Category Archives: Dietitian Advice

Dietitian Advice, Family Meals, Intuitive Eating, Media, Nutrition Education

How do we know when we are hungry/full?

Leave a comment

In a completely perfect world we would eat when hungry, stop when full and eat the foods our body tells us to eat. However few of us are that tuned into our bodies signals. We are bombarded with outside signals for example the media, advertising, other people, shops, restaurants – food is all around us.

You walk down the road and pass someone eating a burger, “hmmm I fancy one of those now”. Then you pass a billboard advertising ice-cream, “oh I could eat an ice-cream later”. Then someone in the office has a birthday so you have a slice of cake. Later on the radio is advertising a meal deal which makes you think of buying one for your lunch. In the shop you are standing waiting to pay and see a cereal bar so pick it up to nibble on. All those extra signals that are overriding your actual body signals. It’s all so easy to be overwhelmed by the external and takes a lot of quietening ourselves to hear the internal cues. 

Many people I work with cannot actually initially  pinpoint what hunger feels like. I ask how hungry they are and am met with a confused look. Hunger on the one hand is quite a simple idea, your body is hungry, it tells you, you eat. Other the other hand it is complex, so complex. There is head hunger, body hunger, stomach hunger, emotional hunger.

Here is my 7 year olds take on how she knows she is hungry. I think this is such an important conversation to have with children AND adults. So have a think this week, how do you feel hunger and how hungry are you before you eat? 

SaveSave

Dietitian Advice, Nutrition Education

The non-diet approach for children.

6 Comments

In a time when there is a focus on reducing sugar, countering obesity and improving the long term health of the nation, it can be hard to know how to approach these topics with your family. On the one hand we want children to be aware of what is in food but we don’t want them to be obsessing over it or feeling they need to go on a diet.

Personally I think that teaching children about nutrition, food preparation, healthy behaviours and their bodies early on is really important and can be part of the solution that our society needs. So as a mum I do my best to educate my children on a daily basis.  Simple messages that we use are “There are no good of bad foods but some foods we eat less of as too much of them are helpful for our bodies”. We also talk about what is in a food and why it is good for us – often using “Funky Facts” such as the fibre in bread or the vitamin C in a kiwi. Top facts like this are things I find they store up and remember.  

We may talk about dental health or how out tummy feels if you eat too much of certain foods.  Both my older children (age 4 and 7 yrs) can associate with a time they have eaten sweet foods and felt unwell from it! I love talking to them about how their tummy feels and what do they feel it needs as well as what does it want!

I prefer to focus on these messages rather than focusing on weight/size/shape.  Being a dietitian who works in the eating disorder field I am well aware of the issues that can occur when there is too much of a focus on weight, shape, size and how your body looks.  Instead I like to focus on the enjoyment of food and on healthy behaviours such as being active, getting fresh sunlight, being outside and taking care of our teeth, hair, nails. 

Here is a little video of my 7 year old explaining her thoughts on food:

I’d love to hear your thoughts! 

 

Dietitian Advice, Vegetarian

The least sexy but vitally important nutrient

Leave a comment
Facebook likes too ask “what’s on my mind” well actually right now it is fibre. An overlooked and neglected nutrient, maybe because bowel health just isn’t sexy. However to my mind, neither is constipation or piles. 
 
When the recommendations for fibre increased to 30g per day there were lots of posts out there about how hard it would be to achieve it and how to meet your fibre needs. At the time I remember thinking how hard this would be for many people to achieve. It’s all about making small changes one at a time and then building on these. In my clinic I see the extremes. Sometimes underweight people who are eating too much of the fibre rich foods (and I have to ask them to decrease these) but then also plenty of people who are just not having enough fibre which is causing some of their symptoms. 
 
(Disclaimer: this advice is not for those who are weight restoring from an eating disorder, too much fibre can be very filling and stop you from eating enough energy).
 
So why is fibre important? 
 
