WHAT TO EXPECT IN WORKING WITH AN ANTI-DIET DIETITIAN

As a dietitian I receive all sorts of first-impression comments when I share what I do. Most of the initial questions and comments come from the assumption that dietitians put clients on a diet, tell them to watch their weight, and they must eat a variety of fruits and vegetables while avoiding processed foods– end of story. Yet there is SO MUCH MORE to what a dietitian does and the advice we give. And believe it or not, we are humans too. We as dietitians, especially weight neutral, anti-diet focused, realize that all individuals are unique, and it’s important to create a safe space around discussing food and all that encompasses the topic. We are trained to provide evidenced-based nutrition advice through motivational interviewing and building rapport with clients, not insinuating a person is bad for how and what he or she eats.

WHY ALL DIETITIANS ARE NUTRITIONISTS, BUT NOT ALL NUTRITIONISTS ARE DIETITIANS

To further explain the role of a dietitian, I’d like to include a brief explanation on the training we receive and why we are qualified nutrition experts who work in various levels of care to treat chronic conditions through food and beverage changes. Dietitians are nutritionists, but not all nutritionists are dietitians. Dietitians are trained to provide specific health and wellness education regarding eating habits, exercise, and food-drug interaction; to develop individualized meal plans for their patients to help them better meet their nutritional needs; and can hold roles in the clinical, food service, research, or community setting. The credential for dietitians is RD or RDN, meaning registered dietitian or registered dietitian-nutritionist, and are interchangeable. This recognizes that the registered dietitian exam has been passed and all requirements have been met to be accredited nationally. Many dietitians will have the follow-up credential LD or LDN, for licensed dietitian or licensed dietitian-nutritionist, meaning the individual is licensed in a specific state(s) in which they practice– and this all depends on state protocols whether state licensure is necessary. Many dietitians hold an optional masters degree, not necessarily in nutrition, and will be required to achieve the RD/RDN credential starting in 2024. There are other credentials a dietitian can hold that highlight an individual’s expertise in the area of dietetics he or she has specialized in.

WHAT TO EXPECT WHEN WORKING WITH A DIETITIAN: CLINICAL DIETITIAN

Dietitians support many populations, varying in degree from one-on-one client coaching in the private practice setting to working with a group as part of a larger organization. Again, dietitians can provide nutrition education within four different roles. Here the focus will be on dietitians supporting clients in the clinical setting, such as when a patient/client is referred to a dietitian by another health care provider. Dietitians are trained to provide medical nutrition therapy (MNT) and incorporate nutrition goals and interventions for the following, but not limited to, conditions:

• Diabetes management, type 1 and type 2
• heart disease
• Hypertension (high blood pressure)
• bariatrics and weight management
• food intolerances, sensitivities, and allergies
• Nutritional deficiencies
• Irritable Bowel Syndrome (IBS)
• Irritable Bowel Disease (IBD)
• Crohn's disease
• Ulcerative Colitis
• eating disorders and disordered eating

The first session typically will last 60-90 minutes for the dietitian to gain as much history as possible. Questions may be asked about food likes and dislikes, daily food/beverage intake, any allergies or food intolerances, or foods specifically avoided due to a concern of an intolerance; frequency of cooking vs ordering takeout, shopping experiences, financial stability to access an adequate amount (in variety and quantity) of food, current medications and dietary supplements, gastrointestinal health and symptoms, medical and mental health history, current and past anthropometrics, the individual’s short and long term goals in working with a dietitian, and more. Follow up sessions with clinical dietitians in the outpatient setting are typically 30-60 minutes in length, weekly to start, and eventually transition to biweekly then monthly as a client’s nutrition goals and interventions are met. In the hospital setting and program levels in between, these sessions could be more than 1x per week and include nutrition educational groups, parenteral nutrition or enteral nutrition, treatment team meetings, etc. as part of the programming. Goals are meant to be timely, measurable, realistic, attainable, and specific to the client– also created by the client with help of the dietitian. Interventions could be assignments, designated ways to adjust one’s eating and lifestyle behaviors, using food logs to track success during the week or something to discuss in follow up sessions, etc. that support achieving set goals.

