rate of weight loss is up to 2#/week, and safe rate of gain is up to 4#/week. (Note: this is NOT a "weight loss" business, I take a weight neutral approach to letting your body figure out healthy weight based on appropriate eating and exercise.)
-Confidentiality: I use secure electronic medical records to keep your information confidential, and as with therapy, nothing you say will be shared unless you are going to harm others or yourself, or you give a release of information.
-Contact with family members: If under 18, or given release; I give parents piece-of-mind when students are away at college by giving updates on progress and health.
-I have a good relationship with local therapists, Cal Poly's Health Center, and other practitioners.
-Eating disorder training: I am working with a credentialed supervisor to get my "certified eating disorder registered dietitian" credential (iaedp.com), and continue to take opportunities for continuing education.
-Constant contact: I am available between sessions by e-mail/text to keep you on the path to success.
-Counseling skills: Motivational Interviewing, cognitive behavioral therapy, intuitive eating, and behavioral interventions.
Still have questions? Contact me!
(originally posted 12/23/2015. libbysfitnutrition.com)
Let's get the new year set up right, so that we can make the most of our goals.
Now I purposely use the term "goals" instead of "resolutions" when talking about changes I am working on in the coming year. Why? Because a goal indicates a measurable end result, whereas I see resolution as a change of habit, but not measurable to track progress. So, how do we make goals we will actually achieve? Make them "SMART".
What does that mean? You are going to be Specific in setting your goal, instead of saying, "I am going to eat healthier" you will say, "I am going to eat a serving of veggies at every meal." Measurable - you can measure success by knowing if you did or did not eat veggies at your meals; Attainable - will you actually eat veggies? Do you know how to prepare them in a way you like? Are you able to get to a grocery store often enough to have them fresh 3 times a day, or will you buy frozen? Realistic - Does this goal fit with your lifestyle? Are you making your own foods and can be sure to eat more veggies, or does someone else do all the shopping and cooking? Will your family eat the veggies with you or at least support you? Timely - Have a way to work up to your goal. Maybe start with I will eat veggies at least once a day, and after a few weeks say you are going to eat them twice a day, and so forth until you are at your goal.
End of the year: How did you do? have you met your goal and been able to maintain it? If yes, then you set a SMART goal :)
Happy Goal setting!
If you need help setting goals, or are in need of accountability, contact me for counseling to get you on the track to making your dreams and goals come true this year!
(originally posted 10/29/2015. libbysfitnutrition.com)
With the World Health Organization recently announcing "Processed meats cause cancer" (this is not new news that processed meats are not healthy), many people are either mad that they have to give up their beloved meat, or aggressively defending their eating habits. It doesn't have to be all-or-nothing!
According to the American Dietetic Association, "most of mankind throughout most of human history has lived on a vegetarian or Lacto-ovo vegetarian diet." During times of war, meat, dairy and sugar were rationed, and vegetable gardens became a main source of food for family meals. Today, a growing number of people are choosing to eat less meat for reasons such as the cost, and reducing dietary fat.
The benefits of eating a primarily plant-based diet include:
-Better heart health, as plants do not have saturated and trans fats, and are lower in cholesterol.
-Greater amounts of filling fiber, vitamins, and minerals.
-Best of all: YOU DON”T HAVE TO GO TO EXTREMES!
The technical term for an omnivore who eats meat only occasionally is a “Flexatarian.”
What benefits do animal products give us? Iron is a nutrient better absorbed in heme sources (animal) than non-heme (vegetable sources of iron). Additionally, Vitamin B12 is impossible to get in a vegan diet without supplementation, and can cause problems with red blood cell formation.
Non-meat protein choices
-beans, high in fiber and protein (ex: soybeans (aka: edamame, is a complete protein)
-legumes (ex: lentils)
-whole grains (ex: quinoa, a complete protein)
-egg whites (limit yokes)
-low-fat and fat-free dairy
-nut butters (think outside the peanut butter jar, try sunflower, almond, and soy-nut butter
How to do it:
-Make most of your meals vegetarian (A “flexitarian” by definition eats meat less than 20% of the time, but you don’t have to jump straight to that).
-Ease into it, by starting with 2 days a week without meat, or start mixing other foods into your meat dishes (ex: ½ taco meat ½ beans, oats in your homemade burger patties, use vegetable protein ”ground meat” in place of ground beef in chili, lasagna, and pasta sauces.
-Do not use junk food to replace the meat part of the meal.
-Find new vegetables and fruits, or new ways to prepare them.
-Enjoy lean meats in moderation.
(originally posted 9/2/2015. libbysfitnutrition.com)
I have this photo of myself in tap shoes
at the age of one.
My mother was a dancer, and I am so thankful she put me in dance lessons at an early age (I love you, Mom!). Though I had my "dance is boring" periods where
I would take time off (age 13-16, 19- basically 26),
after a while I would find myself depressed and yearning to move my body. As a child I took the usual combo classes (tap, Jazz, ballet, lyrical), as a teen
I attempted hip hop and break dance, and as a young adult I found ballroom, swing, and social salsa.
