People often seek out dietitians to “tell me what to eat and not eat”. The profession may also be seen as “just prescribing diets”. It is of course true that registered dietitians—those who are registered with the Health and Care Professions Council—can prescribe diets for medical purposes. Indeed, this is one of the main differences between dietitians and nutritionists, and sometimes it is absolutely essential for managing medical conditions.
However, simply writing a diet plan without providing education, review and support often doesn’t work in the longer term. A diet plan can be a way to lose weight in the short term, but to achieve long-term change, we need a deeper understanding and support.
A changing field
Over recent years, our understanding has grown about the importance of nutrition and diet as a part of an overall approach to health. We now recognise that weight is only one metric in a much broader picture. We see elite athletes seeking advice from dietitians about how to optimise their health for exercise—and clinical approaches have benefited from the cross-fertilisation of ideas.
Birmingham-based expert dietitian Ms Claire Fudge is keen to stress the more relational way of working.
“When you’re managing symptoms, with both medical conditions and intolerances, you need a close working relationship to understand causes and patterns. You also need realistic goals and support to get results. Whether I’m working with elite athletes or people with intolerances and medical conditions, I use the same approach to understanding what is happening in their lives, and making sure that all the pieces of the jigsaw are in the right place.”
There has also been a change in the way that dietitians work with patients. Claire explains that her work has always been one-to-one, and very much tailored to the individual. However, the balance has shifted away from an expert instructing their patient, and towards a partnership where both clinician and individual are working to the same goals. She says,
“I have a very close relationship with my patients, based around accountability and support. My goal is to set people up so that they can manage themselves. My focus is therefore not just on weight, but about people’s relationship with food, and how they manage hunger. We take away the ‘good/bad’ labels about food, and simply try to get to the core of the problem.”
A very practical approach
There is a huge amount of science behind the work of dietitians, and our knowledge is growing every day. Claire Fudge sees her job as translating the findings of those studies into practical, everyday terms for her patients.
“We have to be able to put the science into perspective. It’s got to be useful. For example, I have seen athletes who are starting to use continuous glucose monitors to check their blood glucose. My immediate question is first, whether they actually understand what they are seeing, and second, what are they going to do with the information?” Claire’s focus is on building a trusting partnership with her patients or clients. They will have an initial consultation with Claire, which allows her to do some in-depth exploration of their situation.
They will then have monthly coaching sessions, coupled with a weekly call and light-touch contact in between, as needed.
“This is very flexible, and varies both week to week, and between individuals. Sometimes people need more support, and sometimes they’re able to just get on by themselves. It’s all about the individual relationship.”
Claire adds that nutrition and food is only one part of the picture. She points out that sleep, work, and home life all affect health, and often have a direct impact on diet. Her approach is to address her patients’ whole lifestyle.
“We used to talk about the importance of weight management. Now, though, I often find that when we work on getting these other factors sorted, weight sorts itself without ever being discussed. For me, the key is the partnership approach, where patients are accountable for the goals and how they achieve them.”
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