DEBUNKING MYTHS ABOUT WORKING WITH A DIETITIAN

A common misconception is that sessions with a dietitian will involve judgment, such as scolding someone for not eating the right way, or insinuating that he or she is eating too much and needs to cut back, or tell the individual that the foods he/she loves should be cut out immediately. Yet this is not how we as healthcare providers are trained to administer MNT. (If this has been a personal experience for you, I can only express my sympathy and hope you will give dietitians another chance.) We are trained to build rapport with our clients and provide recommendations to encourage health for the individual. We are trained that ALL macronutrients and micronutrients, each in varying amounts, help our bodies function– so clearly we have the skills to create specific food/beverage recommendations to incorporate unique client likes and dislikes. And we are trained to create meal plans for populations that may need to track or consume a specific nutrient sparingly, such as in Celiac’s disease or Diabetes care. As dietitians, we are passionate about what we do and want to help, are trained to listen, and try to create a safe space for discussing nutrition concerns. In terms of the word “dietitian”, this does not mean that the ultimate goal will include “dieting” interventions. (Here I will use the word diet or dieting as a general explanation for restrictive eating habits focused on changing one’s body, weight, shape or size. The term diet could also stand for specific eating habits related to ethical, cultural, moral, religious, food allergy, or disease needs, not at all associated with wanting to lose weight.) Yes, in our culture this may many times be a long term or short term goal for a client, and the dietitian will create interventions in support of this goal. These are typically providers that advertise, among others, “weight loss” or “weight management”, “bariatrics”, or “obesity prevention” as their areas of expertise. However, not all dietitians practice with this intent. Another approach involves an anti-diet, Health at Every Size, weight-neutral focus. These dietitians see the harm that weight fluctuations and weight stigma inflicts, so support their clients in creating health-enhancing lifestyle changes through nutrition, body neutrality and body respect, and joyful movement.

MORE ABOUT: WHAT TO EXPECT IN WORKING WITH A ANTI-DIET DIETITIAN

We at Enhance Nutrition fully support that everyone is individualized, and that nutrition goals and interventions must be tailored to the person with this in mind. We are just one of many dietetics practices that make up this anti-diet registered dietitian community. Many of us in this community are intuitive eating counselors, trained to support our clients in working through its 10 principles and develop a healthy relationship with food and their bodies. Many of us have lived our own experiences with diet culture telling us we are not good enough unless we change the way we look or eat to fit specific societal standards, but came to realize its fallacy. Or we may have just stumbled upon this anti-diet community out of chance and found it life changing. The important point is that anti-diet dietitians are trained, plus some, to create a safe space to discuss food, body concerns, and joyful movement. Anti-diet dietitians will call out diet culture by, first, debunking the misconceptions that being in a larger body– falling within a higher BMI category– does not equal poor health, cause chronic diseases, or increase the risk of early mortality; second, help their clients make the connection that a person’s weight or shape does not define them, and someone is not good or bad based on what they eat; and third, make the connection that weight stigma in itself is oppressive, discriminatory, and leads to societal biases that can show up within healthcare, the workplace, or one’s home environment. In working with an anti-diet dietitian, a client can expect to learn and create changes in the following areas of their life:

• How to take control of their eating habits through eating enough– this includes enough in terms of both a variety and quantity of food.
• Gentle nutrition concepts and how to incorporate all the food groups in an enjoyable, life-enhancing balance.
• How to break free of the diet cycle and eliminate hyperfixation on how to eat, what to eat, how much to weigh vs spiraling through numerous pre-constructed, one-size-fits-all plans The importance of getting rid of number fixation: calorie counting, macronutrient tracking, frequent weighing.
• The biological, psychological, social, and emotional harms of dieting and the restrict-binge (undereating-overeating) cycle.
• How to enjoy food again in all food related situations.
• Why this approach applies to all populations: any size, any race, any gender, any disease state

NEXT STEPS: HOW TO FIND AN ANTI-DIET REGISTERED DIETITIAN

Intrigued? Start by searching for a provider that highlights anti-diet, weight neutral messages on their platforms. Ways to find an anti-diet dietitian through online searches: look for terms such as health at every size (or HAES-aligned), anti-diet, intuitive eating, and weight-neutral. On social media, anti-diet healthcare providers will sport hashtags such as #dietssuck, #HAES, #antidietdietitian, #disorderedeatingrecovery, #makingpeacewithfood and #allfoodsaregoodfoods. Red flag terminology that is not supportive of an anti-diet approach includes weight management, weight loss, or highlights of specific diets. Social media spaces and websites promising this will finally be a successful diet, the last approach necessary to loose the weight for good, are tempting, but like the diets before are not promoting a weight neutral, life enhancing approach. Also be skeptical if there is one or multiple of the red flag terms coinciding with making peace with food. It’s not possible to find food freedom and body neutrality while also inflicting more food rules and focusing on loosing weight— this keeps an individual further stuck in the restrict-binge, hyperfixation on food cycle. Once an anti-diet dietitian sparks your interest, request an initial 5-15 minute consult call to assess if it will be a good fit for you and the provider as a team. It’s important to find a dietitian that will not only meet you where you are at in your relationship with food, but make sure to push them to be the best version of yourself. Most anti-diet outpatient dietitians will make room in their schedule for these inquiries, so just ask!