  • Bowels, bowels, bowels. As a student dietitian on the wards I remember having to swallow my embarrassment and loudly say to people “how are your bowels today”. These days I’m older, a lot harder to embarrass, mum to small kids and used to talking about bowels a lot… whether it be a clients, a child’s or a worms. Yes this week my girl wanted to chat about worms poo. Having enough insoluble fibre is important for bulking your stool. 

 

  • Soluble fibre forms a gel that slows digestion. This also means it helps stabilise blood sugars, lowers cholesterol and aids satiety, keeping you fuller for longer. Soluble fibre is found in oats, barley, psyllium, nuts, seeds, beans, lentils, peas, and some fruits/vegetables. 

 

  • The microbiome is a fascinating area. Research has shown that the largest influence on the gut microbiome comes from diet. Fibre feeds the gut bacteria so by eating your fibre you are helping ensure your gut stays happy and healthy.

So how much fibre is in your foods? Although I wouldn’t promote you analyse labels all the time it can be interesting to compare the fibre content of some of the foods you eat.

Some fibre rich foods that can help boost your intake are:

Lentils, Spilt peas, beans,  garden peas, nuts, seeds, wholegrain versions of pasta, rice, bread products, wholegrain cereals, grains such as oats, quinoa, cous cous, popcorn, fruit and veggies, potato skins.

Top tips to increase the fibre content of your meals: 

  • Add lentils, beans and pulses to your meals. A couple of handfuls of lentils goes well in casseroles, soups, salads, even stir fries. 
  • When possible opt for wholegrain versions of foods.
  • Add nuts and seeds into meals. I love them sprinkled on breakfast or my yoghurt, you could add to a salad or on top of a stirfry. Sprinkle some in your sandwich or add to baking.
  • Increase your portions of fruit and vegetables if you are not meeting the 5 a day target. 
  • Eating more plant based meals in your week. We aim to eat plant based meals 4-5 times a week in our house. 

Here are some meals where I’ve pimped the fibre:

Oats with fruit, seeds and nuts – 15g fibre. Plus the oats here are soluble fibre. 

  

2 x Rye bread with 1/2 avocado – 10-15g fibre, this particular bread is very high fibre, 10g for 2 slices.

If you used a different rye bread it would be lower, using my normal rye bread plus the avocado it would be 10g fibre.

Risotto made with pearl barley and broccoli – 12-15g fibre per portion. Pearl barley has a high fibre content and is a great grain to cook with. It takes slightly longer to cook than rice but can be used instead of rice, or added to soups and stews. 

Vegetable fajitas with chickpeas, peppers and sesame seeds, smashed avocado and seeded wraps – 10g fibre.

I totally encourage you to try increasing your fibre intake and help your gut bacteria, blood sugars and bowel health. Remember to also drink plenty of fluids to help that fibre move through your system.

 

SaveSaveSaveSave

Dietitian Advice, Eating Disorders

Constant thoughts of food? It could be linked to your diet.

Leave a comment

One statement I hear regularly in my eating disorder clinics is “I feel like I’m going mad, all I think about is food”. Now whilst an eating disorder is a mental health illness it is not a sign of madness. However you can feel so consumed by your thoughts of food that it feel that way. Why? Well let’s have a look at some of the symptoms of being underweight….

Back in 1941 there was a landmark study conducted by Ancel Keys called the Minnesota experiment. The aim of this study was to get information on how to refeed those starving from famine conditions. 32 men completed the study, 12 of these were studied for 8 weeks to assess their baseline intake before the trial began. Then they were all starved for 24 weeks, with their intake reduced from 3,200kcals to just 1,600kcals/day served in 2 meals. which led to a 25% loss of body weight.  Now take a note of the number of calories, yes these men would have been more active and lived a different lifestyle but 1,600kcals led to them being starved. Many of the diets that are advertised today are much lower in calories that this, so are they really healthy for our bodies? 

Fascinatingly the men showed a lot of the symptoms we see in people suffered from an eating disorder. They become obsessed with food. Some read cookery book and stared at pictures of food. Cheating become a huge issue with them trying to find extra snacks. One man became psychotic, having vivid dreams of eating flesh and threatened to kill Keys, he was dismissed and after a few days these dreams and thoughts went away. This to me highlights the affect being a low weight can have on your thoughts and mental health. If you have an eating disorder and are a low weight that pre-occupation you have with food can totally be related to your body being undernourished. It is not you going loopy, it is the impact of being malnourished.

