April 9, 2024 • 21 mins
In this enlightening podcast, we are delighted to have Rachel O'Brien, a private practice dietitian from Australia, as our guest. Rachel brings her expertise in gastrointestinal nutrition, bariatric surgery, and adult weight management to shed light on the true nature of being a dietitian and dismantling some common fallacies.
Rachel unfolds the journey of dietitian training in Australia, a structured and respected pathway involving years of study and ongoing professional education. She opens up about her personal passion for nutrition, demonstrating how a dietitian can have a transformative effect on a person's well-being through well-informed dietary changes.
We spotlight the common misconception about the physical image of dietitians and the assumption that they do not understand the complexities of weight loss. Countering this, Rachel acknowledges that dietitians come from diverse backgrounds and are empathetic to their patients' unique conditions.
We tackle another frequent concern that dietitians enforce restrictive diets and calorie counting only. However, Rachel's methodology is based on enhancements rather than eliminations, by integrating healthier elements into a patient's usual diet while not entirely depriving them of their favorite foods.
Through this engaging conversation, we strive to debunk dietitian-related myths, address the pitfalls of restrictive dieting, and highlight the ultimate objective - fostering lasting and healthful dietary habits.
One of the highlights of the episode is the detailed walkthrough of the first consultation with a dietician. It involves a thorough evaluation of the patient's medical history, lifestyle, food consumption, and nutrition impact symptoms to devise a custom nutrition plan.
The conversation also ventures into other popular misconceptions about, including the expectation of selling expensive supplements and pressuring clients into an unattainable diet.
The mission, as clearly outlined in the episode, is not about eliminating favorite foods or inducing guilt.
If you would like to contact Rachel O'Brien for an individual consultation, please contact her via Coffs Coast Metabolic Surgery.
Consider joining our empowering six-week online course, "Change Your Relationship with Food", accessible on www.acfeb.com and our enlightening journal and workbook available for purchase on Amazon. Empower yourself to step away from imposing rules, diminish mindless eating tendencies, and transform your relationship with food.
Kyla Holley is the Director of the Australian Centre for Eating Behaviour www.acfeb.com
Take our 6 week Change your Relationship with Food online course
https://acfeb.thrivecart.com/change-your-relationship-with-food/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Music.
(00:29):
This podcast to make sure you don't miss a thing. I wanted to find out the truth
about dietitians, so I thought the best way to do that was to capture one and
force her to come and talk to us.
So the person I captured is called Rachel O'Brien, and she is actually a dietitian
in private practice in Australia.
She works mainly in gastrointestinal nutrition, bariatric surgery,
(00:52):
and weight management in adults, but we've managed to drag her away from intestines
and things today to have chat to us.
So hello, Rachel. Thanks for joining us.
Hi, Kyla, and thank you for having me. No problem at all.
Now, the first thing I wanted to clear up was there's lots of words banded around
about food and nutrition experts.
(01:14):
They can be called food coaches. You hear the word nutritionalist quite often,
and you hear the word dietitian.
So within Australia, I know being a a dietitian is protected title.
It's not that same way all over the world, but in Australia it is.
So tell me what sort of training that you had to go through to become a dietitian.
(01:34):
Yeah, so I completed a bachelor's degree in nutrition and dietetics.
And so I believe you can also complete a nutrition science degree and then do
a postgraduate master's in nutrition and dietetics as well.
And so then once completed the bachelor's degree, you then you graduated as
a dietitian, you then enter a supervised mentoring program for about 12 months.
(01:57):
So you're a provisional accredited practicing dietitian until then.
Once you complete the mentoring program, you then need to complete about 30
hours of ongoing professional education and training each year to remain as
an accredited dietitian.
So it's quite a tight regulation that's in place and that's all regulated by Dietitians Australia.
(02:20):
Okay. And how long was the degree that you took? Oh, four years. Yeah.
You have to think back into your youth, which isn't too distant, to be fair, for Rachel.
Wow. So that's actually quite – I mean, I don't know what all the other professions
have to do and I don't know as well –,
you know, as I say, it differs from country to country. I've got a friend who
(02:42):
works in Brazil who came to one of my courses a few years ago,
and she described herself as a nutritionalist.
