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Interviewer: Eating well is a crucial component for good health, but for a lot of us, it's a skill that we never really were taught or learned much about. The Utah Wellness Bus visits communities and offers free health screenings in addition to education to anybody who wants it. And if you visit the Wellness Bus, one of the people you might talk to is our guest today, clinical dietician Alex Marie Hernandez.

In today's interview, we're going to talk to Alex about tips that could help you eat healthier, some common barriers and misconceptions about eating well, and how a free nutrition counseling session from Utah Wellness Bus can help you understand about nutrition and help you improve your health.

Alex, let's go ahead and start with what could somebody expect during a nutrition counseling session if they visit you on the Wellness Bus?

Alex: Part of the sessions when somebody comes to see me for a nutrition or lifestyle coaching is that we take some time to get to know the client. So part of that includes a dietary assessment. So I ask them, "What do you normally eat? What does a normal day of eating look like for you?" And from there, I can then see what are some of the common foods that they eat? What are some of those that maybe we can improve?

Based off of that, then we go into different nutrition, education topics, right? So one thing that's very helpful is learning how to read a nutrition label, which is something that a lot of people aren't too familiar with. So just checking that nutrition label for things like added sugars.

And then a lot of times, if they are drinking something, for example, that has a lot of added sugars . . . Just yesterday, I had a client who mentioned that she was drinking a lot of vitamin water. She was like, "This is great. I'm getting lots of vitamins."

Interviewer: It sounds healthy.

Alex: Yeah. And then I'm like, "What brand is it? Let's take a look at this." So we look it up online, we look at the nutrition label, and it turns out it has like 26 grams of added sugars in one bottle. And she was having multiple every day.

So then we go through and we look at . . . we'll compare that to what the maximum amount that you should be having in a day is, and then they come to that realization, "Wow, I'm having a lot of added sugars and I didn't even know."

So things like that. The nutrition label is a very great tool in figuring out how to make healthier choices.

Interviewer: Do you find that a lot of not such great stuff is hiding in our food and we really need to do some research . . .

Alex: Oh, yeah.

Interviewer: . . . looking at that label to figure out what that is?

Alex: Mm-hmm. Because some things can be marketed as healthy. The label will make it seem like it's a healthy choice, but you look at that nutrition label and it turns out that's not the case.

One example that I talk to a lot about with clients is when it comes to breads, like whole wheat bread. It may say that, but you look at the nutrition label, look at the fiber content, and it actually doesn't have a lot of fiber. You look at the ingredients, whole grains is not one of the first ingredients. So that nutrition label is going to tell you the truth versus what's just marketed or advertised on that label in the front of the product.

Interviewer: And this is kind of a new phenomenon, isn't it? That you have to be aware of what's in your food. I would think many years ago, we made a lot of our meals from scratch, so we kind of knew what was in our food, but now you just really don't know. You do have to do that due diligence.

Alex: Yeah.

Interviewer: Give me a tip on how I can start that process, because it sounds a little overwhelming, right? I've got to know what I'm looking for, and then I've got to know how much of that thing that I can have and still be healthy. I've got to do all that math. So how do you make it simple for people? Or is there not a way to make it simple?

Alex: There is a way to make it simple. But I guess my tip here . . . I don't know if it's appropriate, but come to the Wellness Bus.

Interviewer: That's right. Take advantage of you.

Alex: Yeah. We can talk about it some more, because one of the things we offer as well in these sessions is this health coaching book. And it has a lot of great information, visuals, things are colorful, which makes it easier to understand.

So we go over those things. We point things out. We do some teach-back as well, like, "Well, now that we've learned this, can you tell me this?" So I really think taking the time to talk to someone who can walk you through that is going to be helpful. So come to the Wellness Bus.

Interviewer: And realize that it is complicated.

Alex: It is complicated, yeah.

Interviewer: I think some people might feel a little ashamed, like, "Well, I should understand this stuff," but it's not necessarily super easy to understand all the time.

Alex: Right. And I'm trying to think . . . I don't know if it's always taught in schools. I took a nutrition class in high school, which is where I became interested in nutrition, and that's where we went over the nutrition label. But even then, not too much in depth. It was later on when I studied more nutrition that I better understood how to use that nutrition label.

Interviewer: Right. You've this for how many years of schooling?

Alex: Oh, I took longer to get my Bachelor's, but . . .

Interviewer: But it's a Bachelor's degree, so . . .

Alex: Bachelor's plus Master's. In a few years, Master's will be required for all dieticians.

