Monday, July 23, 2018

Expanding the Arena Initiative - August Edition

My name is Laura Moretti, and I am the Clinical Nutrition Specialist for The Division of Sports Medicine and the Female Athlete Program at Boston Children’s Hospital. I am also the owner/founder of Laura Moretti Nutrition, LLC, the Consulting Dietitian for the Boston Ballet Company, and an Instructor at the Institute for Rowing Leadership.  

At Boston Children’s Hospital and the Female Athlete Program, I specialize in treating all types of athletes from childhood, Olympic, Collegiate, Elite, Professional, and Masters level (we see adults in our division at Children’s Hospital).  In the Female Athlete Program, we specialize in the health and wellness of female athletes, with a special focus on treating Low Energy Availability, Disordered Eating, and Relative Energy Deficiency in Sport (RED-S). Through my private practice, I also see much of the same population. 

As the Consulting Dietitian for the Boston Ballet Company, I have in house clinics several times a month. I meet with dancers individually for nutrition related questions/issues. I also am also responsible for nutrition lectures to the company as well as to the Pre-Professional program at Boston Ballet School. I have a separate clinic dedicated to the care of the school dancers as well. 

2.     What is your educational background and how long have you been an RD? Do you have any additional credentials relevant to your position? 
I completed my DPD and Masters in Clinical Nutrition at New York University, and my Dietetic Internship at New York Presbyterian. I actually pursued nutrition as a second career. I initially graduated from Rutgers College in 2004 with a BA in Economics, and, after spending a few years on Wall Street, I decided to make the switch over to becoming a Registered Dietitian. I am also Certified Specialist in Sports Dietetics (CSSD).

3.     How did you achieve your position/ how did you get started with your current position? 

I was working in New York City at a highly reputable Eating Disorder Practice when I met Dr. Kathryn Ackerman (head of the female athlete program at Boston Children’s Hospital) at an Eating Disorder in Sport Conference in St. Louis. Through a long discussion with Dr. Ackerman, I knew that this was the perfect opportunity to relocate to join her team and focus my practice completely on treating eating disorders and low energy availability in athletes.  Through my work with The Division of Sports Medicine, I earned the role of consulting Dietitian for the Boston Ballet Company and schools. 
4.     What key areas of knowledge/experiences did you need to have before this job? 

I focused the initial years of my practice on laying a strong foundation in eating disorder treatment. I had an incredible mentor at the New York City practice for whom I was previously working. She provided me with weekly supervision and close guidance around every one of my patients. I learned to strengthen my counseling skills and how to best treat this specialty population in a highly collaborative manner. This was an invaluable experience to me and my practice, and I owe a great deal of my success to this work.  I also began learning as much as I could about sports nutrition. I took a course in my Master’s Degree at NYU in sports nutrition and began doing a great deal of reading and research on my own. I knew that when I went back to school to become a Dietitian, I also wanted to pursue my CSSD credentials. I capitalized on every opportunity to connect with Sports RDs in the community. I practiced with lectures to local teams and would attend any conferences that were available. As an endurance athlete myself, I also learned a great deal by trial and error in my own training and by helping out my teammates. 

7.     What advice would you share with an RD (or RD2be) that is interested in a similar career path?

I would encourage anyone looking to work with a specialty population to find a mentor and obtain supervision on all of their cases. While supervision is essential in all of our practice, it is particularly essential if you want to work a more specialized area. In my experience, too many young RDNs graduate school and want to dive right into specialty work open without proper guidance, supervision, and expertise. I encourage young RDNs or RD2be to gain experience in both sports nutrition and eating disorders before trying to tackle the duel diagnosis. If you are able to find a job at an eating disorder treatment center or even an inpatient unit at a hospital first, that will help you build a strong foundation.  You can then also work on building sports expertise, but leaning the basics/essentials of eating disorder treatment (which are not so basic) is necessary to have success in this work. 

I also encourage all RDs to join specialty organizations. If you wish to work with athletes, you need to be current on research and keep up to date on new developments. I have found that my own knowledge base continues to expand as I attend more conferences, do more reading, and as I make more professional connections. Never stop learning!

9.     What are some of your interests outside of work?

I love to be outdoors and active! In the winter, you can usually find me hitting the ski slopes, and in the summers, I enjoy being out on the beach and in the water. I started learning how to sail last summer!  I am also a triathlete and marathon runner, so much of my free time is spent on my bike, in the water, or out for a run. Traveling, cooking, finding new restaurants, and spending time with my nieces are also favorite activities! 

10.    What aspect of sports nutrition (or any other area of dietetics) interested you to pursue it as a career?

When I decided to pursue a second career in nutrition, I knew I wanted to work in the specialized area of treating athletes with eating disorders/disordered eating. I felt that this was a unique area of the work that was a little-known specialty at the time. Growing up as an athlete and still competing as an adult, I saw many friends and teammates struggling with their own nutrition. It was really my own personal struggles in this area that drove the true passion. When I was working in financial services, I was not feeling the personal fulfillment that I was seeking in a career path. I felt that nutrition and dietetics could enable me to truly make a difference in other people’s lives. A career in dietetics truly felt like my passion and calling as opposed to simply just my job/career. I have not looked back since I made the career change!  