These men displayed a biological drive to eat, their hunger was increased and felt out of control. Keys ended up having to have each men chaperoned to stop them eating other snacks when not in the hospital. Our bodies are built to live and to live we need food. So they will do all they can to get us to eat. When you restrict your intake it makes perfect sense you will hungrier than before, stronger signals are being sent out and the body is going into amber alert. So that pre-occupation with food is actually a normal, biological sign that your body is working and doing it’s job.

The good news is, upon being re-fed, for most men, these symptoms disappeared. They were refer back to their usual weight and felt a lot better. Their thoughts, mood and emotional state improved alongside their physical healthy. Some of these men were interviewed in 2003 and they reported being glad they took part in the study, but there being some lingering after-effects. Some were worried about food deprivation for years afterwards. This can also be seen sometimes in recovery from an eating disorder, which is why  it is important to focus on recovery happening in stages and being a continual work in progress. 

If any of this has hit home to you and you feel like you need some support, do get in contact with me, see your GP for advice  or check out the B-eat website who have a helping and a list of eating disorder specialists. Taking that first step can be the hardest but with good support around you, recovery really is possible.

 

 

Dietitian Advice, Eating Disorders, Nutrition Education

Why Weight Watchers for Teenagers is not a good plan.

2 Comments

On the surface this may seem like a good idea. We know the UK population is getting larger and we need multiple ways to help teach people about how to eat for their health… is a diet really the best way? Almost everything in me shouted out “NO” when I read about WW opening it’s doors to teenagers. Part of that may be because I work with lots of teenagers with eating disorders/disordered eating and I know that many of them have gotten to the stage where they need specialist support because of “dieting gone too far”. They started on a diet to lose a little weight and then either liked the knowledge of being lighter, maybe they were complimented or felt they looked better so they lost a bit more and then even more until it spiralled out of control. 

Diet that are focused on weight loss and controlled your food intake via calories do not work for the majority of people longterm. They instead set you up for yet more dieting or for a lifetime of being confined to the same dietplan. Do we want these teenagers to be controlling their intake all the time or bouncing from one diet to the next whilst their weight increases? Or should we instead move away from the focus on weight and to a focus on health related behaviours instead? 

Running Feet

We know that weight can increase the risks of certain chronic disease and that weight loss helps reduce these. However, this does not mean that you cannot be healthy at a larger size or that you are healthier because you are slimmer. Your size does not define your health.

I would love to see an approach where we counter the negative diet messages with positive changes to make for overall health. Encouraging teenagers to eat more plant based foods, to be active daily in fun ways and to choose wholegrain lower sugar options could make a difference without the intense focus on dieting. Education around hunger is something I try to do with anyone I work with at any age – for example, what is it, what does it feel like and when to respond to it. It needs to be about equipping and empowering the person.

Looking at the bigger picture is also key and something that a diet alone will not do. For example:

Why is the person overweight? Are they overeating for a reason or is it that the whole family is overweight?

What is happening in family and social circumstances?

What is their weight history?

How are they coping with life right now? Stress, anxiety, loneliness, tiredness and low mood are all factors that can affect weight and it may be that the weight gain is a symptom rather than a cause.

I do not have the answers but I do know that encouraging teens to diet is not it.

You can see my quote in the Daily Telegraph for this topic. 

SaveSave

SaveSaveSaveSave

Dietitian Advice, Nutrition Education

Teaching intuitive eating in family life

Leave a comment

It seems a lot of you out there are interested in teaching your children about intuitive eating. Which is absolutely amazing! I’m over the moon. Absolutely loving the little experiments people are doing at home too. 

After a few comments and questions about the last blog post I thought I’d do a post on how we talk about nutrition at home. Again this is not a perfect method and I don’t know it all but I am seeing the benefits in my children. 

