KELLY PRICE
Posted: Tuesday, January 10, 2012 10:41 am

Deciphering Food Labels for Better Diabetes Control

One in every three babies born today will be obese at some point in its life.

For Latinos, the number is one in two.

Clearly the obesity tsunami is cresting, and there is an urgent need to teach people the best choices for healthful eating.

Russell Rothman, MD, MPP,  knows this is a difficult task, especially for many Americans who cannot read or understand the ingredient labels on the foods that they choose.

Rothman, director of the Vanderbilt Center for Health Services Research and an associate professor of Internal Medicine and Pediatrics, is conducting research, funded by the American Diabetes Association and other resources, to examine the role that literacy and numeracy play in the food choices that adult and pediatric diabetes patients make.

More than 90 million Americans have poor literacy skills, and Rothman’s studies have shown that patients with diabetes and low literacy often possess a diminished understanding of their diabetes and have worse blood sugar control than the general population. Patients with low literacy and numeracy can have significant difficulties understanding food labels, and addressing literacy might become an important method to improve patient care for diabetics.

Rothman’s research has been reported nationally on CNN and in the New York Times and more than 200 other media sources. He is currently conducting research on a new educational tool kit designed by the Vanderbilt Eskind Diabetes Center to improve care for English- and Spanish-speaking patients in the local community.

Rothman is also focused on designing improved healthcare delivery and quality for children and adolescents with type 2 diabetes. His study is one of the first attempts to systematically characterize how patients comprehend nutrition labels and the relationship between patient comprehension and underlying literacy and numeracy skills. The study demonstrates that patients can have many difficulties interpreting the current design of food labels, and their performance is highly correlated with their underlying skill sets.

Even patients with higher education levels sometimes struggle to interpret the current food labels. Rothman said of particular concern are situations that involve interpretation and application of the serving size, leading to both overestimation and underestimation of the amount of nutrients consumed. Patients also struggled with understanding the ‘percent daily value’

information.

Newer low-carb products were especially difficult for patients to understand —particularly when the net carbs information was located outside of the nutrition facts panel.

Numeracy, the ability to read and interpret numbers in daily life, is an important component of overall literacy that has not been well studied. It consists of a host of skills that include not only basic computation, but also the ability to understand measurement, estimation and logic.

Paying special attention to a patient’s numeracy may be particularly important, since patients can have adequate literary skills but still have inadequate numeracy skills.

Rothman’s research shows that speaking clearly and concisely, avoiding jargon, setting realistic goals, and using low literacy-oriented materials can aid patient comprehension. Additionally, opportunities might also exist to improve comprehension of nutrition labels by improving their design.

Since June 2011, Rothman has served as director of the Vanderbilt Center for Health Services Research, which was established in 2000 by Robert Dittus, MD, MPH. The center includes more than 100 affiliated faculty and staff investigating ways to improve healthcare systems and satisfy the six criteria for patient care as established by the Institute of Medicine: to make healthcare safe, timely, effective, patient-centered, efficient and equitable.

Dittus said, “Dr. Rothman has been a tremendously successful investigator and mentor and has built a superb program in effective health communication. He has been an outstanding leader since joining Vanderbilt, and we have confidence that the center will greatly benefit from his energy, rigor and leadership.”

Rothman’s interest in improving the quality, efficiency and equity of healthcare availability is clearly reflected in his mentoring the development of new investigators as they mature into fully independent scientists.

Growing up in the New York area, Rothman recalled, “As long as I can remember, I wanted to be a physician.” In his Vanderbilt office, a framed self portrait from second grade certainly affirms that memory. The picture is captioned, “I want to be a doctor.”

After graduating cum laude from Duke with a major in zoology and a second major in political science, Rothman spent two years getting a Master of Public Policy degree from Duke’s Sanford Institute of Public Policy. He then graduated from Duke’s School of Medicine in 1996 as a Fellow in the Robert Wood Johnson Clinical Scholars Program before completing his residency in internal medicine and pediatrics.

In his roles as tenured academic, researcher, author and mentor at Vanderbilt, Rothman notes he has “walked in many shoes.” Currently, he mentors one to three students a year and writes on diabetes and health literacy in his position as deputy director of the Prevention and Control Division of the Vanderbilt Diabetes Research and Training Center.

“Health habits last a lifetime,” Rothman said. “Obesity problems often start at birth. New medications and treatments are being developed, from oral medicine to bariatrics, and I am optimistic that we might be able to get on top of this problem. And technologies … education … are really going to help us.”

Rothman and his wife, also a physician who practices general pediatrics at Vanderbilt, have two children, ages 6 and 5. He happily admitted, “My primary hobby is currently taking care of the children! My former hobbies include running, cooking, and travel.”