If you’re a health professional, particularly one who may talk about different ways of eating – I’m specifically talking about Doctors, Dietitians, Naturopaths, Nutritionists, anyone who may find themselves in a position of offering nutrition advice or counselling, you may wonder why it is that people respond so differently to undertaking seemingly similar dietary modifications. Why is it that some people can make certain changes (such as reducing, increasing, or eliminating a food, food group or nutrient – any dietary modification at all) and others just find it impossible? It’s not about the diet (although it is, in some circumstances!). It’s probably not about you, I’m sure you’re really supportive! It’s about the very important lived experience of the person in front of you. Someone who has struggled in their relationship with food, eating and their body is going to be a very different recipient of your well-intentioned suggestions compared to someone who has never restricted their eating, has a very “practical, no-fuss” attitude to food or has enjoyed a positive body image. Just the “feeling” of restriction (or impending restriction) can be a living hell for people who have experienced trauma, have been restricted of food during childhood or who have engaged in repetitive episodes of restrictive eating.
Let’s be clear. It’s highly likely that you make recommendations that you don’t intend to come across as a diet, or restriction, or making life difficult for your patient. It’s just that that’s possibly not how they hear it, or experience it. “My Doctor/Dietitian/Specialist says” holds significant importance, and what we say matters. Intention does not equal impact, particularly where dietary matters lie.
When discussing a certain dietary school of thought, or program that you feel may benefit your patient, it’s fine to refer to “evidence says” but please remember the human in front of you – and that “evidence” does not adequately cover for things like eating disorder attitudes or symptomology. Or, often, long term outcomes (5 years or more). You may have had some personal “success” in eating a certain way, and be keen to share that information, but you are not your patient. You may have attended a conference, symposium or workshop which presented different management strategies but again, your skill lies in the what, when, how and why you may share that information.
In other words,
WHAT of the information would be wise to share
WHEN might be good to share this (is it right now?)
HOW would be best to communicate this information?
WHY would this patient benefit from knowing this information?
Assessment is everything
You may have 15 minutes or less. And in this time, you’ll have to gather a lot of information, process it and offer some guidance, support, feedback or advice. Yikes. But if you’re going to offer dietary advice, please always assess for previous dieting, weight loss attempts, disordered eating and eating disorders. You could do a test (eg. the EDEQ-S) but if you’ve got limited time, you’re probably better off just asking a few questions. Like, have you tried to change your diet in the past? Have you ever had an eating disorder? How do you feel about your body?
If your patient has EVER had an eating disorder, even if it’s many years ago, please remember that discussing dietary changes for whatever reason (even for medical reasons) is a life-long vulnerability. No one just has a “little bit of an eating disorder” – it ranges from a hideous but brief experience, to a debilitating, life-crippling illness that can last many years, even a lifetime. Take care discussing any dietary changes by referring to a specialist Eating Disorder Dietitian (even if it’s far back in the patients history) because they will understand this vulnerability and be able to navigate it with the care your patient deserves.
If your patient has a history of weight loss dieting, be aware that they are very likely to take your advice, however well intentioned, and turn it into another weight loss diet (it’s even got a name…”diet mentality”). What I mean by this is that they’re likely not to view it as a long-term endeavour, but as something they are either “on” or “off”, they’re more likely to get caught up in viewing success by numbers, rather than the myriad of other measures of health or wellbeing, more likely to go hard, then drop it all together, more likely to blame themselves if they don’t get the “results” they feel they should, less likely to be truthful with you if things are going as planned (due to feeling embarrassed or ashamed), and less likely to present for follow up if they feel that they haven’t “followed” the diet as you’ve asked. All very much a problem when it comes to optimal wellbeing.
Know your patient.
Nothing replaces the relationship you have with your patient and what you know about them that extends beyond your practice room. You care, that’s why you do what you do. And caring includes taking best care when offering dietary advice to your patient, and making sure that you’re not putting them at risk of harm (remembering that just the feeling of “I’m not supposed to eat that” can be very difficult for many people).
The good news is that there is a do-no-harm approach that can support your patients understand how they may (if they wish) pursue improved wellbeing without getting caught up in what may feel to them like just another diet. A Non Diet Approach Dietitian can support your patient in making individualised adjustments that is most suitable for them. These specialist Dietitians are specifically trained to conduct thorough assessments & support people with engaging in behavioural changes to optimise physical and mental wellbeing. We all care, and this way we can help people, without harming them.