But when I started talking to her about her training, it turns out that she
was probably a dietician, but maybe there's a different sort of structure in
Brazil that works differently.
But that's the way it works in Australia.
(03:02):
Going back three, your degree, what first ignited this sort of interest in dietetics for you?
So I've always been interested in all aspects of health and improving people's health.
I grew up where my father was a health professional, so that probably contributed to it.
I originally started off in an exercise science degree, when I think back.
(03:27):
I did that for about a year. And then during that first year,
I did a nutrition lecture.
And it was in that lecture where I was just fascinated by nutrition itself.
And I'm a big foodie myself, as many of us are. And I was fascinated also by
how food modification can really improve someone's health.
(03:47):
So from there, I transferred into the Bachelor of Nutrition and Dietetics.
And then that took, yeah, the four years from there.
And I loved it ever since. Did a clinical placement at the end of the degree,
and that was in a hospital setting as well as private practice.
And I just knew at the end of that placement that private practice was for me.
(04:09):
Finished up and landed my first job up in central Queensland as a private practice
the dietitian there in Gladstone and did that for about 12 months and then moved back to Coffs Harbour.
I mean, it's pretty obvious when you think about it that what you put into your
body has an effect on your health.
But more often we see certainly in medicine, you know, people going along to
(04:31):
the doctor with all sorts of health issues.
And rather than look at how they're fueling their body and what's going into
them nutritionally, they're after a bit of a quick fix, Give me a tablet to sort that out.
It must be a quick fix rather than actually addressing our fuel.
Because when you think about it, I mean, when you go and fill up your car with
(04:51):
petrol, you get a choice of petrels to use even.
So it sort of figures that our bodies would work in a similar way.
Yeah, that's right. Yeah, exactly.
I wanted to do this podcast because a lot of the people that come to see me
have a lot of preconceived ideas about dietitians, just probably the same sort
of preconceived ideas they have about coming to see me in the first place.
(05:15):
But I want to run through a few of them and hopefully we can sort of squash
some myths around what to expect when you go and see a dietitian.
And I suppose the angle I'm going in at with this is don't be scared if you
get a referral to a dietitian.
Don't be scared. They're there
to help you and hopefully teach you a few things that you didn't know.
(05:36):
Now, the first misconception I wanted to talk about is all dietitians are thin
and none of them understand how hard weight loss is.
So what do you think about that? So I have definitely heard that one before.
No, us dietitians come in all shapes and sizes.
But I think it's also, I really do take the time to listen to,
(05:57):
yeah, my patient's concerns.
And I really do recognize that there's so many different things that impact someone's food intake.
It can be the environment. It can be family life, finances, yeah,
work, lifestyle, medical issues. is.
And I think once you really take the time to listen to what that patient's concerns
(06:18):
are and what is making it tricky for them to lose weight or to improve their nutrition,
I think that just really helps to build that rapport and that trust.
And I think once you've got that trust with the patient, yeah,
I'm really hoping that misconception disappears in their head.
You know, when we think about our own bodies as well, I remember saying this
(06:41):
when I used to do eating disorder courses to everybody in the room because you
will be dealing with patients that come to you in very small bodies and patients
that come in very large bodies.
And the truth of the matter is us as clinicians, you are always going to be
bigger than someone and smaller than someone else.
So really, regardless of your own size, you're never going to please everybody.
(07:05):
You'll be too thin for some people. You'll be too fat for others.
So you've really got to, I think reflect on just accepting the package that
you come in and kind of making it irrelevant almost.
So true. Yeah, I definitely agree with that. So another
misconception that people might think of is that a dietician is going to restrict
(07:27):
their eating some way or get them to calorie count or put them on a diet because
a lot of people come in with this fear of they're going to take take away all
the foods that I love and tell me to eat lettuce and carrots and cucumber.
So what's the reality of that? Yeah. And it doesn't help that the word diet
is actually in our name as a profession with dietitians.
(07:49):
What could we change it to? We'll have to change the name.
Oh, that's right. I don't think that helps us at all. I think people,
yeah, straight away do think that, yeah, we are going to pop someone on a diet straight away.
