5 Myths About Being A Dietitian
Are there rules that you learned about your profession early on? Perhaps some philosophies about how a (teacher, engineer, nurse, etc) should act or even look? Messages such as “this is who we are” or “we’ve always done it this way.”
Well, in honor of Registered Dietitian Day - the 2nd Wednesday of March - I’m writing about the rules I learned early and ways I’ve changed as a dietitian over the past 13 years.
Myth #1: Dietitians take a detailed 24-hour food recall.
In college, I was trained to obtain every detail of what a person ate within a 24-hour time period. It goes something like this:
Me: What is the first thing that you ate yesterday morning?
You: Cereal
Me: What kind? How much cereal compared to this food model? What type of milk did you use? How much of the bowl did you finish?
You: *patiently answer the follow-up questions*
…
Me: What did you drink with it?
You: Coffee
Me: What did you put in your coffee? How much sugar? How much creamer? What kind of creamer (…full fat? fat-free?)
You: *answer the follow-up questions, feeling a bit attacked about the way you take your coffee.*
…
Me: Did you have anything else with breakfast? Ok, and approximately how many grapes did you eat with it? How big were the grapes? (Ok that last question is an exaggeration.)
You: *start to question yourself, your food choices, and your entire existence.*
Nasco food model - I’ve got one of these sitting in my basement rn!
This line of questioning could take a good 20 minutes, maybe more?
I would later analyze my findings to determine how many calories and macronutrients your recall contained. Then I would compare it to my calculations of your energy needs.
WHAT’S CHANGED?
So much.
Now, I get the general gist of what you eat in a day - your routine - but have ditched the details.
Instead of getting lost in calculations, my gaze is fixed on you, the client. It’s much more important for me to know you as a whole person. To understand how you feel about seeing a dietitian, how you make choices, what bothers you about your relationship with food, how much it bothers you, what you want to change, and what foods give you joy.
WHY?
Answering why I’ve stopped the detailed 24-hour recall will require a numbered list!
First, eating varies day to day. Sometimes you eat a lot. Other days you eat a little. So why analyze one random day?
Second, even the most honest and well-intentioned clients will not be 100% truthful about what they eat. That’s ok, no judgment from me…I skew my answers when I go to the doctor sometimes too! One JAMA study* found that 60 to 80% of us fail to share relevant information with our healthcare providers, like food and exercise habits, because we “don’t want to be judged or lectured”, don’t want to “hear how harmful the behavior is,” and because we’re embarrassed.
Thirdly, energy need calculations aren’t accurate for people with a history of yo-yo dieting. Weight cycling causes the metabolism to change in a way that we don’t have a calculation for yet (to my knowledge). So why go through the effort of determining how many calories you’re eating if we don’t have an accurate view of what you need?
Myth #2: Dietitians measure and weigh their clients.
Here’s another distinct memory from college: SKIN FOLD CALIPERS. This is an instrument that pinches a person’s skin and fat in order to determine their percentage of body fat.
These are skinfold calipers.
We used this tool on each other in a nutrition assessment lab. How awkward! Looking back, I can recognize the harm this likely caused to my classmates in bigger bodies or for anyone struggling with body image.
WHAT’S CHANGED?
Um, I’ve never used skin fold calipers, other than in that class.
I have changed how often I use the scale in sessions over the years. I won’t weigh you unless you’re coming from a higher level of care for a restrictive eating disorder. I do ask about weight in my intake paperwork, but you can choose to leave that section blank. If you want to talk about weight, I’m all ears, but that’s up to you!
I now measure progress using the EDE-Q 6.0 and CIA questionnaires. (That’s for another blog post.)
WHY?
The number on the scale does not measure how much we care for our bodies. If we want to look at your progress, then let’s look at how your eating has changed over time. How often are you bingeing? How distraught are you about your eating habits? How are you making food choices?
Choosing foods based on what your body is telling you on the inside (i.e. hunger and fullness cues, what sounds good in the moment) leads you to a genetically-appropriate weight. Eating based on how your body looks on the outside leads to unhealthy weight cycling because you’re either “eating your feelings” or restricting too much to control your weight.
Myth #3: Dietitians see back-to-back clients all day.
I picked up this message from hustle culture and capitalism somewhere along the way in my career. I’ll be honest, it’s a tough one for me to shake. I’m still in the middle of it.
It’s been ingrained in me to define success based on how many clients I’ve seen and how much money I’m making. But this just doesn’t sit right with me anymore. I’ve been asking myself how else to measure my success as a dietitian quite a bit in the past year.
WHAT’S CHANGED
I’ve recognized my limits are not only based on time, but on my mental and emotional energy capacities. Instead of seeing 6 or 7 clients per day, my upper limit is now 4 per day MAX. And I’m tired after those 4…
WHY?