11.     How do you deal with the daily stresses presented to you in your career?

Working with eating disorder patients is extraordinarily intense work, and the stress levels can be high from day to day. I am a huge advocate of self-care and have a few ways that I try and keep that a priority. Sleep is something that I feel very strongly about; I try to get 8 hours every night.  I also see a psychologist to make sure I have somewhere to process some of the stressors that result from my work with my patients. I put a great deal of time and effort into building relationships with my patients; therefore, it is sometimes hard to leave this type of work “at work.” My teammates at Boston Children’s in the Female Athlete Program are absolutely incredible, and I can honestly say I would not be able to do this type of work without them. We are very close knit, and someone is always willing to listen. Sometimes, just making sure we talk things out before we head home for the night is very helpful. Dr. Ackerman and I have our nightly chats on our way home from work to make sure we debrief before we walk into the door to be with our families/significant others. I also find that getting myself out for a run or some fresh air is helpful to clear my head. 
12.     Prior to getting your credentials, did you have any experience in nutrition (ie. food service, volunteering, etc.)?

I worked as a nutrition research assistant and practice manager for a practice in New York City. Through this work, I learned the inner workings of running a nutrition practice. It also helped me to keep current on new research that was being published. 

13.     What do you love about your career/job?

First and foremost, I absolutely love connecting with so many different people on a daily basis. As mentioned earlier, I prioritize building relationships with my patients which I think strengthens my work as a clinician. There is nothing more rewarding than helping a patient meet their goals, whether these are health or sports related.  It makes all the difference to know you are making a difference in someone’s life. I also love that all of my days are different and provide new and exciting challenges. My career has also brought me some of my closest friends and brought me to places near and far. I recently had the opportunity to travel to Australia!

14.     What are some of the unique nutritional considerations you must consider for the group(s) you work with?

I think it is important to understand the athlete mindset when working in this population. Athletes are used to pushing beyond their comfort zones and persevering through pain and discomfort. Extra workouts and additional training are characteristics often found to be things that help an athlete succeed.  Although this can be helpful when an athlete is healthy and fueled, it is very dangerous trait when they are struggling from an eating disorder.  I always try to help an athlete channel that drive into their recovery.

In my work with dancers, one of the most common issues that comes up is adequate nutritional intake to support the volume and intensity of their training. I also treat the many issues that can occur often as a result of the low energy availability, such as menstrual irregularities, iron deficiency, gastrointestinal issues, and bone stress injuries. Dancers are aesthetic athletes, which means there is a delicate balance between maintaining a strong body and supporting the aesthetic ideals of the profession. My role is to help these dancers achieve both. I am constantly educating my dancers on the importance of fueling consistently throughout the day, particularly the professionals, as their schedules are very demanding, and they often do not have time to sit down for full meals. I work closely with them to help customize energy dense meals to optimize performance and promote proper recovery.  During periods of more intense training and performances, I find myself working double time to help keep the dancers strong and injury free.

I was once told that my specialty was unique since it involves blending the often black and white world of sports nutrition with the often very gray area of eating disorder treatment. Striking the balance between these two worlds is what enables a clinician to be most effective in working in this population of patients.   

Tuesday, July 3, 2018

Expanding the Arena - July Edition

This July, we spoke with Alicia Fogarty MS, RDN, CSSD, LDN, based in the Charlotte, North Carolina area.  Primarily, Alicia provides sports nutrition intervention and education to high school athletes through a partnership between Atrium Health (formerly Carolinas Healthcare System) and Charlotte Mecklenburg Schools.  She also offers support to other area high schools and middle schools in which Atrium provides Athletic Training coverage. Finally, Alicia assists with providing community nutrition intervention and education to support another dietitians on her team.  

What is your educational background and how long have you been an RD?
My undergraduate degree is from Ithaca College with a major in exercise science and a minor nutrition. I obtained my masters in clinical nutrition at NYU and became a registered dietitian in 1997. I also became a Certified Specialist in Sports Dietetics in July 2013.

How did you achieve your position/ how did you get started with your current position?
I have been working with Atrium Health for the last ten years. Initially my position was contracted with the YMCA’s of Greater Charlotte to provide nutrition education and support to all the Y locations in the area. We provided services including sports nutrition education, and I used these to earn part of my CSSD hour minimum. It took the first five years to obtain the hours. Our team began providing sports nutrition education during a yearly event, Heart of a Champion Day, which offers sports physicals, a cardiac evaluation, and at minimum, 12 lead EKG evaluation. I worked closely with our sports medicine team to provide sports nutrition education and intervention to any athlete they deemed necessary.
In January of 2016, my position evolved from only working at YMCA to contracting with Charlotte Mecklenburg Schools. It was my goal to introduce sports nutrition into this population as I saw it as a community wellness and sports nutrition initiative.

