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Cancer Nutrition Consortium

CNC Interview: Kathy McManus

November 18, 2019

Kathy McManus is Director of the Department of Nutrition and Director of the Dietetic Internship at the Brigham and Women’s Hospital and Director of Nutrition Services at Dana Farber Cancer Institute. In addition, she serves as the Director of Nutrition and Behavior Modification Programs for the Program for Weight Management at the Brigham.

Kathy co-authored an article published in the New England Journal of Medicine about the POUNDS (Preventing Obesity Using Novel Dietary Strategies) Lost study, of which she served as co-Investigator. She has presented her research around the globe: China, Japan, Germany, Italy, Mexico, United Kingdom and Crete.

She is a faculty member of the Harvard Medical School’s and Culinary Institute of America’s “Healthy Kitchens, Healthy Lives” program, which uses culinary experiences to bring physicians up to date on the latest advances in nutrition science. More than 2500 physicians have attended since 2007.

Q: How did you end up focusing on nutrition and behavior change?

My mother was a major influence. My father and brother both had insulin-resistant diabetes. That strongly influenced our daily lives and the meals my mother prepared for us. 

I went on to study nutrition at Simmons College as an undergraduate. After graduation, I was accepted at Brigham & Women’s, where I started with a dietetic internship and then began my clinical practice, working with coronary care patients.

Q: What’s the approach you’ve found most effective to change dietary and activity behaviors in your patients?

One of the first things I realized was that just because you have the knowledge doesn’t mean you’re actually going to make the changes necessary to get healthier. 

Instead of just handing someone a regimen, start with the question: “What matters to you, and why?” 

Once they’re involved, they are more likely to mobilize their own resources. It’s much more effective having them make the connections for themselves.

Q: How much does marketing by food companies contribute to poor dietary and habits?

Marketing by food companies contributes significantly to diet habits. In the U.S. we produce 4,000 calories a day for every man, woman and child. The food industry needs to sell these calories. 

It’s not just what we choose to eat – the production of our food needs revamping.

Q: What one piece of advice would you want every parent to follow regarding their kids’ diets?

Start cooking! Use whole, real foods. People think kids like bland foods, but if you expose them to everything grown-ups eat, they will get curious about different cultures’ foods and explore new things.

Q: What’s the best way for our society to deal with cardiometabolic disease – Type 2 diabetes, heart disease, and stroke? 

Better than focusing entirely on treatment, the focus really should be on how we can prevent development of these diseases – diseases that are actually affecting us at an even earlier age. Lifestyle is a major component to all of them. A healthy, plant-forward diet, daily physical activity, stress management, healthy bodyweight, no smoking, sleep, connection with others. All of those kinds of lifestyle pieces can help prevent and reduce instance.

Q: Does the leading health threat change for other regional or cultural populations around the world? Europe? Asia? Africa? South America?

In emerging areas of Africa and Asia, some continue to deal with malnutrition. But the rise in the incidence of obesity and type two diabetes is also is beginning to plague them, as it does in more developed countries.

Q:Our research shows a global population shift away from rural areas and into cities. What are your biggest concerns for human health as a consequence of this shift?

As people shift from rural areas into cities, they’re in contact with more processed foods and sugar-sweetened beverages. They’re relatively cheap, and more available in the cities. And then, of course, the daily activity patterns are different – there’s considerably more physical activity in rural and farm areas, and less in the city. So it’s a concern.

Q: What’s the most useful book you’ve read on bringing about behavioral change?

Savor: Mindful Eating, Mindful Life, by Thich Nhat Hanh and Lilian Cheung. It teaches how to adopt the practice of mindfulness and integrate it into eating, physical activity and many facets of daily life. 

I work with my patients a lot on decreasing “mindless eating.”

Q: What’s the most promising technological approach you’re seeing, in terms of bringing about positive behavioral change?

One of the big areas I like is self-monitoring technology: diabetic patients can now get constant blood sugar results to tweak what they’re doing. Watches and phones can track steps, stairs, and miles and so on. Those technologies support individuals in their quest to be more active, getting involved in group competitions or competing against themselves: “Hey, I’ve only got 8,000 steps today – I’d better get out and do two more.”

I also like apps that help guide with calories, point of purchase information, scanning, taking photos of food – all of that information can translate into people beginning to make better choices. 

I also think telemedicine is crucial: connecting healthcare providers and physicians to support bringing about change by serving as a coach. It also allows us to reach out to folks who may be homebound and folks in rural areas who may not have the kind of access to care that we do in in big cities.

Q: If you could instantly change one common character trait in people, what would it be?

People tend to stay safe, you know, inside the box. What’s familiar to us is comfortable. I’d say: be more explorative, more inventive.

Q: Describe an ideal day for a human from an activity and dietary perspective.

Doing something active outside that they enjoy, connected to family, friends, neighbors, or meeting someone new. Expressing gratitude for what you have, and giving back in some small way. From a diet standpoint: whole real foods prepared at home with a group of friends and family, contributing and enjoying the moment.

Q: Describe an ideal day for Kathy McManus.

All of those things I just described – it’s the same day. For me, the outside activity is running 8-10 miles.