But no, that's not necessarily the case. And as you would know too,
Kyla, we find that, yeah, when we do follow a diet or when we restrict our eating,
(08:10):
it might be effective in the short term, but we never really find it to be be
effective in that long term to be sustainable.
So we know that as dietitians and we're all about, we want to add things in
to the diet, into your food intake.
We don't want to take away your favorite foods or anything like that.
We want to add in. And we find that if we're doing that, we're going to get better outcomes.
(08:35):
It's going to help you to actually follow the recommendations that we give so
that they are effective and you do want to stick to them long term.
And they are sustainable.
I mean, that's just the right thing. I talk about diets a lot with the patients
that come to me and the fact that they do work in the short term.
But I have this phrase that I say to everyone, the best way to get fat is to go on a diet.
(09:01):
Because over the longer term, you get this J-shaped curve that appears.
And when you meet someone that's had, say,
30 or 40 years of diet history behind them you can virtually guarantee that
their weight is much higher now than it was when they first went on a diet age
16 or something like that so it's really important not to go with that restrictive
(09:24):
eating plan where people are going to feel,
really deprived really hemmed in and then they're going to feel so sorry for
themselves that they feel that they have to break out of that pattern and and
go the other direction and overindulge Yeah, that's right.
And that's with calorie counting as well. So it can also lead to that restriction.
(09:44):
If they feel like they have this set number of calories that they need to aim for each day.
And yeah, they could potentially be restricting themselves by following that.
And it's time consuming as well, counting calories. And so it's normally something that
we wouldn't necessarily recommend. We kind of do that counting of calories on
(10:05):
our side of things rather than get the patient to actually count calories themselves.
But I think in saying that, I've had patients come to me that that's something they enjoy.
They're quite up to date with all the latest apps that count calories and they're really keen to do it.
And so, look, if I've screened them for any disordered eating and they're all
clear and, yeah, I may say, okay, yeah, yeah, we'll support you with this.
(10:29):
But normally it is only for about a short term thing.
And then eventually we transition them off counting calories and focusing on
just the food on itself rather than the numbers.
When you think about it, Michael Mosley's making a fortune off calorie counting
at the moment with the fast 800.
Do you get people in that have tried all these different diets,
the latest book that's come out?
(10:50):
Because sometimes people get so indoctrinated into a like a certain method that
they've read about, it's almost like a sort of a cult-like thing and that they
get really enthusiastic about this particular method that they've found.
How difficult is it to deprogram people from that, do you think?
Oh, it takes a lot. It can.
(11:11):
It's tricky. Yeah, you see this all on social media, you see it on television,
you see it on news articles, the friends are doing it, the family's doing it.
It can, it can become so ingrained in their heads and that's
what what they think is right so it does I think once you've really built that
rapport with the patient I think it's taking the time to really sit down and
explain explain it all to them give it that education with how yeah a different
(11:35):
approach may potentially suit them better in that long term I think I'm definitely
all for that long-term sustainable results.
And it's much more individualized, the approach that you have as well.
I mean, what those diets are sold on, particularly, I mean, it says it in the
title, the fast 800, the idea that this is going to be quick.
(11:55):
And quite often when people come to us, they want that quick solution that they've
been kind of led to believe is attainable.
You know, there's hundreds of books and methods out there that tell you you
can do this in 10 days or you can do a 12-week challenge and it will change your life.
Whereas the reality is to make a proper change, a sustainable change,
(12:20):
you've got to adopt a completely different mindset towards it.
Yeah, I definitely agree with that. Very true. True.
So you take your time to actually look at the individual, their lifestyle,
what they're bringing into the room before you decide sort of where to go with
them, which none of those books do any of that. It's a one size fits all approach.
(12:42):
So what can people actually expect? Let's say I go to my GP and the GP says
to me, I'm going to refer you to a dietician.
Give me an idea of what what I can expect in that first session with a dietician.
Okay, so normally the patient would come in and see me.
I may have some information that's been sent to me from the doctor.
(13:04):
That might have some information on medical history, medications,
and then sometimes we don't receive any information at all.
So it's more straight away just asking the client why they are coming to see
me today, what their goals are.
And then we go into nutrition assessment.
So the nutrition assessment is quite comprehensive. It does involve quite a lot of questions.