In college I taught beginning ballroom, competed in swing, and was eventually known for my dance ability at the University of Minnesota (never thought that would happen when I first got there!). After college, between working, starting a married life, and not having the funds, I fell out of dance. I don't have to tell the dancers out there that I felt something missing - not expressing myself through music fueled my depression. I wish I had figured that out quicker.
Pulling me back up, re-awakening my love of dance, was musical theatre. My first show since moving to CA, "A Chorus Line" kicked my butt with rehearsals from our amazing, but challenging, choreographer. I was hooked once again.
Getting back to studio dance as an adult was far harder than I expected it to be. I had once moved with ease, carrying myself proudly. Now I had an extra 30 lbs, and couldn't find my balance. It stung to think I had once been as good as the little teens literally pirouetting circles around me. Maybe ballet was not a good idea after all...
I am not ready to give up! My body has re-awakened, and I have found contemporary - my new love, allowing me to feel emotion in the music as I do in acting - and tap which I now have a real drive to excel at.
My message is for adults, and those who have stopped doing what they love: It is never too late to get back into doing what you are passionate about. Whether it is dance, sports, art, writing, or other passions, don't let age or time stop you!
I'm pulling for you!
"Dancer's dream with their feet."
P.S. I offer nutrition counseling for dancers!
(originally posted 12/21/2014. libbysfitnutrition.com)
As a Registered Dietitian, I don't often get to work with insurance, due to the fact that nutrition services are rarely covered by any form of insurance. How frustrating!
(Personally, I will write up a "super-bill" for you to submit to your insurance in hopes of getting reimbursement for nutrition services. I also take CenCal Health Insurance.)
Certain insurances, or certain levels of "illness" may get you full or partial coverage for nutrition counseling/Medical Nutrition Therapy by a RD (not just any "nutritionist").
Anyway, I have found a few articles by other websites/authors that may help you in your quest to get covered for services related to an eating disorder... good luck!!
P.S.- if anyone has more tips on getting reimbursement, please post in comments or e-mail me!
(originally posted 5/6/2014. libbysfitnutrition.com)
This blog is now on the "100 Leading Sites for Holistic Nutrition Consulting & Therapy." I liked the intro to the list, where they write, "...Even for people with a general idea of what is healthy and what isn’t, the guidance of a professional can provide the added knowledge and motivation need to truly stick with a holistic health routine. This can involve:
As a side note, I am also now listed on www.EDReferral.com as a provider of eating disorder nutrition therapy (search: Southern CA- San Luis Obispo County).
(originally posted 3/8/2014. Libbysfitnutrition.com)
Do you find yourself eating out a lot? Frequently eating out usually happens because it is quick, convenient, and –let’s be honest- it tastes good. However, if you are wanting to eat healthier or lose weight, making meals at home is often a healthier choice. Cooking your own meals can be just as fast, or faster, than restaurant eating when you factor in waiting for your order to be taken and food to be prepared. Below are some strategies, with help from the Academy of Nutrition and Dietetics, to help you eat at home conveniently, and in more healthy ways.
-First, look at what your favorite types of foods are. Italian, burgers, Mexican, stir fry? These can be replicated at home for fewer calories, and catered to your tastes. You can find recipes all over- at the library, on pinterest, cooking light magazine, friends and family, your dietitian, and many other places.
-Try convenient products at the grocery store- like whole grain, quick cooking, quinoa or you can freeze brown rice after cooking for quick reheating. Buy pre-cut veggies or melons for snacking, and frozen veggies to add to pastas and stir-frys. How about pre-cooked chicken strips or shrimp? They can make meals a snap to make. What else can you think of? Make a list before you go to the store using recipes.
-Write down 5 easy meal ideas to leave on your refrigerator. Keep the pantry stocked with the ingredients for them so you always have a plan when you are too tired to think of what to make. A quick example is bean burritos: on a whole-grain tortilla, add ½ cup of fat-free refried beans, 1/3 cup shredded cheese, tomato or salsa, shredded romaine lettuce, and microwave about 3 minutes until warm through. Add a side salad and you’ve got a meal!
-Are your cupboards currently bare? Keep healthy snack and meal options at home so you have them on hand. You can’t eat healthy at home if you don’t buy any food!
References: Blatner, D., Et al. Counseling Overweight Adults: A Lifestyle Patterns Approach and Toolkit. American Dietetic Association, Chicago, IL. 2009.
Libby is a non-diet Registered Dietitian focusing on eating disorder treatment and prevention. She approaches health from the inclusive standpoint that any "body" can focus on health regardless of size. She is a ally in diversity.
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Disclaimer: This website is for educational & informational purposes only,
it is not a substitute for medical or mental health advice or treatment.