We talked to Gayle M. Timmerman, a researcher at the University of Texas at Austin School of Nursing about her latest research and how she contributes to the mission of TCRSS.
Gayle M. Timmerman, PhD, CNS, FNAP, FAAN is a professor and associate dean at the University of Texas at Austin School of Nursing. She is also a lead researcher for TRCSS. We talked to her about her latest research and how she contributes to the mission of TCRSS.
Until recently, Gayle Timmerman didn’t really think of herself as a self-management scientist. She is best known in the academic community and popular press for her seminal research on mindful restaurant eating in perimenopausal women who wanted to lose weight. “This research is really about guiding people through a process of behavior change. In this case, we helped study subjects learn to slow down and think about what they were eating and why they were eating it. For example, are you finishing the French fries on your plate because they taste good and you want them, or just because they happen to be sitting there?” explains Dr. Timmerman. Then, she was approached by Miyong Kim, PhD, director of TCRSS, to pilot a study on dietary self-management in chronic kidney disease (CKD) patients. “I’d never studied kidney disease—I’d always thought of myself as a food and behavior change researcher. But it occurred to me that implementing an intervention that provides study participants with tools and information they can use to make better decisions about managing their disease is about behavior change—and ultimately, a part of self-management science.” Her article appeared in the Journal of Behavioral Medicine; click the image to access the article.
Chronic kidney disease affects 31,000,000 Americans. In its early stages, it is often without symptoms, so many people are diagnosed when the disease has already caused end organ damage. It often occurs with other chronic illnesses–obesity, hypertension, and Type 2 diabetes—all of which negatively impact kidney function. “Dietary adjustments are often aimed at better managing chronic diseases that contribute to CKD. Common changes are reducing sodium and adjusting protein intake. Some patients may need to watch their potassium intake—others may not, so recommendations are not going to be the same for all,” says Dr. Timmerman. Another goal of dietary change in renal disease is to reduce wear and tear on the kidneys by limiting amount of filtered waste. For example, altering protein intake to fit body size and kidney function reduces the amount of waste processed through the renal (kidney) system. Decreasing sodium intake also lessens renal workload. It may also lower hypertension, which strains the renal vascular system.
But changing habits—dietary or otherwise—is never a straightforward process. That’s where self-management and mindfulness come in. The purpose of self-management in chronic illness is not only to educate patients, but to provide them with a sense of control and empowerment that allows them to implement changes on their own. Mindfulness is the practice of bringing one’s attention to the present moment; for the purpose ofthis study, its aim was to assist clients in dietary decision making. The two concepts naturally support each other—mindfulness supports the patient in making beneficial self-management decisions.
Dr. Timmerman collaborated with local providers and colleagues from the University of Texas at Austin’s schools of pharmacy and nutrition to devise a six-session nutritional education intervention designed for 19 early stage CKD patients. Outcome measures included weight, body mass index (BMI), eGFR (a measure of kidney function), and serum carotenoid levels (a measure of fruit and vegetable intake). The intervention had several components: information and problem-solving strategies on how to improve dietary practices, behavioral change strategies to improve self-management activities, such as reading food labels, as well as mindful eating and mindful eating meditations.
Dr. Timmerman developed the education modules and conducted the sessions herself. “Participants really seemed to enjoy the sessions—only 10 percent left the study. And the outcome measures demonstrated some positive change, particularly in terms of weight and body mass index (BMI). Nearly half of participants lost an average of 8.4 pounds, and plasma carotenoid levels reflected a significant increase in fruit and vegetable consumption.” More research is needed to determine the generalizability of the intervention, but this study is paving the way for further exploration in helping people with CKD to help themselves.