(13:24):
So I do tend to give the heads up at the start, but I will be asking quite a
few questions today. day, but it's all just to make sure that the recommendations
I give, yeah, as we've talked about, tailored to them and their individual needs.
So I will explore medical history, medications, if that's not already given to me.
I'll look at social history. So who lives at home, who does the cooking,
(13:46):
shopping, work, lifestyle, involved in any sports, yeah, physical activity levels.
I'll then go on to explore any nutrition impact symptoms.
So what that means is I'll most Most likely ask about bowels,
do they experience any constipation, diarrhea, so anything that can really impact their food intake.
(14:08):
So if they're quite constipated, potentially that might be affecting the types
of foods they eat or how they eat.
We'll then go on to explore food intake. So we do a diet history,
see what they're eating on a typical day or a not so typical day.
And then from there, we set individual goals, yeah,
that the patient's keen to achieve, set some strategies give some education
(14:31):
and then organize a follow-up review and how many times are they likely to have
to come and see you do you think or is that wildly different with everybody.
Wildly different yes so depending on what the
reason why they've come to see me I may see a
client again in about every fortnight until
(14:52):
we start to achieve the goals that we're aiming
for or it might be monthly yeah it really does
depend on on the individual and will
you force them to do a food diary i'm asking on
behalf of the nation because a lot of people think oh i'm gonna have to log
everything that i eat or drink for this woman tell the truth rachel tell the
(15:13):
truth well to be honest i will admit my first year out when i was working in
private practice up in Gladstone,
I did try and encourage my patients to do food diaries and I probably did that
for a couple of months and then I learnt quite quick that that was not the method.
No, so we don't recommend food diaries unless in saying that.
(15:37):
We're looking at gut issues or gut complaints and I need them to really do quite
a big food diary that's detailed to identify any food intolerances or allergies or so forth.
I mean, full disclosure, I use them within eating disorder work,
but I don't, because I'm not a dietician, I'm not really looking at the food.
What I'm looking for is behavioural patterns.
So I'm looking for, you know, does this person crave something sweet at four
(16:02):
o'clock every afternoon?
Or do they eat the majority of their food late in the day as opposed to early in the day?
Or do they always skip breakfast? So I'm really looking at the patterns rather
than looking at the actual food, which you would do because you're more of a scientist than me.
You look at the science behind things, whereas I'm more of a behaviouralist, if you like.
(16:23):
I'm looking at what inspires people to do what they do.
So it's slightly different. But yeah, I think they're just universally hated
and I often have to really sort of sell the idea of a food diary as being.
A good tool to examine your own behavior and
just reflect on it with no judgment that's the
(16:44):
big thing is I always say to people I'm never going to
go oh wow you know what did you do
on Tuesday or you know I'm not going to judge their behavior at
all it's just purely that we can't follow
them around the whole time looking at what they're doing
so it's just a kind of reporting back mechanism I suppose yeah I agree and definitely
(17:04):
helps with awareness I think a lot of the times I won't necessarily recommend
them to do a food diary but they'll do a food diary anyway and bring it in yeah
so yeah the ones that want to do it will do it.
Now, can you think of any, because I mean, I was struggling to think of all
these misconceptions, but do you get any others that I've missed out?
(17:25):
Some people that come to you and go, I thought you would, whatever the gaps
are. Anything else that we've missed?
I think a lot of the times too, I get people assuming we're going to recommend
quite a lot of supplements, expensive supplements, which isn't necessarily the case.
We look more at at food first and then if things can't be achieved through food
(17:49):
that's when we may suggest,
supplementation if that's vitamins minerals protein supplements
and so forth so i do find that that's something
a lot of people assume happens straight away and yeah i think we've covered
quite a lot kyla so far with the other ones definitely people think that we
take their favorite foods away or quite restrictive that's definitely a big
(18:11):
one i've also heard that many Many people assume dietitians eat perfectly.
Yes, yes. I should have come up with that, obviously. So are people peering
into your trolley in Woolworths, that sort of thing?
I have had that happen before and I do get asked on a regular basis what I eat
(18:32):
for breakfast, lunch and dinner as well.
Yeah, yeah. And what do you do when that happens?