For example this week at lunch my boy aged 4

“Mummy why are we having grapes for lunch”

Me: “Because Miss E wanted them” (she is a grape-a-holic, though she hasn’t tried wine yet!). 

J-boy: “We had grapes yesterday and the day before”

Me: “I know, is there a problem with that?”

J-boy: “Well we shouldn’t just eat the same foods we should have different colours and types”. 

Me: in a flabbergasted tone “Ummmm yes exactly” 

Is it just me who is amazed when their children actually listen and take on board what you say?

So here we go, how we chat about nutrition at home:

Take the relaxed road. Several people asked me how can I be sure the kids won’t over eat the food like sweets and biscuits? I guess I can’t ever be sure, but I also cannot be in control of their food intake for ever. I want them to listen to their inner signals and to have a good grasp of nutrition. The more I trust them and let go, the more they surprise me.  So we talk about how sugary foods are absolutely delicious and all foods are great to eat but too many lollipops, cakes, biscuits, dried fruit can lead to tooth decay and tummy ache. On those occasions when the children do over-eat sweeter foods it is a great chance to talk about how that feels.  

A recent example being Eton Mess, my girl had a serving, then came back to ask me if she could have more. I suggested she think about her tummy and decide herself. After another serving she felt a bit sickly and later on reflected on this being due to the sweet, creamy dessert.

Now if I had told her not to have another serving she would have just felt a bit disgruntled, whereas now she understands more about listening to her body. 

Fullness and Hunger Cues. We talk about how it feels to be full and hungry. In the words of my children:

Fullness = my tummy has had enough, it feels uncomfortable, my mouth has eaten enough, I’m not empty. Hungry = rumbles and my tummy aches. Sometimes when I’m hungry I don’t have my energy.

Miss K has always been good at stopping when she is full. the J-boy is another kettle of fish. He will happily keep munching on foods such as biscuits unless you remind him to tune into his tummy. Distraction for him is a biggie. Yesterday in the car he had been given a pack of biscuits, he asked how many to have and I asked him to ask his tummy and see after 1 if he should have another or keep it for later. He happily munched his way through 2 and stopped. Now I’m pretty sure it would have been 3 or 4 biscuits if he had been watching TV whilst snacking or distracted.

 

Nutrition Facts. Now I’m not organised enough to sit down with them and give planned nutrition lessons, I find relaxed or undercover stealth like approach works best.  So don’t feel you need to become a teacher to teach nutrition. When we eat a meal we tend to have a few facts about the food we are eating and talk about the meal. It could be where the meat comes from, how something is grown, the colours on the plate or why something is good for your body. My kids love a handy fact and they will then repeat things back at a later meal. This can prove amusing when someone else is eating a food that they know about.

Your language matters. How you talk about food is so important. Labelling foods as good/bad, healthy/unhealthy, treats or special foods put those foods up on a pedestal. If there are foods that you disapprove of your children will soon pick up on it. I feel like it is a daily occurance that I am having to challenge my own thinking on this and change my words/tone. It seems I am not alone, phew.

Eat using the Senses. Talk about how food tastes, smells and the texture. This can help them to zone in on what they are eating and to not eat it without noticing. One way we have done this recently is to talk about taste buds, where they are in the mouth and what you are tasting when you eat certain foods. My boy enjoys the noises that foods make and how they feel when he eats them with his fingers. Yes it may be not be good table manners but it is a way to get him to connect with his food and think about what he is eating. Later in life people spend lots of time getting back to mindful eating… our children can teach us alot about enjoying our food.

I’d love to know your thoughts. How do you talk about food at home? 

SaveSave

SaveSave

SaveSave

SaveSave

SaveSave

SaveSave

Dietitian Advice, Nutrition Education

Food trends 2018 I’d be pleased to see.

Leave a comment

January always brings the weird, the wonderful and the wahey of food. I’ve highlighted a few trends that I predict are on the rise for 2018 and ones that I would be happy to see more of. You can check out my 2017 trends post here and see how I did! 

