FITNESS : Making Nutritional House Calls : Registered Dietitian and Psychiatric Technician Designs and Then Supervises Programs in the Homes of Clients

When Bea Shapiro of San Juan Capistrano decided she wanted to learn more about proper nutrition, she could have simply gone out and bought a book.

But that would not have taken her aisle-by-aisle through her neighborhood supermarket, learning to decode labels for hidden fat. Nor could a book come to her door with a basket of fresh-baked muffins, or listen to her complaints on discouraging days. For that, she needed Lori Gelgur.

Gelgur is a personal nutrition consultant. A registered dietitian as well as a licensed psychiatric technician, she travels to her clients’ homes and offices to see them through dietary and fitness programs customized for their particular health needs, lifestyles and personalities, among other factors.

“One of the drawbacks with diet programs that use prepackaged foods is that you have to do it their way,” Gelgur says. “There’s no flexibility, no alternative. For some people that works, but not others. I try to come up with something they can live with, and to do that I have to work around the way they live.”

Although the underlying basics are the same for everyone--cut down on fat, eat more complex carbohydrates, get regular aerobic exercise--the actual implementation of those changes is different for each client. For some, it may take the form of cooking lessons, learning to steam vegetables or prepare creative potato and pasta dishes.

“But if you have someone who travels a lot or doesn’t even have many pots and pans in their kitchen, that approach won’t work,” Gelgur says. “We may need to concentrate more on how to order healthy choices from a restaurant menu.”

For that purpose, Gelgur has collected menus from an assortment of area restaurants, and she allows her clients to rehearse--and make mistakes--with her before going out on their own.

“On the other hand, if I were working with a client who was a housewife with a family, I would need to be familiar not only with her food habits and food preferences but her family’s as well,” Gelgur says.

Making house calls allows Gelgur to deal with her clients in context. She meets their families, checks out their kitchens, even goes through their cupboards, if they want.

“Typically, we sit together at the kitchen table, and as we talk about certain foods, it’s easy for them to go get things out of the cupboard or the refrigerator and ask me about them.”

Going through the recipe box is one of Gelgur’s favorite pastimes. She likes taking a traditional family recipe and adapting it, either by changing the cooking technique or by reducing, eliminating or substituting ingredients. She often takes recipes back to her Laguna Beach home and experiments with them before presenting her client with a revised version.

And if there are certain foods, from Grandma’s double-chocolate cake to designer ice cream, that the client doesn’t want to give up completely, Gelgur doesn’t insist.

“The most important thing is for (the program) to be realistic, something they can live with. Deviating from the plan is still part of the program. You really can eat anything you want so long as the portions are reasonable.”

Another advantage to visiting clients in their homes, Gelgur says, is that “people don’t cancel their appointments or not show up. I’ve been doing this since last July, and only once has a client not shown up for an appointment.”

Shapiro, who has lost 20 pounds with Gelgur’s help, says, “I really like it that I don’t have to drive anywhere to meet with her.”

“I plan to stick with her for another 10 (pounds),” she says. “I don’t feel like I’m dieting. I’m learning how to eat differently, that’s all. And I’m not starving. If I’m hungry, I can find something. I’m not deprived.”

Gelgur also takes her clients on field trips to the supermarket, pointing out the best and worst choices, answering their questions about the nutritional value of the foods they usually buy.

“There are so many simple things I learned from that,” Shapiro says. “Tomato paste, for example. Lori pointed out that it’s much lower in sodium than tomato sauce, so now I buy the paste instead.”

Shapiro says one of the most important services Gelgur provides is that “she listens to me, even when I complain. She always tries to make you feel good.”

Gelgur says her training in psychology comes in handy for that.

“After I became a dietitian 12 years ago, I realized that eating is so complex, I needed more training to understand the reasons people overeat. So I went back to school and got a license as a psychiatric technician. Then I worked with eating-disorder patients in a hospital setting for awhile.”

Gelgur visits Shapiro once a week for an hour, but each client has an individualized schedule. For some, it may mean three intense visits and nothing more, while others prefer to see her regularly for up to several months. Some clients are referred by doctors for weight loss or specialized diets for pregnancy, allergies or chronic illnesses such as diabetes, while others sign up on their own.

Even with custom-designed programs, there is some advice Gelgur gives all her clients:

* “Don’t expect perfection. We all slip up once in awhile. Give yourself credit for the progress you’ve made. Be patient with yourself and avoid self-recrimination. Harsh discipline on ourselves does not make us reach our goals any quicker. In fact, probably the opposite is true.

* “Focus only on what you can achieve today.

* “Try to exercise at least 30 minutes a day. This will not only speed up weight loss and help keep it from coming back, but it will make you feel good about yourself.

* “Remember that a realistic weight-loss program should be a life commitment, not a temporary change.”