March 5, 2020

Bite by Bite: The History of the Registered Dietitian at MANNA

March marks the month-long celebration of National Nutrition Month®. It is a campaign set forth by the Academy of Nutrition and Dietetics to inform the public to make balanced food choices, encourage physical activity and sustainable food practices, and most importantly, acknowledge the role the registered dietitian plays in promoting these messages to the clients they serve. MANNA has six registered dietitians on staff who are vital in the leadership, research, outreach, and nutrition education of the organization. Here is the journey, bite by bite, that led us to have this diverse and talented group of professionals today.

MANNA kicked off its 30th year on Martin Luther King Jr Day, and from the beginning, has always understood the positive impact of nutrition on the clients we serve. MANNA was founded during the height of the HIV/AIDS epidemic. According to the Morbidity and Mortality Weekly Report from the CDC, AIDS was the second leading cause of death among men, and in the top five causes in women by the end of 1991[1]. MANNA delivered meals as a way to provide comfort and dignity to those who were dying. Clients enrolled on our program received meals indefinitely. By the late 1990s, medications to help stop the progression of HIV to AIDS were advancing and people were living with HIV longer.

It was around this time when MANNA added dietitians to its staff. MANNA’s CEO Sue Daugherty was one of the first dietitians employed at MANNA. During her first years at the organization, she recalls only reporting to MANNA for half day per week and spending the rest of her time at various infectious disease clinics. She and the other dietitians on staff spent their time at these clinics to provide nutrition education to people living with HIV/AIDS and screen for HIV wasting. This screening was essential for physicians to prescribe the needed medications such as appetite stimulants to improve this side effect.

The turn of the century led to many exciting changes at MANNA. The menu was completely revamped from comfort foods to a six-week menu cycle of balanced meals. Sue described this process as the moment the “science was born” at MANNA. The dietitians on staff were involved in this transition and imported recipes into nutrition analysis software to make sure the meals were balanced and following dietary guidelines. MANNA envisioned their meals as part of the intervention, along with medical care to support individuals with HIV/AIDS to live longer and healthier lives.

It was also at this time when the dietitians began to recertify clients. The process of recertifying includes collecting updated health information as a means to determine program eligibility. If a client’s nutritional status improved, they cycled off the program. This was a tough transition for some clients that were on the program for years because they now had to face the fact that their meals would eventually end. With the implementation of the recertification process, and a growing client census, came the need for a system to hold client information. So in 2001, MealService was developed in order to hold client information, assign diets, and create routes for drivers.

By the late 2000s, the dietitians on staff were still going to infectious disease clinics, but not as often as they were in the earlier years. Now, they split their time at the clinics and at MANNA, where they would enroll clients onto the program and provide on-site nutrition counseling, also known as medical nutrition therapy (MNT). Dietitians were also traveling off-site a few times a month to provide group nutrition education in the community.

In 2013, MANNA published research in the Journal of Primary Care & Community Health. This study was the first of its kind examining MANNA’s model of medically tailored meals and their impact on healthcare cost savings. The dietitians on staff were trying to seek community partnerships and sustainable income to support the continued growth of the organization and believed that this research would pave the way for that. It did just that. In 2014 during National Nutrition Month®, MANNA held a Nourish event to invite health professionals and stakeholders to learn about the research findings. Bill George, the former CEO of Health Partners Plans, was fascinated by the outcomes and initiated the idea of piloting a program with MANNA in which MANNA would send their meals and provide nutritional counseling to their high-risk diabetes population. The pilot began in 2015, creating the need to hire an additional Dietitian to coordinate deliveries and provide nutritional counseling to these members.

By 2018, there seemed to be no limit to the possibilities at MANNA. The Health Partners Plans pilot program was so successful that it opened the doors to six additional health insurance contracts. This growth led to hiring two additional dietitians in the Nutrition Department. They demonstrated creative methods for educating clients such as creating handouts and booklets tailored to disease state, developing content for on-site cooking classes, producing mini-nutrition videos, and developing social media content. This is the same year that MANNA welcomed Dr. Jule Anne Henstenburg, also a dietitian, to lead future research opportunities at MANNA and in 2019 the MANNA Institute was born.

This National Nutrition Month® we are thankful for the leadership, research, and education that the six dietitians at MANNA provide daily at MANNA. Here’s to another 30 years!