Characterizing goal setting by the Registered Dietician for adolescents with newly diagnosed Polycystic Ovary Syndrome (PCOS)
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Registered dietitian, PCOS, diet, goals, nutrition education
Gadiraju, Manasa; Green, EM; Burgert, Tania S.; MacMillan Uribe, A; and Vanden Brink, Heidi, "Characterizing goal setting by the Registered Dietician for adolescents with newly diagnosed Polycystic Ovary Syndrome (PCOS)" (2023). Research at Children's Mercy Month 2023. 12.
Background: Polycystic Ovary Syndrome (PCOS) is a prevalent condition that manifests in adolescence and is associated with significant metabolic comorbidities, including obesity and type 2 diabetes. Because of this lifelong burden, early strategies for dietary modifications are beneficial to mitigate PCOS severity. Registered Dietitians (RD) have an important role in guiding diet-related strategies following a PCOS diagnosis. While goal setting is a critical tool for promoting behavior change, an understanding of current goal setting approaches among RDs for dietary management of adolescents with PCOS are lacking.
Objective: To characterize goal setting by RDs for adolescents newly diagnosed with PCOS at a multispecialty PCOS clinic.
Methods: Nutrition notes recorded by RDs of patients (n=118) seen for PCOS between 2015 and 2020 were extracted from medical records and de-identified. A collaboratively generated code book was used to code nutrition notes in Dedoose® based on open coding and a priori objectives.
Measurable Outcome: Goals were characterized for emerging themes using qualitative content analysis by four investigators.
Results: Adolescents were on average 15.6 years old and 70.3% had a BMI >30 kg/m2. Parent(s) attended 89% of visits. Of the 118 nutrition notes, 7 notes had 0 goals, 10 had 1 goal, 40 had 2 goals, and 61 had 3+ goals. The main themes identified were: 1) the MyPlate tool was used consistently, regardless of number of goals; 2) modifying carbohydrate intake was commonly included in goals and often focused on restricting simple carbohydrates (e.g. reduce sugar-sweetened beverages) or pairing carbohydrates with other macronutrients (e.g. protein or fat), and seldom focused on adding complex carbohydrates (e.g. increase whole grains); and 3) there was a lack of parental inclusion in the nutrition note goals; 4) despite a high prevalence of obesity, most goals were focused on nutrition and behavior change, and not on weight change.
Conclusions: MyPlate and carbohydrate intake is a frequent starting point for RD goal setting for adolescents with PCOS. RDs providing many goals at once may result in barriers to making dietary changes among newly diagnosed adolescents. An emphasis on nutrition and lifestyle goals rather than weight change was a positive observation in nutrition counselling, focused on creating life -long healthy relationships with food as opposed to weight loss. Parental involvement in goal setting for adolescents with PCOS may be a missed opportunity to create feasible, effective nutrition goals.