Plant Power

I think we’ve all seen the rise of the vegan diet with veganuary in full swing. Whilst being vegan is perfectly great way to live life and eat I don’t think it is something to take lightly or do for a month. Being a vegan is a lifestyle choice and not a fad. Rant over. I do think that eating more plants and less meat will be high on the 2018 agenda which is fabulous. Foods like tofu, tempeh and quinoa are growing in popularity as are meat free days. Check out Meatfreemonday for great recipes and inspiration.

Sustainable eating

This ties in with eating a plants based diet but goes further. Consumers are becoming more conscious and choosy about where their food comes from. Choosing foods that are not just heathy but are obtained in a way that does not damage the ecosystem or deplete a food source is important and coming higher up the agenda for people.

Fermented foods, probiotics and gut health

The chatter on these has been increasing in 2017 with people starting to think and talk about making them at home. As research on the microbiome grows this is a natural area to grow alongside it. Gut health and how your feed those bacteria is likely to become popular. Personally I love this idea and it’s certainly something I will be getting on board with. Making your own kefir, sauerkraut, kimchi, live yoghurt , sourdough are all things you can make yourself.
Less diets more body signals. This could just be the circle I am in or my own hopefulness but could 2018 be the rise of intuitive eating? Listening to the bodies hunger and fullness signals, guilt free eating and take the labels of good and bad away from food. It’s a journey and no quick fix but boy it would be fabulous to see and I think it’s on the way up.

Recycling food

Using up leftovers can seem hard work to some and second nature to others. Chefs are coming on the scene who are pushing this as a trend. Not only will it reduce food waste but also your food bill. A great place to go for inspiration on how to use your leftovers is Love Food Hate Waste.

SaveSave

SaveSave

Dietitian Advice, Nutrition Education

Raising Intuitive Eaters

6 Comments

Being a dietitian is the easy part. Being a mum, now that’s a much harder job. Currently I have 3 children, Miss K aged 7, J-boy aged 4 and Miss E, 18 months. Teaching them how to eat a balanced intake, how to listen to their hunger and fullness signals and helping each child on their journey with this in different ways is hard. I find myself having to change my language, change my mindset and be flexible a lot. My children do not eat like I do. They are their own individuals and have their own signals to listen and respond to. Too often I try to parent their eating and actually I’m not in their bodies. They are.

Here are some of the mistakes I’ve made along the way. A dietitan who makes mistakes, with her own kids, ummmm yes. All the time. I’m sharing these so hopefully it will help someone else and to show that we all make mistakes.

  1. Don’t be the Food Police.  This is all too easy a trap to fall into.  Oh so easy. As a parent boundaries are important and you don’t want your child to be eating all the biscuits all day, everyday. I’ve certainly had a child who will ask for a biscuit continually until they get one. No matter how often you offer another snack it just comes back to that biscuit. For ages I would say No to the biscuit, I’ve had a lot of biscuit tantrums. It’s now with great relief I can say I now say yes to the biscuit in the context of a balanced snack. After pre/school snacks are often a biscuit with apple and crackers, or toast with peanut butter and something from the sweet tin.
  2. Keep the sweetie tin open.  Ours used to be on the top shelf of the cupboard. Visible but out of reach. However all this actually did was make the sweetie tin special and lusted after which is the opposite of what I was trying to achieve. When you restrict a food it can make it more desirable, we want the things we cannot have. It also sets those foods apart from the rest, but why are sweets anymore special than say an apple? So the sweet tin is now lower down and we have sweets at the end of a meal or as part of a snack. I talk about having less of the sweet foods so we don’t get tummy ache and to keep our teeth healthy in the same way we talk about this with dried fruit. 
  3. No foods are less healthy. Much like I would not recommend you call foods good or bad, try not to call some foods healthy and some less healthy. Why? Well it is often the way nutrition and healthy eating is taught in school but it actually doesn’t make sense. What makes a food bad? Thinking about foods as good/bad or healthy/less healthy can lead to guilt when you eat them. In actual fact it is not a problem to eat any food as long as you are enjoying it and eating it guilt free. We focus on all foods being good foods, it is just some you eat less of as they make you feel sick or damage your teeth. I encourage the children to think about how their tummies feel when they are eating and to stop when they have had enough as there will be another day to finish it. If my children choose to overeat sweeter foods it can be quite useful, as later we can reflect on why they feel a bit queasy! This happened recently after too much Eton Mess, resulting in a mess on the floor. 
  4. Eat your vegetables but don’t force them to. Oh boy, this is one I struggle with. I want my children to eat their veggies so much. Yet the more I push this, the less likely they are to enjoy them and just eat them under pressure. This could then lead to them not liking veggies at all. I had a boy who was not into his veg at all, but by keeping things pressure free, ignoring him and just putting the veg on his plate each day he eventually just started to eat it. Role modeling is so important here, showing how much you like vegetables and talking about why they are needed by the body can have more impact than you expect. 
  5. Pudding is not on a pedestal. It is so easy to use pudding as a way to encourage your children to eat their main course. I know, as I’ve done it. Guilty. By using pudding as the carrot, it makes it seem like the prize and if we are saying all foods are equal then the pudding is the same as the main course. Tricky hey. So let your children leave some of their main course if they want to. Perhaps talk to them about how full they are feeling. If they are really full then they may not have any space for pudding anyway! It makes for an interesting conversation at the table. We sometimes rank our fullness from 1-5. It you are at 5 then you don’t need pudding. 