Do you just be absolutely truthful or do you kind of do the sort of do as I
say, not as I do approach?
No, I'm definitely truthful.
I was just thinking the other day, well, we just had Easter,
didn't we? And I was thinking, oh, I actually did have some chocolate for breakfast.
(18:55):
I was going to say having some chocolate, but chocolate for breakfast,
yeah. Chocolate before I had my cereal. Yeah.
And to be honest, that's absolutely fine. If you're not doing that every day,
which we're not generally, you know, it's just another different type of food.
You know, I don't criminalize chocolate at all.
(19:16):
It's just another type of food. I've mentioned this a whole load in the podcast
that the way that we separate food into good and bad,
we give those foods that we view or we perceive as bad a lot more power than
they actually deserve, really.
And we create that. We give them the power by calling them a treat or an indulgence.
(19:38):
We make them way more special than they actually are.
So having chocolate for breakfast, completely legitimate in the world of Rachel. No problem at all.
Well,
look, thank you so much for taking the time out to speak to me today.
I really hope we have quashed a few worries from people because I think always
(20:02):
when you get a GP referral to any medical professional, it's always what are they going to do?
Are they going to charge me money for things I already know?
Are they going to make me do things I don't want to do? So I think if we can
just alleviate a little bit of that apprehension around meeting someone and
talking to them about your relationship with food, then hopefully we've done an OK job today.
(20:26):
So thank you so much, Rachel. And we will be coming back next week with more
Change Your Relationship with Food.
Thank you so much for your company today. I would also love it if you could follow this podcast.
It really does mean a lot to me. also we have
a six-week online change your relationship with food
course that you can take just visit www.acfeb.com and click on the ACFEB and
(20:55):
me courses link there's also a journal and a workbook available on Amazon and
you'll find that link in our bio I really hope you can join me again next week.
Music.
Music.
(00:29):
This podcast to make sure you don't miss a thing. I wanted to find out the truth
about dietitians, so I thought the best way to do that was to capture one and
force her to come and talk to us.
So the person I captured is called Rachel O'Brien, and she is actually a dietitian
in private practice in Australia.
She works mainly in gastrointestinal nutrition, bariatric surgery,
(00:52):
and weight management in adults, but we've managed to drag her away from intestines
and things today to have chat to us.
So hello, Rachel. Thanks for joining us.
Hi, Kyla, and thank you for having me. No problem at all.
Now, the first thing I wanted to clear up was there's lots of words banded around
about food and nutrition experts.
(01:14):
They can be called food coaches. You hear the word nutritionalist quite often,
and you hear the word dietitian.
So within Australia, I know being a a dietitian is protected title.
It's not that same way all over the world, but in Australia it is.
So tell me what sort of training that you had to go through to become a dietitian.
(01:34):
Yeah, so I completed a bachelor's degree in nutrition and dietetics.
And so I believe you can also complete a nutrition science degree and then do
a postgraduate master's in nutrition and dietetics as well.
And so then once completed the bachelor's degree, you then you graduated as
a dietitian, you then enter a supervised mentoring program for about 12 months.
(01:57):
So you're a provisional accredited practicing dietitian until then.
Once you complete the mentoring program, you then need to complete about 30
hours of ongoing professional education and training each year to remain as
an accredited dietitian.
So it's quite a tight regulation that's in place and that's all regulated by Dietitians Australia.
(02:20):
Okay. And how long was the degree that you took? Oh, four years. Yeah.
You have to think back into your youth, which isn't too distant, to be fair, for Rachel.
Wow. So that's actually quite – I mean, I don't know what all the other professions
have to do and I don't know as well –,
you know, as I say, it differs from country to country. I've got a friend who
(02:42):
works in Brazil who came to one of my courses a few years ago,
and she described herself as a nutritionalist.
But when I started talking to her about her training, it turns out that she
was probably a dietician, but maybe there's a different sort of structure in
Brazil that works differently.
But that's the way it works in Australia.
(03:02):
Going back three, your degree, what first ignited this sort of interest in dietetics for you?
So I've always been interested in all aspects of health and improving people's health.
I grew up where my father was a health professional, so that probably contributed to it.
I originally started off in an exercise science degree, when I think back.