Interviewer: Okay. So I think that really illustrates how much there is out there to know that somebody could dedicate two degrees to it, right? So come to the bus and capitalize on that knowledge that you have.

Alex: Yes.

Interviewer: What do people think their nutritional challenges are generally, and do they align with what you know?

Alex: We work with a lot of diverse communities, right? So I think with that, a lot of people come to the bus thinking that their cultural foods are not healthy foods. And we want to highlight that you can still eat healthy within your cultural foods.

When they come to the United States, maybe they're presented with one way of eating, and that that's the only way of healthy eating. But that's not true. There are so many healthy foods across the world.

For example, the Mediterranean diet, right? That's one of the healthiest diets in the world. So it's just highlighting their staple foods and why those are healthy.

A lot of times, it just comes down to portion sizes, right? Maybe people are eating too much of one thing and not really balancing it out with the other nutrients that they need.

Interviewer: What are some of the barriers to good nutrition that you encounter? So we talked about just knowledge. Are there other barriers?

Alex: There are other barriers. For example, access to healthy foods. That's a big challenge. Sometimes, we'll talk about some . . . For an example, healthy fats like salmon, great source of healthy fats. But when I mention that, they'll say, "Oh, that's too expensive." So then we can talk about other sources of healthy fats as well, right?

Or even thinking about frozen or canned foods, it's okay to eat those foods. Again, just reading that nutrition label is going to help you make better choices there.

But we can also talk about food pantry, local resources, where they can go get more food if they're not able to afford that at the grocery store. And also just talking about how you can still eat healthy on a budget is important. So I think that access to foods is another big barrier that we encounter.

Interviewer: How about time to make meals at home? Is that a barrier?

Alex: That is another one as well, yeah. That's a good point. And there, we talk about ideas. Based on what they like, their food preferences, what are some quick, easy meals or even snacks that you can eat to incorporate more healthy eating?

One thing, for example, that I mention a lot is baby carrots are super easy to take with you as a way to add some more vegetable in your day. However, people don't think that. Maybe it's not as glamorous, but there are ways to do it. There are.

Interviewer: When somebody comes to the Wellness Bus, if they see it in their neighborhood and they want to come in and talk to a nutritionist there, you, is there something they should prepare? Should they come in with a list of what they've eaten for the past couple days? Is there anything else that they should come in with that could make the job a little bit easier, more productive?

Alex: I want to say that they don't have to prepare at all if it's going to make it easier for them to come in. No worries. Just come in. I'll ask you the questions to learn what I need to know to help you.

Interviewer: One of the programs on the bus is called Journey to Health. Tell me a little bit about that.

Alex: It's a nutrition education program. We're collaborating with the Nutrition Department at the University of Utah. It's six months long. There are four nutrition classes that a participant would go to. And then part of it is also to come see me, dietician on the bus, for two sessions. And then at the end, the participants gather together for a community meal to celebrate their successes and what they've accomplished throughout the program.

The program has been very well received by the community. People are loving it. Some of the classes include cooking demos. You get free gifts like kitchen items, which is wonderful. Learn how to shop around a grocery store and find healthy foods on a budget.

It's been something that people have really enjoyed. And when they come see me, they rave about the classes, like, "They were great. I love them. When are there more?" I was like, "Sorry, there were only four classes."

But it's great because they get a good foundation of healthy eating from the classes. And then when they come see me, we can talk more individualized about their specific situation, what's going on, and how we can set some goals specific to them. It's open to the community, so come check it out.

Interviewer: When you've been out and about, you may have seen it driving or in a parking lot in South Salt Lake, Ogden, Provo, Kearns, Glendale, or maybe some place else in the Salt Lake Valley. And you've always wondered, "What is the Wellness Bus and who can take advantage of this free resource?"

Nancy Ortiz is the mobile health program operations manager, which includes overseeing the University of Utah Wellness Bus. Nancy, let's just start off with what is the Wellness Bus?

Nancy: So the Wellness Bus is a mobile prevention and education clinic that is focused on really making communities healthier. So it's a 39-foot Winnebago that has been outfitted to travel around to different communities and provide free screening services for not only diabetes but other chronic disease.

So when you come to the bus, you can get . . . Everything is no cost. It's free. You can get a simple glucose test, and if your sugar is high, we can also do what's called an A1C test. Additionally, we can test your cholesterol, a whole lipid panel. We test your height, weight, your BMI. We test your waist circumference. And then, additionally, we have a registered dietician that offers free nutritional counseling or coaching on the bus.

