We caught up with Colleen Tewksbury, PhD, MPH, RD, LDN, senior research investigator and bariatric program manager, on topics ranging from how she and her patients work together to set goals to bad advice she hears regularly. Tewksbury has been a registered dietitian for eight years, nearly the past five of which have been with Penn Medicine's Metabolic and Bariatric Surgery Program.
What inspired you to become a registered dietitian, and more specifically, why did you choose to work with bariatrics patients?
I actually was all over the place with my career prospects growing up: it ranged from lawyer to CEO to gastroenterologist. I did know that I loved food, science, and working with people. When I discovered the RD career path, it all clicked into place for me.
The same thing happened in bariatrics. I didn’t specifically seek to get a job in the field, but as soon as I started, I knew this was the area I wanted to focus on.
What are some of the most common questions you receive from patients?
“What can I eat?”
My response is typically that if you ever hear a clinician say to never ever eat something ever again, it’d be best to re-evaluate if you want to work with them.
Another thing I hear often is “you’re going to get mad at me,” when someone is about to tell me what they’ve eaten recently. I would never! Your food is your food, and my job is not to judge. I am here to help you figure out how to reach your diet goals without any shame or judgement involved.
Is there anything you have learned since becoming an RD that you wish everyone knew and why?
Dietitians don’t have scope of practice in the state of Pennsylvania! What does that mean?
Each state license has a defined scope of practice where you cannot do certain things without getting that license.
As two end examples, you cannot perform surgery in Pa. without a medical license and you cannot perform a massage without the appropriate massage therapist license. There is no required licensure for nutrition for PA.
What that means for the public is that anyone can technically provide nutrition counseling (what we call Medical Nutrition Therapy) without the proper knowledge or training.
RDs have to complete a bachelor’s degree and at least 1,200 hours of supervised practice, a registration exam, and ongoing to continuing education. Many of us, including me, have advanced degrees.
Without that protection in the state, it is very important that people get their nutrition information from those with an “RD”or “RDN” at the end of their name, ensuring they have advanced training and skills.
What’s your favorite part about your job?
Everyone has their piece to the puzzle when it comes to treatment in our program. The dietitian, nurse, nurse practitioner, surgeon, psychologist, and, most importantly, patient, are all equal partners in care and members of the team.
When patients with experiences at other programs point out the difference in all the providers working together with them and not separately, that is a wonderful thing to hear since we work so hard to make that happen.
What’s the most challenging part about your role?
Time. I have so many things I want to conduct studies on, so many team-building events I want to do, so many patients I want to see, so many support groups I want to run and time is my limiting factor. For now, my calendar is everything.
When a patient first comes to meet with you, it’s understandable that he or she might be nervous. What is one way you put new patients at ease?
I hope I set the tone that you never feel judged. I’m here to help you, not grade you. And dietitians eat and live in the real world, too. We’re human, I promise.
How do you get to know a patient in order to make a plan and set goals that are right for them?
I try to just keep asking questions.
To some, nutrition can seem like an overwhelming and confusing concept — with advice on what’s best coming from many angles. How do you work with your patients to demystify good nutrition?
I try to understand where they are coming from, where they get their information, and walk them through thinking critically about the information. It’s less about what’s good or bad, and more about critically assessing the information they come across and weighing whether it is the best for them.
To follow up on that, what’s one piece of bad advice you hear regularly and would like your patients to forget?
Don’t drink straight apple cider vinegar. It can damage the lining of the esophagus and cause some significant damage.
What is your favorite, easy-to-make or grab-and-go snack that is appropriate for a bariatrics patient and why?
I have two. Lots of patients really enjoy meal-prepping and planning out what they are going to eat for the next day(s). Once recipe I hear often that I think is a great idea are muffin-tin omelets. People will make a bunch of egg omelets with additions they love in a muffin tin, and eat them throughout the week.
We also have a lot of patients who begin high-intensity or distance training (triathlons/marathons) after surgery and need to carb load before long sessions or races. Applesauce squeeze packs are not just for toddlers. They have just the right amount of carbs needed before a high-level, high-intensity race or workout, are only 60 calories, are convenient, portable, and delicious.
Anything else you think is important for current or future patients to know about you?
Woodrow Wilson once said, “Far and away the best prize that life has to offer is the chance to work hard at work worth doing.” I am honored to be able to work with these amazing clinicians and even more humbled to be given the opportunity to apply my skills towards improving your chance at a long, healthy, and full life.