When I was studying to be a dietitian, the role of the RD in patient care was specific. Follow the diet prescription, be quick, move on. The problem with that approach of course, is that it is ineffective. Not only does it do nothing for the patient, but it does nothing for the career stability of the dietitian. In recent years, I've had the good fortune of being able to slow down and see patients outside of the acute care facilities. I've been been able to hone active listening and motivational interviewing skills to help patients realize their own path to behavior change and improved outcomes. Thankfully, since more insurance plans are paying for Nutrition Therapy services with unlimited visits, I can make a modest income and be an effective health educator.
Follow up visits really are the key to a patient's success. Multiple visits help dietitians to help their patients find THEIR way to successful behavior change. Multiple visits help dietitians avoid the "putting patients on a diet" trap and instead lead them to a life of intuitive eating and lifelong behavior change. Multiple visits with a dietitian helps the patient by reinforcing good nutrition information, continuously evaluating appropriateness and success of goals, reducing patient's self-doubt, and breaking down barriers to behavior change. It is unrealistic to believe that Nutrition Therapy can be effective in one visit. Just as it is unrealistic to expect physical therapy and mental health therapies to be effective in one visit. It is important to the field of dietetics but also to health care in general that more value be placed on Nutrition Therapy by the public, doctors, nurses, insurance companies, etc.
Follow up visits really are the key to a patient's success. Multiple visits help dietitians to help their patients find THEIR way to successful behavior change. Multiple visits help dietitians avoid the "putting patients on a diet" trap and instead lead them to a life of intuitive eating and lifelong behavior change. Multiple visits with a dietitian helps the patient by reinforcing good nutrition information, continuously evaluating appropriateness and success of goals, reducing patient's self-doubt, and breaking down barriers to behavior change. It is unrealistic to believe that Nutrition Therapy can be effective in one visit. Just as it is unrealistic to expect physical therapy and mental health therapies to be effective in one visit. It is important to the field of dietetics but also to health care in general that more value be placed on Nutrition Therapy by the public, doctors, nurses, insurance companies, etc.
Yesterday was a great day to do what I do! During their follow up appointments yesterday, two of my patients described behaviors that were clearly intuitive eating behaviors. One patient has taken years to get there and one is three visits in. These were beautiful moments for me because that is exactly what I'd hoped to see in them! Of course, they want weight loss and better blood sugar and lipid outcomes, which they are achieving. But in order for this success to be long term, the THINKING part of eating has to change. The work these two patients have put into improving their health has gotten them to a more healthful state of mind which in turn is giving them the physical outcomes they'd hoped for. These patients have placed their trust in me to help get them there. This goes beyond counting calories, carbohydrate and fat grams. This goes beyond label reading. This goes WAY beyond the concepts of "I cheated on my diet yesterday" or "I was so good yesterday because I didn't eat any ice cream." Instead what I heard was, "There has been a chocolate cake sitting in my refrigerator this whole week and I haven't even touched it." When I asked why, he stated, "I don't know. I guess it's because I know I have permission to eat it, and I guess I decided that I really don't want it right now. I can have it another day." Can we all say BREAK THROUGH? The second patient I mentioned also had his own break through moment. "I don't know if I've ever actually felt hunger my whole life. I just ate whenever and usually ended up overeating. Now, I actually feel hungry when it's meal time. Not overly hungry, but I know it's meal time. It's a whole new thing." Some breakthroughs happen sooner than others, but if you have a patient willing to take the steps to get there, no matter how slow, then it's absolutely worth the wait. It's why I do what I do.
Dietitians/Nutritionists have great opportunities to help people overcome bad feelings about food and normalize their eating behavior, without them "dieting" per se. I might go as far as to say that dietitians/nutritionists are obligated to terminate the word "diet"' from what we do so we can stop being lumped into all the fad, ineffective, expensive, impractical, short-term weight loss programs out there. Hmmmm....I've always resisted using my Nutritionist title vs. my Dietitian title, but I may start embracing "Nutritionist" from here on out.
Dietitians/Nutritionists have great opportunities to help people overcome bad feelings about food and normalize their eating behavior, without them "dieting" per se. I might go as far as to say that dietitians/nutritionists are obligated to terminate the word "diet"' from what we do so we can stop being lumped into all the fad, ineffective, expensive, impractical, short-term weight loss programs out there. Hmmmm....I've always resisted using my Nutritionist title vs. my Dietitian title, but I may start embracing "Nutritionist" from here on out.
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