Again, all services are free. And we go to the same locations because we want people to come back. We want to help people manage their diabetes or their pre-diabetes, or prevent pre-diabetes or diabetes, or help them with their high blood pressure. So we encourage people to come back and that's why we go to the same locations every week.

Interviewer: And the individuals that come and visit the Wellness Bus, what is the impetus? What inspired them to actually go into this bus, into this situation that they might not be familiar with? What got them there?

Nancy: That's a great question because as we found out, just because you build it or park it there doesn't mean they come inside, right? A lot of people just go walk by out of curiosity, like, "What is that?" But people, they do want to know, and we hope more people want to know. As we say, what are your numbers? What is your glucose? What is your blood pressure? What is your cholesterol? What do those numbers look like? Sometimes they can be a burden.

We don't diagnose on the bus because we don't have medical providers. We work with community health workers. So we say we identify. So the person that does finally make that decision to come into the bus, we do the screenings. And of course, they hope that their health looks pretty good. But in the event that it doesn't look . . . the numbers aren't ideal, we can help them find a provider if they don't have one.

And studies have shown that lots of times, people will not seek care because of the cost. They don't want to burden their family. Money is already tight. So we have services available where we can help people get either free or low-cost medical care. So we are there trying to help the person find affordable resources.

Interviewer: That would be a scary thing, finding out that you have a health condition, and definitely a reason why you just walk on by as opposed to finding out.

Nancy: Exactly.

Interviewer: So it's great that you're connecting people with community to resources that can help in their situation. Tell me about somebody. Walk me through somebody comes in, they find out, "I've got a high fasting glucose. I might have diabetes." You connect them with some resources. What's the journey like after that point?

Nancy: Right. Again, they've gotten this bad news, but we are there to encourage and say, "Through education and lifestyle changes," which is why we have a registered dietician on the bus, "you can really manage it."

We're here to educate you on ways to reduce your sugar levels or you're high cholesterol levels. And we highly encourage you to see a medical provider because it could be that you they need to be on other medication or insulin.

And once you've met with the provider, we encourage you to come back to the bus. We are here, again, for support. And a lot of times, Scot, it's just the social support.

We have an individual. He had diabetes when he came onboard. He comes to the bus pretty much every week. And his glucose levels are improving because I think that social interaction. He knows the people on the bus, like, "Hey, Alex. Hi, Maria. Hi, Veka." That really helps people, I think, pay attention more to their health and make them feel like somebody cares.

We try to make people feel comfortable. We try to break down on the bus as many barriers as possible.

People can come on the bus and remain anonymous if they want. We ask them general information, name, address, a little bit of medical history, but you don't have to fill it out. If people don't want to give their information, and some don't for fear that it's going to come back to them in some bad ways, it's like, "You don't have to give your real name. You don't have to give your address." We don't want that to be a barrier.

We have Spanish speakers on board, so we have that language, but we have an interpretation service that we use that we have access to 240 languages and dialects. We can get someone that speaks their language within a minute on the phone. So we don't want that to be a barrier.

We travel to communities that have high rates of diabetes and chronic disease, trying to make it easier for people to come to the bus. So just trying to break down those barriers of . . .

You asked me previously why someone would or wouldn't come on to the bus. We're just trying to get as close to them as we can and say, "Just please come on board. Let's just have a conversation. Let's look at your blood. It's just a finger prick. We're not doing blood draws out of the arm. It's just a simple prick on the finger."

So it's just about letting you know where you are, again, on the spectrum of good health versus ill health, and that's what we want people to know. We are not there to shame anybody. So, again, we want people to feel comfortable that we're not here to judge you on your weight or how you eat.

Interviewer: It's no reflection of a personal shortcoming at all.

Nancy: It's not. It part, lots of times, it's about education.

Interviewer: What would you say to somebody that might see the Wellness Bus parked some place and they're thinking about coming in but they're not sure?

Nancy: Don't even give it a second thought. Just open the door and come on in. Our staff is so friendly. They're going to make you feel like you're just sitting in your living room while you're getting your finger poked.

I mean, please, don't hesitate to come in. Just find out what your health looks like. Just get a baseline. And if it needs improvement, we can help you make those improvements. And if the numbers look good, that's even better. You can walk out of there feeling, "Hey, I'm even healthier than I thought I was," or, "There are little improvements that I need to make," or, "Wow, I do need to see a doctor or a provider at this point."

But again, we are there to help you on this journey not just today and say, "Oh, this is what your numbers look like," but, "Hey, come back. We are here every week whatever location we're at. We will help you on this journey to better health." So please, hop on board.