Some examples from my family in the past couple of weeks:

We bought some large cookies, I gave the older 2 kids free range to eat as much as they wanted and to stop when they had enough. I fully expected my boy to eat the whole thing and yet he only ate half and handed it back. I don’t think he would have done this if we hadn’t have chatted about fullness beforehand.

When visiting Santa they were given sweets/chocolate and again I suggested they ate what they wanted and then stopped and kept the rest for another day. What fascinated me with this was the constant chatter about “hmmm I think I will have one more and then that it enough for my tummy” and the lovely sharing that went on.

I’m certainly still on the journey with intuitive eating and I have a feeling I will be for many years. However it is a journey I am enjoying and such a priviledge to be able to encourage and watch my children as they do this too. They often teach me more than I teach them.

Dietitian Advice

Dear new food brands, please be responsible.

Leave a comment

We are living in a time of innovation in food. There has been a literal explosion of new products using a range of different ingredients, with new techniques and with all kinds of claims.

Now I totally love trying new foods and am always on the look out for brands and products that I can recommend. When companies approach me and ask me to try something or review it my answer is usually yes. Going to a food show is always a time of huge excitement, it’s like Christmas and Easter all at once. What new goodies will I find? What novel products will there be to taste?

Food Matters Live is one of those events that fuses seminars on the evidence base with talks on food manufacture and then has a huge arena for brands to showcase their products. It can be a great place to network, get your brand in front of people who purchase, recommend and know about foods and a place to learn.

As a dietitian I am literally learning everyday. Nutrition is an evolving science, we have new studies being conducted everyday. we are very much still finding new nutrients and discovering the effects of nutrients. It is an exciting time and I am always grateful to those who continue to bring us new, high quality research. I’m also grateful to those who continue to think of new ways to add foods to a product or come up with new food ideas. We need this. However there is a way to do it.

The food exhibition at Food Matters Live caused my dietitian soul to cry out. It left me with a sour taste and very skeptical, which for me is not the norm. Talk to my husband and he will tell you I’m a very positive, upbeat person who dreams big.

I met some fabulous people and brands.

I got to taste some delicious new products.

I tasted some foods I’ve wanted to try for a while.

I definitely discovered some new things to recommend.

So why so sad?

