Anne-Julie Tessier: “Beware of self-treating and promote self-management instead”

Technologies can gamify the experience to encourage patients to adhere to healthy eating recommendations or for participants to comply with a research protocol. One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in […]

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Technologies can gamify the experience to encourage patients to adhere to healthy eating recommendations or for participants to comply with a research protocol.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewingAnne-Julie Tessier.

Anne-Julie is a registered dietitian and Ph.D. candidate in human nutrition at McGill University. Her research focuses on nutritional epidemiology, more specifically the interplay between nutrition, muscle mass, physical performance, and cognitive function. She is the co-founder of Keenoa, an intelligent mobile food diary created exclusively for dietitians and nutrition researchers. Their mission is to create cutting-edge technologies to elevate dietetics practice and nutrition research.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

I graduated with an undergraduate degree in dietetics from McGill University in Quebec, Canada. After graduating and becoming a registered dietitian, I didn’t know exactly what career path I wanted to take and I decided to further my knowledge by enrolling in a master’s program in human nutrition.

Pursuing my master’s in human nutrition, I uncovered an untapped passion for nutritional epidemiology and surprisingly, statistics. To continue my studies in human nutrition, I decided to fast-track my program and pursue a Ph.D. in human nutrition with a research focus on the role nutrition has in muscle mass, physical performance, and cognitive function.

Can you share the most interesting story that happened to you since you began your career?

My most interesting story probably has to be how I founded a technology start-up, Keenoa, while pursuing my Ph.D. in human nutrition.

The inspiration for Keenoa originates from how dietitians must understand the eating habits of their patients to help them reach their goals. Throughout my undergraduate degree in dietetics, I began to realize that the dietary assessment tools available and taught to us were time-consuming, inefficient, and not the most accurate.

We were taught to use lengthy, pen and paper approaches such as food journals, questionnaires, and interviews. Although essential to our practice, I found these methods wasted a lot of valuable consultation time and made it challenging to effectively pinpoint nutritional aspects to improve in a patients’ diet. As I spent most of the time calculating nutrition intake by hand, I knew that as dietitians we could do better for our patients.

When I was collecting nutrition data for my thesis project, my frustration only grew towards these pen and paper methods of dietary assessment. Now not only did I see how they may compromise patient care, but also the quality of data collection in nutrition research.

So, while pursuing my Ph.D. in human nutrition I decided to validate the concept for an intelligent mobile application that could recognize food items using a smartphone camera. My co-founder Anthony and I took a road trip to Harvard University to attend a Hackathon event to test our concept. Since then, the concept has come a long way and is now known as Keenoa, a smart mobile food diary powered by artificial intelligence and is used by tens of thousands of patients across North America and Europe.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Love what you do, do what you love

I love studying and working in the field of nutrition and it has become a true passion of mine. Nutrition is not only a driving force behind my ambitions and accomplishments but also a core lifestyle factor that can improve the lives of many. I strongly believe that health starts with prevention, and nutrition plays an enormous role in how that can be achieved.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

When I had the idea for Keenoa, I knew I had the right nutritional knowledge as a dietitian to conceptualize the food diary but, as in any business, complementary skills are crucial and we needed software development. I am grateful for my life and business partner and software engineer, Anthony Garant with whom I co-founded Keenoa. Together, we combined our professional passions to bring our product to market.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

One of the main benefits of having the patient in front of you is the ease of fostering the human connection required for a successful nutrition consultation. Nutrition can be a very personal topic as it extends beyond calories or nutrients and dives into an individual’s food culture, budget, preferences, hesitations, and medical history.

As both humans and nutrition professionals, we know how to best develop this relationship in person as it is how we were trained and also how we learned to socialize growing up. For example, in-person interviews provide us with more non-verbal communication cues, such as eye contact and body language. While subtle, these cues are paramount to helping both dietitians and nutrition researchers adapt their interview to best meet the needs of the patient, rewarding both the patient with a better nutrition plan and the practitioner with more insightful data.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

One of the challenges when the patient is not in the same space as you is the reliance on self-reported data for measurements like height, weight and waist-circumference. Since scales are not calibrated and the way one patient takes their measurements compared to another may not be consistent, these measurements can be less accurate versus if they were taken by a professional.

Sometimes, another challenge that can arise is overusing these measurement tools at home. While these metrics are helpful for dietitians to perform their assessment, having scales and measuring tapes at home may tempt patients to weigh and measure themselves more frequently. For example, instead of being weighed once every few months in the office, they may be tempted to weigh themselves multiple times per week and potentially risk the development of unhealthy habits towards their weight.

Another challenge for both patients and practitioners is the use of food tracking mobile applications created for the general public. Both parties should be aware that many of these apps are created with little to no healthcare professional input. Consequently, they can distort what a “healthy diet” really is, often blurring the lines between calories consumed and diet quality. These apps are also usually based on user-generated data, meaning the nutrition analysis is not very accurate as anyone in the world can decide how many grams of protein are in peanut butter or how many milligrams of calcium are in a glass of milk.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)

  1. Establish a human connection in the virtual world

A human connection is the most basic, important foundation for a successful lifestyle change or compliance to a research protocol. Find a way to blend your human touch with the virtual world, and know that no telehealth platform or application should entirely replace the patient-practitioner relationship.

