What`s Your Care Plan?

According to the World Health Organization, an estimated 80% of heart disease, stroke and type 2 diabetes, and 40% of cancer could be avoided if common lifestyle risk factors were eliminated. When Julia Buss, RN, MS, found a 2008 study in the Journal of the American Academy of Nurse Practitioners that showed 54% of nurses are overweight or obese, she knew she had to take action.

Armed with that information, Buss set out to send an active message to the 3 million registered nurses in the United States, as well as anyone else who wants to prevent chronic health issues. She offers Your Care Plan: A Nurse's Guide to Healthy Living as a guidebook for healthy living.

Is this your first experience writing a book?

This is actually the second book I have written. My first book was a travel memoir about a trip my husband and I took where we flew a single-engine plane around the edge of the lower 48 states of the U.S. It was the trip of a lifetime and I realized how much I liked writing.

At the time, I was also working for the American Heart Association and was visiting a lot of hospitals. Subjectively I started thinking about how nurses and healthcare professionals have information about eating and living healthy, yet many of them still have some of the same issues as the rest of the general population when it comes to weight gain and health behaviors.

It prompted me to write this book for nurses--although anyone can benefit from reading it--to make them think, to make changes and to encourage them to look after themselves as well as they look after everyone else.

You indicate you wrote the book for nurses. Are there special issues they face that make it more difficult for them to eat healthy? Can other professionals, such as EMS workers, benefit from reading the book?

The book contains general advice that is useful for anyone. The No. 1 problem in a nurse's environment is shift work, which is also relatable to EMS. In some jobs it's easier to take an hour lunch break, to know when to start and finish a shift. Oftentimes, nurses work long hours and stay late. They may not take a proper break. Shift work can also correlate to sleep deprivation and stress. And in the case of nurses and EMS workers, they're coping with life and death issues, which can be emotional.

The hospital environment may not provide healthy food options either so nurses may rely on vending machines. There's also often a culture of using food as a reward. Many of these same issues relate to EMS professionals. They have the same work schedules and job-related issues such a lack of sleep, long hours and limited access to healthy food options.

How did you determine what information to include in the book?

I didn't want to include any information that science couldn't back up. However, I didn't want it to turn into a science book. It wanted to make it a reference book, something that is useful to have and to look at. I wanted readers to be able to browse through it to find things that would encourage them to make a change.

Many of my sources include organizations such as the American Heart Association, the Center for Disease Control, the USDA, the National Institutes of Health, the Mayo Clinic, the Stroke Association and the American Diabetes Association.

One of the most interesting things I found while researching the book was that not all calories are the same. It's isn't necessarily how much you eat, but also what kinds of foods you eat.

I became interested in the research of Dr. Robert Lustig, a pediatric endocrinologist at the University of California, San Francisco. He's seen a lot of obese children, even babies, and he wanted to figure out why so he studied how our bodies metabolize sugar. He theorizes how too much sugar, in the form of fructose, and too little fiber increases insulin and leads to weight gain. When you eat a carbohydrate that comes with fiber, such as an apple, it has lots of vitamins and some sugar. But if you eat a processed food with table sugar or high fructose corn syrup, it has a different kind of carbohydrate, one that is metabolized differently in your body.

More research needs to be done, but I found this theory interesting enough that I wanted to include it in the book. It was a key piece of information that was a wakeup call for me. Personally, I stopped eating foods with added sugar. I used to eat a lot of low-fat yogurt, but now I don't. I buy plain yogurt and add my own fruit. Since making that change, I've lost 20 lbs., without changing my diet in any other way. I didn't necessarily set out to lose weight, it just happened.

Your book sounds like a compilation of mainstream guidelines brought together into one place. Is this a correct assumption?

I used to work in quality improvement and I've tried to use that as a model to construct the book.

The first section encourages readers to conduct a self-assessment to determine if they have a problem. I encourage them to evaluate their eating habits, such as do they eat breakfast? Do they eat fiber? How much salt do they consume? Do they read food labels?

The next section includes health-related issues such tobacco and alcohol use and activity levels. I also discuss the main problems associated with obesity, inactivity, smoking and alcohol use.

I think one of the most interesting sections of the book is the guidelines and bottom lines section. Sometimes we hear about certain guidelines but we don't know what they mean, such as how much salt is too much? Where do you get salt from? How do you avoid it? I wanted to make the guidelines practical so readers know how to eat and how to shop to meet those guidelines.

I've also incorporated a "take-action" section where I've included suggestions, such as those from the National Weight Control Registry. They've looked at people with long-term weight loss to see what has worked for them. This section is intended as a quality improvement process for individuals to encourage them to start with a small change and gradually build upon it see what works for them.

Environment is also a big factor in how we eat so I've written some about that, too, to encourage readers to be advocates for change in their work places and communities. I took all the photographs in the book, many of them taken at farmers' markets. Farmers' markets are growing in popularity, which is great so more people have access to fresh food that is locally grown. One of the problems we've had is that food production became mass production. The kinds of foods we were eating had less fiber and more sugar and were overall less healthy for us. The foods that were more nutritious became less accessible so even if someone had good intentions, it wasn't always easy to eat healthy.

At the end of the book I've included some simple, easy recipes that promote healthy eating. My book is about encouraging people to change their habits and environments and to look after themselves. Stop and think about all the factors in your life and see what ones you can change. Do it slowly. It's a lifestyle, a long-term project. It's about gradually making small changes and turning them into habits.

Julia Buss trained to be a nurse in London and earned a master's degree in health policy from the University of California, San Francisco. Now a registered nurse in California, she also has a bachelor's degree in literature from Brown University and regularly writes online health articles. For more information, visit www.yourcareplan.org.