Telenutrition grows as waistlines shrink

Choir director Sallie Middleton is turning heads at Spring Hill Missionary Baptist Church in Eutawville, South Carolina, these days and she loves it. “Last night, I went to rehearsal. I had on a close-fitting outfit. They said, ‘Ms. Middleton, what happened to you? Are you sick?’”

No, she told them. The 45-pound weight loss they were noticing has been intentional and life changing. “I said, ‘I feel awesome getting rid of all that weight. I feel so awesome.’ I said, ‘It’s just like the Holy Ghost. God comes into your life and changes you. It’s a different feeling.’”

Middleton, whose eating habits were once so bad that she worried she’d end up having a stroke or needing dialysis for kidney problems, is now a telenutritionsuccess story out of the Medical University of South Carolina. “I’m just enjoying life. I thank God for Amanda. I could never do it without her.”

If Middleton is the poster child at her church for telenutrition, Amanda Peterson is the woman who made that possible with the help of their regular appointments. “I’d say telenutrition works as a viable alternative to in-person, traditional visits for the majority of people,” said Peterson, a registered dietitian who works with MUSC's Center for Telehealth.

Simply put, telenutrition is a video appointment with a health care expert, similar to using Skype or the iPhone’s FaceTime. It’s designed for people such as Middleton who live in places with limited access to specialists. They can go to a local doctor’s office and have their MUSC appointment without having to travel to downtown Charleston. Research, including studies done at MUSC, shows telehealth improves health and saves money, and more than 30 medical practices around the state use it. The number of people using telenutrition through MUSC more than doubled from 2014 to 2015.

On a recent morning, Middleton sat in a doctor’s office near her home while Peterson talked with her via video from downtown Charleston. “How are you doing?” Peterson asked. “I haven’t seen you in a while. How were the holidays?”

Middleton answered with a wry smile, “Fine. I didn’t have any turkey. I didn’t have any ham. All I had was green grass.”

Green grass is what Middleton calls the diet of mostly vegetables and lean protein that has helped her lose weight and find the energy to do things she’s never done before, like mow the yard and clean the house late into the evening. In the past, she was just too exhausted.

“You didn’t want turkey?” Peterson said. “You can eat turkey.”

No, Middleton told her. She stuck with what she knew worked for her. “I was home all day eating green grass if I got hungry.”

They talked about Middleton’s weight, her new walking regimen of six miles a day and how she’s feeling. “I’m enjoying life,” Middleton said.

“You’re doing such a good job,” Peterson answered.

Middleton’s appointments with Peterson are supplemented with care from doctors and nurses in her home area. They do tests, weigh Middleton and talk with her about her health, then share that information with Peterson so the dietitian can prepare for their appointments.

One of Middleton’s doctors, Monnie Singleton, M.D., called telenutrition the wave of the future. “I like to ride the crest of the wave,” he said. “I think once the reimbursement gets right, we’re going to see an explosion of this technology.” By reimbursement, he means getting insurance companies to cover telenutrition.

For now, the MUSC Center for Telehealth isn’t charging patients for the counseling since Medicaid, the government insurance program that many telenutrition patients use, doesn’t cover it yet. “We want to show that telenutrition is a good alternative to in-person appointments for some people, because of course, obesity is prevalent in rural areas where they don’t have access to a registered dietitian,” Peterson said.

An estimated 66 percent of South Carolinians are overweight or obese, she said. Middleton is happy to be leaving that category. After struggling with her weight her whole life, the heart attack death of her niece finally shocked her into committing to losing weight through telenutrition. “I said, 'I love to eat, but I can stop because I want to live.'”

With Peterson’s guidance, Middleton has learned how to shop for and cook healthy meals that help her lose weight. “It’s cauliflower, spinach, carrots, zucchini and eggplant with a yellow onion. I stir-fry it in a little bit of olive oil and I put Mrs. Dash across it.” She also eats fish, beans, eggs and chicken and drinks mostly water and diet cranberry juice.

“Nothing worked but this. And I’m so happy and grateful, I’ve got to stick with it,” Middleton said. “At 67, I feel that if I can do this, anybody should be able to do it. I’ll be 68 in March. I feel like I’m 16 because I’m moving all the time.”