On a regular basis I see patients who range in age from toddlers to seniors, and for a variety of health and nutrition reasons. A repeating theme in appointments lately has been "negative food relationships". It worries me..... to say the least. What is it that we are doing in our society and among our family/peer groups to cause such disordered eating and what can be done to reverse the negative effects?
One morning I had a sixty-something year old female in for follow up and we were working together to determine what drives her negative food relationship and how it manifests. She has been on the brink of undergoing gastric bypass surgery with the hopes that it will "solve her problems". This is a woman who has been "dieting all [her] adult life". A woman who has a family who though well-intentioned, tends to offer dieting advice during nearly every encounter. A woman who says "I love food but I just can't control how I eat sometimes". A woman who is probably her own biggest critic and who feels that she has failed over and over again in her weight loss goals. A woman who admitted, "My worth is directly related to my weight, even though I know it shouldn't be." There is a great deal of work going into helping her let go of the guilt associated with her dieting failures. Also, helping her recognize queues such as hunger and understanding that her body telling her she is hungry is a GOOD thing, not something she should be ashamed of and try to hide. Along with this type of coaching, help in formulating strategies for discussing her diet changes with family and friends, planning for holiday and family parties, dining out, menu planning and grocery shopping are essential. This person has been inundated with so much conflicting and not-so-great diet advice for several decades.
A few appointments later that same day, I had a teen-aged female with Type 1 Diabetes and Obesity in for follow up. Again, the negative food relationship found it's way into our discussion. The added barrier in the adolescent patient is the desire to go against the grain and the satisfaction found in being stubborn when mom suggests food or exercise ideas. My younger patient is also different from the first patient mentioned because first and foremost, there are parents involved here. Parents who want what is best for their child, but who may be misguided and pushing too hard. Therefore, modeling good coaching behavior on the part of the dietitian is key. Providing good nutrition education is just as important in these sessions as reinforcing the importance of staying focused on the behavior goals set in the appointments. There is absolutely no room for the food police and that needs to be stressed with caregivers at every encounter.
In both of these examples there is a loss of normal eating, negative self-body image, and low self-esteem in general and I have a multitude of other patients (mostly female) with these same issues. If negative comments, thoughts, and repeated diet failures is the root cause in many of these problems, then it stands to argue that positive comments, reinforcing normal eating queues, and small but repeated behavioral successes might be the cure. It's a slow process and one that is patient-centered. It requires the Coach to be louder than all the other voices coming from family, friends, and the internet. The ultimate goal being the same for all: To help people find their own way to better health, self-satisfaction, and true enjoyment of food.
No comments:
Post a Comment