What key areas of knowledge/experiences did you need to have before this job?
During our transition, I continued to take CEU’s on sports nutrition and began learning what I could from respected resources on adolescence and adolescent athlete nutrition. The sports nutrition care manual gave a general review of age group guidelines that was helpful. Fellow sports dietitians are always a great resource. I have used Tavis Piatolly and Heather Mangieri to name a few resources.

What are the highs and lows of your position?
For nutrition intervention, generally, it is a thankless job because you may see a client/patient once or twice depending on the structure of your job.  Since my team and I are located at schools, we are beginning to gain more visibility, and student athletes are coming up to me and saying, “Wow, this actually works!” They are gaining muscle, having energy at the right times, and having many other positive responses.  Also, we are trying to do something that is not available in many areas, which is provide sports nutrition coverage to athletes as part of the medical team, essentially providing a service that if obtained privately, would be fee based. 
Battling misinformation is the biggest low!  With many public/community-based education programs, people obtain information from the internet, and this age group in particular is very in tune with social media resources. Often times, the social media voice is the loudest voice they are listening to, not necessarily the correct voice. We try to meet the students where they are, but it is a slow process.  We are also working against years and years of coaches and parents providing information and resources themselves, and some of that information is not accurate.

What is a typical day for you?
Our department, in general, is less than typical, but usually, the morning is reserved for clerical/paperwork type activities. That may consist of developing programs, reviewing food journals, and checking email.  My afternoon, starting around 1 pm, is when we are in the schools.  We try to get to our primary schools around 2pm to talk with the ATC’s, coaches, etc. since school lets out around this time. Once the students are out of school, we host a session or group with a specific team. This can include what we refer to “sports nutrition rounding,” which is when we are available for Q and A for any athlete, coach, or parent wanting to ask questions.  On busy days, we may have multiple teams or schools to attend.

What advice would you share with an RD (or RD2be) that is interested in a similar career path?
Since I had a very roundabout way to become a sports dietitian, I wish I had a great answer.  In general, do not hold back from realizing what drives you and what you are passionate about.  I had a passion for helping student athletes become the best version of themselves and wish I had that guidance when I was their age.  Because of my interests, it led me to look at ways to provide those services to our area student athletes.  As an RD/RD2Be, if working with high school athletes interests you, connect with the coaches and trainers to see what their needs are and see what types of relationships you can form. 

What is your greatest strength/weakness as a dietitian?
I love what I do and try to be empathetic to each person I work with in their goals to become whatever they define as healthy.  What works for one person may not work for another.  I feel that I do well with helping each person as an individual.  For this population, I feel I can relate to them in that I have been in their shoes, wanting to be a collegiate athlete, and doing whatever it takes to achieve that.
A weakness is I talk too fast. I also feel that sometimes I can’t stay ahead of the newest developments in science and nutrition, but I try to read as much as I can to avoid falling behind on the evidence.

What are some of your interests outside of work?
I enjoy reading, exercise, cooking, art, soccer, and family time. I have a husband, 4 kids, and 2 golden retrievers.

What aspect of sports nutrition interested you to pursue it as a career/ decided to work with athletes or similar groups?
I played college soccer and had challenges with injuries and weight gain my first 2 years, so I did not see the playing time I wanted.  My junior year, I took my first nutrition class as I explored through my liberal arts program (originally went to school for Art), and it all clicked.  It made sense, I improved, became a starter for our team, and I knew what I wanted to do with my career.

Prior to getting your credentials, did you have any experience in nutrition (ie. food service, volunteering, etc.)?
No, originally I went to school for art and ended up a dietitian.  I also come from an Italian family and LOVE food and cooking.  

What do you love about your career/job?
Our team is fantastic, and I have had the most amazing experiences as we have evolved and grown over the past 10 years.  I love that I am now able to put my passion into practice.

Is there a course you took in undergrad or grad school that has helped you in your current role?
I feel like I draw on my counseling classes often.  Of course, they are all important, but the ability to connect with people is so important in our field.

What are some of the unique nutritional considerations you must consider for the group(s) you work with?
When we first started this program, I was asked why I was educating the “healthy kids” since we were focusing on a subset of high school students.  I have never encountered a group of people in my life that have worse eating habits as a whole as high school athletes.  Teenagers are prone to transitioning to making their own choices about food compared to that of a younger child, and in today’s society, unhealthy food has never been more accessible than it is now. They can have it delivered to the school if they want!  They are also notorious for not eating anything either for breakfast or both breakfast and lunch for a variety of reasons, and it does not matter who or where I am talking to athletes, at least 50% of them don’t eat enough. The reality is only 6 – 8% of high school student athletes will continue on playing sports in college competitively.  We also see this as a way to help those 95% of athletes not making that transition to learn how to become healthier eaters overall, which will hopefully shape their health and wellness patterns in the future.