What an injured worker eats has become a talking point for workers compensation claims handlers as they explore the intersection of nutrition and injury recovery. 

Proper nutrition “is something that we identified because if there’s poor nutrition, they’re not going to recover as quickly or as well, especially if they’re having a surgery,” said Dr. Adam Seidner, Hartford, Connecticut-based chief medical officer at Hartford Financial Services Group Inc.

The discussions over nutrition branched out from worker advocacy models in workers comp — where there’s more interaction between injured workers and claims handlers on issues that may not be directly related to a claim but could affect the outcome. 

“We know that proper nutrition is a key governor of health,” said Dr. Teresa Bartlett, Troy, Michigan-based managing director, senior medical officer, at third-party administrator Sedgwick Claims Management Services Inc. It’s especially important for the aging workforce, which already faces delayed recovery, she added.

Nutrition is “one of the key factors that determines if someone will age well, if their bones are healthy, if their muscles are healthy,” she said. “We know that if you’re having a surgery, just like the fact that you shouldn’t be smoking because you won’t recover adequately, if you’re not getting proper nutrition your bones and your skin will not heal properly.” 

More recently, the issue of social determinants of health — how such factors as access to healthy food, income and education can affect health outcomes — has contributed to the discussion over nutrition. 

“It’s being looked at in a number of different ways — food insecurity, for instance,” Dr. Seidner said. “Do people understand what they should be eating? (It’s) not just portion control but the quality of food.” 

Talking about nutrition “is part of our educating them,” said Linda Summerlin, Avon, Indiana-based assistant vice president of national case management services with Gallagher Bassett Insurance Services Inc., which has a handout it provides to workers and claims handlers that provides nutrition advice. 

“Obesity is one comorbidity that leads to or contributes to other conditions, and good nutrition education is important for aiding in healing and just ensuring the overall well-being of the person,” she said.

Gallagher Bassett’s document includes a list of foods that would hinder recovery and those that would promote healing, such as proteins, which aid in building and repairing muscle, and vegetables, which contain vitamins and minerals that can speed healing. Typically, it’s when they are injured that workers are seeing such facts on nutrition and the connection to healing for the first time, Ms. Summerlin said.

Those working in the nutrition field say it’s common for people to be late in understanding the role of food in recovery, and there’s a growing interest in such factors as inflammation, a component of injury, and how food can help alleviate symptoms that lead to increased pain and delayed recovery. 

The advice is to “steer clear of processed foods because processed foods tend to cause inflammation in the body … which could actually slow down or inhibit one’s healing,” said Melissa Eboli, a nutritionist in New York who runs her own business providing meals to those in recovery.

For comp patients it’s common to talk about avoiding processed and easy-to-access fast food, especially because such high-calorie foods can lead to weight gain while a worker is in recovery — another complicating factor if the patient is not as active as he or she once was, according to Dr. Bartlett. 

“When someone is off work or they’re frequently in pain they eat foods that make them feel happy, or the comfort foods, and they’re also moving much less than they were by going to work every day, and therefore they tend to gain weight,” she said.

Irene Opoku-Acheampong, a clinical dietitian who works with patients at Atlanta-based Emory Healthcare, said a decrease in mobility causes the risk of entering “a vicious cycle” of trying to get proper nutrition when access to healthy food may be limited. 

Physically, weight gain can slow recovery and increase claims costs by “deconditioning the worker,” Dr. Bartlett said. “And, so, when they go back to the job there is a higher risk for more injury and illness because they’ve gained weight and they’re not in shape. They’re huffing and puffing and struggling to keep up with what they used to do every day.” 

Mental issues can also be at play, Ms. Opoku-Acheampong said. “If we’re not eating properly, it may lead to exacerbation of depression or anxiety, or maybe even the manifestation for someone who hasn’t had those symptoms or that diagnosis before,” she said. 

Healing at macronutrient level crucial

Macronutrients, elements in foods such as protein and vitamins that help build tissue, comprise a growing field of interest in treating patients in injury or surgery recovery. 

“When you injure any kind of tissue — hard tissue like bone or soft tissue muscles, tendons, ligaments, cartilage — your body needs nutrients to regrow itself,” said Dr. Jason Winkelmann, a naturopathic doctor and chiropractor who treats chronic pain patients at his practice True Health Natural Pain Clinic in Arvada, Colorado.

“We have really taken that (knowledge) for granted because if you break an arm, we can put a cast on it and in six weeks take the cast off and your arm is healed. We don’t think about what is going on at the biochemical level to heal those tissues. It’s protein, it’s fat, it’s vitamins and minerals that are the building blocks that your body uses from the food that you eat to heal and make new tissues when they’re damaged and injured.”

Nutritionist Beth Wyman, who works independently in Albany, New York, said focusing on protein alone is often helpful enough for some. 

“If you’ve got a torn ligament and you need to be able to rebuild that tissue … you need those amino acid building blocks in protein in order to do that. And so your protein needs go up when you’re trying to recover.” 

To add to the simplicity, New York-based nutritionist Melissa Eboli said it’s the “notion of eating the color of the rainbow; so you eat a myriad of fruits and vegetables,” in addition to protein.