There was a sea of health claims being made that I just couldn’t see were true, proven or even allowed. Some of the products were frankly laughable. The science did not stack up. In fact at the show I bumped into a lady from trading standards who was blown away by the number of claims that needed to be looked into. The whole thing has led to quite a debate chat on twitter in the nutrition community. Registered nutritionists and dietitians being united in their views on how unhelpful and wrong it is to be advertising products with claims such as “boosts metabolism” and “calming” “anti-inflammatory” or “makes you feel energised”. I don’t think that all these brands are trying to dupe us or to lie, I just think they are confused about the science. That could totally be me being naive of course! Also, I don’t want to single these out by any means but what I do want to point out is:

  1. In order to make a health claim a nutrient needs to have the science to back it up and health claim has to be EFSA approved.

2.  There needs to be enough of a nutrient in a product for it to have an effect. Sometimes there is some science but the amount of the nutrient needed is just not palatable to have in a single serving.

3. By making wild claims a product may look good but consumers are becoming savvy and some will definitely start avoiding these types of food items.

4. What is the science? Is it good quality or a one off study on 10 people?

5. If you  are a brand and have used a different technique or added extras to a food product then be prepared to explain why. I chatted to multiple food brands who couldn’t tell me the role of an ingredient or how a product had been made.

6. Is there a need for your product or for the claim you are making? High protein water for example, why is that needed?

If you are a food brand or new starter to the market and you want your product/brand to be credible then it is not just a case of having a few studies to back it up. Ideally you want an approved health claim. If that isn’t possible then are still ways to word things. Working with a registered nutritionist or dietitian to get the wording, science and understanding of right is so important. We want to have the right messages going out into the public domain so that great brands flourish and the consumer knows they can trust labelling and advertising. Isn’t it better to make less claims and have a trusted product? Yes working with someone like myself will cost you some pennies, but in the long run you will end up with a much better product.

Dietitian Advice, Eating Disorders

The goal of recovery is not about weight.  

Leave a comment

I’m constantly on a journey with my clinical practice and dietetic thinking. One of the keys to a good health professional (or any professional) in my mind is one who constantly evaluates their practice, the evidence, the new trends and uses this to shape how they work and think.  

I started work as an eating disorder dietitian in 2007. On my first day I was handed a box file that contained a few black and white print outs of out of date dietary information and told those were all the resources. There had been no dietitian for 5 years. I built up the resources, my knowledge and educates the team as well as myself. As a lone dietitian on a psychology based team it was at times very tough but it was the making of me and I loved it. When I left that job I had experience of helping run a day care programme, groupwork, meal support, out patients, inpatients and I had gained a whole new language. I am so thankful for those years. 

Now as someone who works in the private eating disorder field I am constantly working to better the support I offer. Not so that I am better, but because I want to do myself out of a job. I want to see my patients recover, I want them to have a good relationship with food, I want them to no longer need my support. 

We live in a weight focused culture. I personally struggle with this. I would love to not weigh anyone who comes to clinic, yet most of the time I have to. Working with people who are very low weight it would be negligent of me to not know what their weight is doing. It has to be a focus, but I don’t want it to be the primary and only focus.  So we get it out of the way, debrief and then move onto other areas. Weight is never an easy topic and is certainly not foolproof. The simple idea of eating so much leading to so much weight gain every week just isn’t that simple  in the community. There are so many factors than can complicate the picture. Activity levels, mental energy used in work/study, looking after children, anxiety etc… So focusing on the weight alone can make it slow, hard and distressing. 

Instead of a weight focus only, I like to work with people looking at their relationship with food. We may look at the their food beliefs, busting any incorrect ones. Ideas such as carbohydrates are fattening or I shouldn’t eat fat are common ones. It doesn’t always work but I try to stay away from calories and strict meal plans and instead focus on eating regularly and including a good balance of foods at meals.  No food is off limits, no food is good or bad. Switching the focus from weight to health has always been one of my aims. Instead of what foods you need to gain weight I look at why food groups are good for your health and how restriction is unhealthy and can cause physical harm. Finding out what foods people have been avoiding and why, is always a good place to start.

 As people make progress it can be so liberating to weigh less often and incorporate more freedom into the meal plan. Learning to listen to those signals of hunger and fullness can be very scary and overwhelming at first but it opens up a whole new future and a way of eating that will see you through life, with no need to restrict, binge or diet every again. Let’s make that the goal.