Courtesy of Hudson Headwaters
By Christine Graf
As part of its mission to provide comprehensive primary care throughout the North Country, Hudson Headwaters Health Network has a team of three registered dietitians who provide nutrition counseling to patients. Hudson Headwaters has 25 centers located throughout the North Country.
Registered Dietitian Alexandra Barbieri is responsible for covering the southern tier which includes centers in Moreau and Glens Falls. A native of Hudson Falls, she has a master’s degree in applied nutrition and has been working as a registered dietitian for 10 years.
At Hudson Headwaters, registered dietitians are considered an integral part of the treatment team. In addition to seeing patients in person, they also offer telehealth and telephone consultations. They accept patients only through the Hudson Headwater network, providing their services at no cost to the patient. The practice also has a certified diabetes educator who works closely with patients with diabetes.
“There’s a real demand for our services, and we are scheduling about three months out,” said Barbieri. “I might meet with a patient as little as once or twice, or I could work with them for years. A big part of being a dietitian is providing accountability and continued education.”
On average, Barbieri estimates that she meets with most patients three to six times over the course of one year or more.
“From a health and habit standpoint, in the beginning, you work on education. In order to make changes, habits need to be created. We call that the action stage, and that can take about six months to one year. After that, there is the maintenance stage.”
According to Barbieri, diabetes is the number one reason patients are referred to a registered dietitian.
“We aren’t just seeing people in their 60s and 70s with diabetes. We’re seeing people in their 30s, 40s, and 50s, and we are also seeing more children. It’s a combination of genetics, a lot of sugar-sweetened beverages, a lot of junk food and convenience food, and people being more sedentary.”
Barbieri said the majority of her patients are very receptive to the changes she recommends.
“Most of the time people are quite receptive. They typically have a good rapport with their provider who made referral, or they may have asked for the referral. By the time they come to see me, they have been waiting a couple of weeks or a couple of months, and in most cases, they are looking forward to the appointment.”
According to Barbieri, many of Hudson Headwaters’ patients live in areas that qualify as food deserts—areas where residents have limited access to affordable and nutritious food, particularly fresh fruits, vegetables, and other healthy foods. Some of these patients may not have the financial resources necessary to purchase healthy food.
“As we go further north, it becomes really rural. Food deserts exist in Franklin and Essex counties, and some people are shopping at Stewart’s or the Dollar Store. So, we have to tailor our recommendations, and we have to start looking at where the local food pantries are. We try our best to reduce all barriers.”
For those interested in general guidelines to improve their health, Barbieri recommends the Mediterranean diet as a good starting point.
“I like it because it focuses on less processed foods but also give you a range of animal foods–chicken, fish, and some beef—along with low-fat dairy. There are a lot of fruits, vegetables, nuts, seeds, and beans. It’s considered anti-inflammatory and helps with a lot of things including type 2 diabetes, cardiovascular disease, and weight management.”
Barbieri advised against relying on social media influencers for nutrition advice, saying that much of the advice they offer is “absolutely false.” Fad diets can also be problematic, Barbieri mentioning the keto diet as an example.
“The keto diet is very restrictive, not sustainable, and extremely expensive. Because it focuses on high fat, it can be a problem for someone with cardiovascular disease or type 2 diabetes,” she said.
In recent years, registered dietitians have been working with more and more individuals who have been prescribed semaglutide weight loss medications.
“Medications such as Monjauro and Ozempic are very effective for people with type 2 diabetes. They are great for controlling blood sugar,” said Barbieri. “They have also been very effective for losing weight. The concern is that insurance companies aren’t wanting to pay for them unless you have a pre-existing condition. Patients might be approved one month and not approved the next month. There’s no tapering. You’re just done.”
When that happens, those who haven’t developed healthy eating and exercise habits typically gain the weight back very quickly.
“There are people who have lost a large amount of weight and don’t know what to do to maintain it,” she said.
For that reason, Hudson Headwaters’ primary care physicians typically refer patients to one of the registered dietitians before prescribing a weight loss medication. Some insurance companies also require patients to meet with a dietitian before they will cover the medication.
With the new school year underway, Barbieri is providing advice to parents of her young patients, suggesting nutritious lunch box options. She recommends pairing fiber filled snacks—things like whole grain crackers and fruit—with some sort of protein. Protein options include cheese sticks, Greek yogurt, and nuts. When opting for canned fruit, it is important to make sure it is packed in its own juice. For sandwiches, lean turkey, chicken, or peanut butter on whole grain bread are healthy options.
This fall, Hudson Headwaters will be offering a variety of free nutrition classes to its patients.
For more information, visit www.hhhn.org.