For example, dietitians can take advantage of being able to virtually visit their client’s kitchens and pantries during virtual consultations, something that would otherwise be impossible in person. In this context, an app like Keenoa lets dietitians and researchers view photos of foods their patients are eating and their associated nutritional composition instantly, something that has never been possible with previous dietary assessment methods.

2. Make nutrition technology fun & engaging for your patients

Technologies can gamify the experience to encourage patients to adhere to healthy eating recommendations or for participants to comply with a research protocol.

To do this, try finding an application that doesn’t just have great reviews from practitioners, but from their patients. An easy way to do this is to read through Google, Apple Store or Google Play Store reviews. These reviews come directly from the patients and provide a good indicator as to how they will perform with your own patients.

3. Beware of self-treating and promote self-management instead.

Self-treating is when a patient makes a decision about their nutritional status without the guidance of a healthcare professional. When using technology with your patients, beware of patients using applications that provide too much nutrition information or set weight-loss goals for the patients. For example, some applications have been reported to suggest a “safe” weight-loss of up to 10 pounds per week, a target that professionals would agree to be dangerous and unrealistic.

If a patient is interested in using a mobile application to track their eating habits, try finding a mobile application that can be used under the supervision of a dietitian. This professional guidance is when technology changes from self-treating to self-management, empowering the patient with the confidence and ability to reach their nutritional objectives.

4. Use the right mobile tools for staying connected

Let’s pretend we are conducting a study in which we ask patients to consume a specific amount of carbohydrates every day. Before technology, we would have to rely on memory-based, lengthy questionnaires or pen and paper diaries to approximate carbohydrate intake. Now, we have mobile applications where patients can take a photo every time they eat and the carbohydrate intake (alongside many other nutrients) is accessible by the nutrition researcher in real-time.

The researcher can then monitor compliance with the protocol and send a quick message to the patient through the mobile app if they forget a meal or to clarify portion sizes. Tools like these can be truly revolutionary when it comes to assessing dietary intake as it allows the nutrition researcher to access higher quality data with less burden on the patient and the researcher.

5. Take advantage of the geographical flexibility technology has to offer

Instead of being able to only serve patients within a certain range of a physical clinic or office space, we can now see patients anywhere insurance will cover. This geographical flexibility means that patients have a wider range of care to choose from and can participate in research studies they would otherwise not have access to. This is especially true for rural areas, where technology can lower their barriers to access care and enroll in cutting-edge research.

In the world of nutrition research, technology and its geographical flexibility could help improve the generalizability of results. Generalizability means to what extent the results of a study with a certain sample size will apply to the rest of the population. In other words, it makes the findings more helpful for everyday people.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

When the pandemic started to unroll in March, my research team and I heard many reports of how the lockdown was impacting eating habits. Whether it was baking more, eating snack foods, or eating healthy home-cooked meals, we wanted to investigate these eating changes as they were happening. Our challenge was that we knew our entire research team and participants had to be 100% virtual due to public health measures.

We got the pan-Canadian COVIDiet study up and running within two months, and throughout the summer we were able to recruit 2000 individuals to track their food intake using Keenoa. Without ever meeting face-to-face, we analyzed thousands of food journals and now have nutrition data that informs public health.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

It’s important to have access to virtual video conferencing software, electronic medical records, and a method of dietary assessment that’s easy for your patients to complete. It’s also advisable to make sure that all the virtual platforms you are using have a high level of security to protect patient privacy.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

I think it would be very interesting to be able to integrate the data collected by the Apple and Google Health applications to complement the data from telehealth platforms. Sharing this personal health data may help health care professionals have a more holistic view of the patients and help researchers make data collection more efficient.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Health care professionals and researchers are trained to always put their patients first. This means that even if they are not in the same space as you, they adapted their services to best meet your needs and to help you achieve your goals. I’m also optimistic that the rise of digital health and telehealth will help not just approximate, but improve outcomes compared to traditional in-office visits especially with added technologies like artificial-intelligence.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

All these technologies are certainly exciting for the team and I at Keenoa. As technology evolves, we are always integrating state-of-the-art technology to make sure that our tools stay relevant and innovative to improve the health of the population.

Is there a part of this future vision that concerns you? Can you explain?

I believe that the human connection needs to stay at the core of telehealth, dietetics practice, and nutrition research. Some mobile applications and artificial intelligence-based technology may try to replace dietitians, eroding the human connection.

Moreover, there are no guarantees that new technologies will be trained by dietitians and nutrition researchers. This could risk poor nutrition advice and misinformation guiding the general population.

Ultimately, we want to ensure that any new technologies used to give nutrition advice to the general public lie in the hands of dietitians and nutrition researchers, the only nutrition experts.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

For any dietitians or nutrition researchers out there, we need to leverage technology and not fear innovation. Adapting to new technologies including artificial intelligence is essential to improve the quality of nutritional data collected and meet the demands of our patients. Using these technologies enables us to amplify our evidence-based nutrition messages, helping us to improve the health of the population through food and nutrition.

How can our readers further follow your work online?

Feel free to check out and follow us on social media @keenoanutrition on Facebook, Instagram and LinkedIn!

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.

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