Marisa Silver is a dietetic intern at NYU Langone Health and a master’s candidate in the Nutrition and Dietetics program at NYU Steinhardt. She decided to attend graduate school after working in corporate communications. We spoke to her about her recent work in nutrition clinical practice and her passion for incorporating nutritional guidance into the treatment plan of some of the most prevalent health issues facing society.
Where are you working now and what are you learning?
I'm currently doing my clinical rotations at NYU Langone. My first month of clinical rotations was in surgery and rehabilitation at Langone Orthopedic Hospital. There, I learned a lot (you truly learn so much by doing!), such as how to educate patients about the importance of fluid and protein intake for healing after surgeries for brain cancer or hip/knee replacements. It has also been interesting to learn how to help post-stroke patients who need modified consistency diets (blended, pureed, etc.) due to chewing and swallowing issues. We learn how to assess for and then help address a wide range of complex nutrition-related problems, including vitamin deficiencies, inadequate fluid intake and malnutrition.
I also completed rotations in food service, where I learned what it takes to get meals to patients and hospital visitors, including purchasing, production, patient services, retail, sanitation, and overall management of food service operations. I think we really don’t realize how important and complex food service is at a hospital, since it is done behind the scenes. One of my challenges was to develop a recipe that would comply with a wide range of diets for patients with different needs (soft diets, heart healthy, renal, etc.), and make it look appealing and taste good for patients while considering costs, safety, and other factors. This really opened my eyes to how complicated it is to provide quality food to people with a variety of medical issues.
Before beginning my clinical rotations, I had an amazing experience completing my community service rotation at the Center for Discovery in upstate New York. Located on 1,500 acres of land, the Center is a multidisciplinary facility to help children and adults with complex conditions, such as autism. Residents live on acres of biodynamic farmland, and work with staff to farm and produce locally grown food, which they then eat. (This is known as the “seed to belly” approach). It was incredible to see firsthand that food truly is medicine, that it can be therapeutic and healing for people with complicated behavioral and medical conditions.
Research has shown that eating together can help with maintaining a healthy weight, less disordered eating, reduce depression and substance abuse, and can even help build self-esteem.
How did working for biotechnology companies influence your desire to pursue a degree in clinical nutrition at NYU?
During my previous career, I translated breaking pharmaceutical scientific data results into language suitable for general audiences. In the journals where these data were published, I often came across studies about how nutrition therapy improved the lives of people with serious diseases. I was intrigued by the subject matter and started voraciously reading outside of work about topics ranging from the effectiveness of dietary interventions for people with cancer to recommendations about malnutrition in the context of chronic illness. I often found myself up late at night questioning research methods and limitations in conflicting clinical nutrition data results. I was hooked.
As my interest in nutrition grew, I began to notice a trend at work. When preparing patients who benefitted from our clients’ therapies to share their stories with external audiences, I found that they knew very little about incorporating a healthy diet into disease management. During this time, I felt that my profession limited me from directly impacting patient care. In summer 2017, I decided to leave the biotechnology industry and return to school to pursue, what is clearly my passion, clinical nutrition. From there, I began volunteering at a hospital and taking course work and applied to the master’s program at NYU.
Can you share a little bit about your interest in working with patients who have chronic conditions?
While in healthcare corporate communications, I had the opportunity to work with patients struggling with chronic illness, to help tell their stories through speaking events and media interviews. I distinctly remember working with a 23-year old with severe atopic dermatitis, an inflammatory disease with such unbearable symptoms that some patients take their own lives. I watched him order fried mozzarella balls and fries, staples in his diet.
Afterward, I casually asked, “Did you receive nutrition counseling during your treatment?”
“Nope,” he answered.
I hid how much it bothered me, particularly because of my past experiences with patients who had poor diets. Since then, I’ve worked more directly with patients struggling with heart disease and obesity by volunteering at both New York-Presbyterian (NYP) and the Comprehensive Weight Control Center at Weill Cornell Medicine (CWCC). People struggling with chronic illness have complex challenges, including the need for education and help with eating food that can truly improve their lives. These experiences have emboldened my commitment to the field and have driven my curiosity to learn more about nutrition therapy for chronic illness.
How can nutritional counseling help people with medical issues?
The possibilities are endless. A small amount of weight loss could improve health outcomes in someone struggling with obesity and other comorbidities such as heart disease and diabetes. A diet of nutrient-dense small, frequent meals could help a cancer patient undergoing chemotherapy with unbearable side effects. It is important to listen, understand the person and his/her needs to figure out how to help with diet. If an ill patient is not eating, we need to figure out the root cause and strategize about how to help. At the hospital, I’ve helped patients on tube feeds progress in their diets so that they are able to tolerate solid foods again. It is rewarding to see a family thrilled that their loved one is able to eat again.
It was incredible to see firsthand that food truly is medicine, that it can be therapeutic and healing for people with complicated behavioral and medical conditions.
Can you share some highlights of your student experience in our Department of Nutrition and Food Studies?
I have taken advantage of many unique opportunities NYU has offered, including a summer Nutrition and Food Studies course abroad in Israel led by Lisa Sasson. Taking a nutrition course abroad is a way to study a different pattern of eating. In New York City (and most of America) where efficiency, convenience and speed are valued, on-the-go eating and fast-casual dining are mainstream and a way of life. Even in the bustling city of Tel Aviv, things were different, and taking time to enjoy a meal with people was common.
Israelis are shaped by their complicated history to become an independent nation while facing adversity and other complex challenges. This became clear through my interactions with people passionate about building community and working to preserve and advance Israeli heritage and the wellbeing of its people. Sitting around the table and sharing food with others is integral to Israeli culture and lifestyle. I experience the Israeli way of sharing meals (such as at a gathering during Shabbat or at a Kibbutz), which has many known health and social benefits that are important not only for an individual, but also for the wellbeing, productivity and future of a greater community. Research has shown that eating together can help with maintaining a healthy weight, less disordered eating, reduce depression and substance abuse, and can even help build self-esteem.
During the course, we were able to visit the Holocaust museum, Yad Vashem, which has special meaning to me. My husband’s grandfather is a Holocaust survivor and the family who rescued him has a memorial at the museum. Our guide, quite familiar with his story, gave our group a special tour of the museum, intertwining his personal story with the history of the Holocaust. He told us how those suffering in concentration camps used food to lift their spirits, sharing recipes and imagining meals they once enjoyed. It was moving and emotional, and showed us the power of food has in the human experience.