My nutrition coaching approach
and why I don't do weight loss diets/plans/programs
I’ve gotten some inquiries lately in my nutrition coaching practice and from Instagram about weight loss diets - can I write about them? can we work on them together? - and thought I’d address it here as my practice expands (more on that very soon!).
welcome to our office
Diet culture is everywhere, usually with promises like “do this for X time period to [insert bogus health claim], lose X amount of weight and feel amazing.” Even though it’s becoming more known that weight loss diets do not work (in fact, about 95% of the time), we still live in a world that celebrates small bodies, stigmatizes larger ones and uses a totally bogus calculation (looking at you, BMI) to measure health. All of this took me a while to learn.
When I started working in an outpatient breast cancer center full time (about 6.5 years ago up until now), I received consults for “weight management” all the time, usually for women finished with breast cancer surgeries and treatment. And being only a couple years into my career as a dietitian* with a very dated nutrition education, I did what I thought was appropriate. I talked about calories, what to eat less of, tracking food intake, and even weighed patients during their visits (ugh, this can be so demeaning). Weight loss was always the primary goal for these patients. In doing this work for some time (maybe a year or two), I realized a few things that changed how I practice in every way:
None of my interventions or recommendations for these women actually worked. Sure, they may lose weight for a short time period, but it usually came back. And they felt terrible about it - I was bad, I failed, I’ll be good again - and eventually would stop seeing me.
Many of the women I worked with seemed to have a long history of dieting. They had tried every diet, protocol, cleanse, etc. over several years or decades, and their weights read like a roller coaster of ups and downs. None of those diets had ever “worked.”
A lot of women seemed to have a challenging relationship with food. Relationship with food was not addressed AT ALL in my dietetic internship, nor in my experience in the hospital up until now. So often, I heard about fear of eating various foods, skipping meals, bingeing, rigid food rules, intense restriction, and so much shame for eating certain foods or meals. I started doing some research on this, following RDs who were talking about it on social media and listening to podcasts that talked about disordered eating and relationship with food. It was all mind blowing. It felt like a huge missing piece in my nutrition education and practice, and something I needed to start talking with patients about to really make a difference in their care. I took courses, went to trainings, read a ton and talked with other RDs in order to be confident doing this.
Women’s bodies are supposed to change throughout the life cycle. WHY IS NO ONE TALKING ABOUT THIS? Many women living with breast cancer are going through a chemically-induced menopause if not a natural one, and their bodies are changing accordingly. Because of the hormonal changes brought on by menopause, body composition changes and weight gain are common, especially in the mid-section. This is natural and normal, and very hard to lose as your body goes through hormonal chaos, so to speak, and it will fight against most weight loss efforts. It can’t go without saying that women’s bodies are also meant to change after puberty, childbirth and just with aging in general. We aren’t supposed to look the same at age 55 as we did at age 25.
Weight stigma in healthcare is real. I’ll leave it at that for now.
Here’s how I changed my approach
I stopped using weight loss and weight loss diets as a primary goal for women I worked with, for ethical reasons. I could see the harm it was causing them, their relationship with food and how it could be contributing to disordered eating behaviors. Also, if a medication failed 95% of the time, it would never be approved by the FDA for use so WHY ARE WE STILL SUPPORTING WEIGHT LOSS DIETS IN HEALTHCARE? Of course, some women were resistant to my new approach and chose to seek counseling elsewhere, but most felt so relieved and seen.
Taking weight out of the equation helped me get to know my patients and now clients, and hone in on their behaviors and develop more individualized recommendations and goals with them. There are always behavior changes we can make that will impact health and quality of life in a positive way, regardless of weight, and these were so much easier for my ladies to focus on.
What I do now
Now I use positive, health-promoting behavior change depending on the individual client, their lifestyle and goals. For one client it may start with, “every week, aim to cook three meals at home” in order to eat out less and increase vegetable intake, “have X snack 30 minutes after your run” to help your body refuel, or “have X fear food with lunch on Tuesday and journal about it” to help heal the relationship with food, and “take yourself out to a meal with no distractions or screens this weekend” to help you work on mindful eating. Health-promoting behaviors look different for everybody, and they can evolve over time along with your health goals. Weight changes can be a side effect of behavior changes, but I keep them on a totally neutral playing field. Health goals like improving running performance, lowering cholesterol, having better energy levels, reducing risk for chronic disease, healing your relationship with food, managing blood sugar, can ALL occur regardless of whether your weight has changed.
If you got this far, thank you. This was very cathartic to write as I reflect back on my clinical career (more on that soon!). For more information on working with me, please visit my website!
*nutrition and dietetics is actually my second career! I worked at an NYC PR firm for several years prior.