Active listening is hard work, ya’ll. Bearing witness to your pain is important and… exhausting.
Holding all the pieces of your ongoing story and then reflecting back what you most need to hear takes brain power.
So in order to be present with you, I will let go of society’s definition of success ($$) and redefine it using my own values. I acknowledge my privilege of being able to limit the number of clients I see because I have a financially stable partner. I realize that not everyone has that option.
Myth #4: Dietitians give nutrition advice.
This one seems innocent enough. Aren’t dietitians trained to tell people what to eat? Yep, we were taught to create a plan at the end of a SOAP note. The nutrition intervention of the NCP (Nutrition Care Process). The recommendation. The answer. The fix.
WHAT’S CHANGED?
“So, what exactly do you do here?” you’re probably wondering, if you’re not giving nutrition advice?
Well, here’s what I do:
I ask a lot of questions like “how do you know when to stop eating?” and “what time of day are you the most hungry?”
I make observations like “remember when this happened last time, and how you’re handling it so differently this time?!”
Sometimes I give people information, like how the body works or studies about weight stigma.
Most importantly, I listen.
Check out the blog post “A Typical Meeting with a Non-Diet Dietitian” for more details.
When I observe instead of order, clients naturally become curious about their food decisions. They experiment with different foods and different amounts and observe how they feel later on. They see for themselves. They grow in body autonomy - an expert on their own body.
WHY?
I’ve learned that I’m more effective as a sounding board than a billboard.
When I give directions like a billboard, you might do it for a day or two, but it won’t stick.
Alternatively, we learn most about ourselves through trial and error. Find what works best for you by talking it out with your sounding board —that’s me! “Feeling good physically and mentally” is a way better motivator for behavior change than “pleasing the dietitian.”
Fun fact - I didn’t realize what a sounding board was until I wrote this. Look it up!
You’ve probably been trying to follow other people’s nutrition advice your whole life. It’s not sustainable and can make you feel like a failure. After all the commotion of striving and shame, you (temporarily) lose the ability to hear yourself. Guiding you to follow your own inner body wisdom is the key to sustainable wellness.
This isn’t a black-and-white issue. There is certainly a useful place for nutrition advice, and I’m happy to give it when you’re ready. I’m just saying there is so much more to being a dietitian than giving advice!
Myth #5: Dietitians are only thin and white.
Lack of diversity and fat-phobia in our field wasn’t talked about in college in the late 2000s. We didn’t question why there wasn’t a person of color sitting next to us in class. We didn’t admit our underlying fear of fatness or talk about how fat people are discriminated against.
WHAT’S CHANGED
Though the demographics for dietitians unfortunately haven’t changed much in the past 15 years, it’s now being talked about. We’re beginning to acknowledge how systemic racism prevents BIPOC folks from entering the field. Dietitians on Instagram like AntiRacistRD are educating us on this subject. A non-profit called Diversity Dietetics is working to increase diversity in the profession.
We are also now talking about the incidence of eating disorders among nutrition students. There are studies about it. There are interviews on it. Diet culture and weight stigma are being called out. Intuitive eating and HAES® are being taught in college curriculums.
WHY
Diversifying our field is so important. Removing barriers to getting into the field is essential. If you have a passion for nutrition, you should have a fair shot at becoming a dietitian.
It’s harmful to our clients if the only “nutrition experts” available look the same because it engrains the false concept of an ideal body. Clients will be more open and trusting to receive care if they can relate with their providers, whether it be through race or size.
We’re All Good Dietitians
You can be a good dietitian whether you weigh your clients or not. There is a place for detailed-oriented dietitians and big-picture dietitians. Whether you’re a talker or a listener, you can succeed either way as a dietitian.
There’s more than one right way to be a dietitian. It’s taken me years to develop my philosophy and voice as an RD that fits my personality, values, and work experiences. And it will probably continue to shift as I’m always learning.
This year I participated in a group supervision program that made me feel less alone as a solo-entrepreneur dietitian. Meeting together with fellow dietitians who have been there offers me hope and validation. As a result, I can see my perspective of other dietitians shifting from competition to fellow teammate. This feels right!
I’m thankful for my fellow dietitians who are different from me. The ones who have different life experiences that can empathize in a way that I can’t. The ones with a perspective that challenges my own. Those who have stronger personalities that engage clients who I’d be too soft for.
There’s a lot of controversy in nutrition. Unfortunately, this can also cause divisiveness in the field - placing us in categories of those who promote weight-inclusive, anti-diet care and dietitians who don’t follow those frameworks. My hope for our profession is that we can meet each other face-to-face instead of in the comments section. That we would stay true to who we are, listen to each other even if we disagree, and celebrate our differences.
Happy Registered Dietitian Day!!
Do you want to know more about what a dietitian does? Check out my services page for what I have to offer!