(03:27):
I did that for about a year. And then during that first year,
I did a nutrition lecture.
And it was in that lecture where I was just fascinated by nutrition itself.
And I'm a big foodie myself, as many of us are. And I was fascinated also by
how food modification can really improve someone's health.
(03:47):
So from there, I transferred into the Bachelor of Nutrition and Dietetics.
And then that took, yeah, the four years from there.
And I loved it ever since. Did a clinical placement at the end of the degree,
and that was in a hospital setting as well as private practice.
And I just knew at the end of that placement that private practice was for me.
(04:09):
Finished up and landed my first job up in central Queensland as a private practice
the dietitian there in Gladstone and did that for about 12 months and then moved back to Coffs Harbour.
I mean, it's pretty obvious when you think about it that what you put into your
body has an effect on your health.
But more often we see certainly in medicine, you know, people going along to
(04:31):
the doctor with all sorts of health issues.
And rather than look at how they're fueling their body and what's going into
them nutritionally, they're after a bit of a quick fix, Give me a tablet to sort that out.
It must be a quick fix rather than actually addressing our fuel.
Because when you think about it, I mean, when you go and fill up your car with
(04:51):
petrol, you get a choice of petrels to use even.
So it sort of figures that our bodies would work in a similar way.
Yeah, that's right. Yeah, exactly.
I wanted to do this podcast because a lot of the people that come to see me
have a lot of preconceived ideas about dietitians, just probably the same sort
of preconceived ideas they have about coming to see me in the first place.
(05:15):
But I want to run through a few of them and hopefully we can sort of squash
some myths around what to expect when you go and see a dietitian.
And I suppose the angle I'm going in at with this is don't be scared if you
get a referral to a dietitian.
Don't be scared. They're there
to help you and hopefully teach you a few things that you didn't know.
(05:36):
Now, the first misconception I wanted to talk about is all dietitians are thin
and none of them understand how hard weight loss is.
So what do you think about that? So I have definitely heard that one before.
No, us dietitians come in all shapes and sizes.
But I think it's also, I really do take the time to listen to,
(05:57):
yeah, my patient's concerns.
And I really do recognize that there's so many different things that impact someone's food intake.
It can be the environment. It can be family life, finances, yeah,
work, lifestyle, medical issues. is.
And I think once you really take the time to listen to what that patient's concerns
(06:18):
are and what is making it tricky for them to lose weight or to improve their nutrition,
I think that just really helps to build that rapport and that trust.
And I think once you've got that trust with the patient, yeah,
I'm really hoping that misconception disappears in their head.
You know, when we think about our own bodies as well, I remember saying this
(06:41):
when I used to do eating disorder courses to everybody in the room because you
will be dealing with patients that come to you in very small bodies and patients
that come in very large bodies.
And the truth of the matter is us as clinicians, you are always going to be
bigger than someone and smaller than someone else.
So really, regardless of your own size, you're never going to please everybody.
(07:05):
You'll be too thin for some people. You'll be too fat for others.
So you've really got to, I think reflect on just accepting the package that
you come in and kind of making it irrelevant almost.
So true. Yeah, I definitely agree with that. So another
misconception that people might think of is that a dietician is going to restrict
(07:27):
their eating some way or get them to calorie count or put them on a diet because
a lot of people come in with this fear of they're going to take take away all
the foods that I love and tell me to eat lettuce and carrots and cucumber.
So what's the reality of that? Yeah. And it doesn't help that the word diet
is actually in our name as a profession with dietitians.
(07:49):
What could we change it to? We'll have to change the name.
Oh, that's right. I don't think that helps us at all. I think people,
yeah, straight away do think that, yeah, we are going to pop someone on a diet straight away.
But no, that's not necessarily the case. And as you would know too,
Kyla, we find that, yeah, when we do follow a diet or when we restrict our eating,
(08:10):
it might be effective in the short term, but we never really find it to be be
effective in that long term to be sustainable.
So we know that as dietitians and we're all about, we want to add things in
to the diet, into your food intake.
We don't want to take away your favorite foods or anything like that.
We want to add in. And we find that if we're doing that, we're going to get better outcomes.
(08:35):
It's going to help you to actually follow the recommendations that we give so
that they are effective and you do want to stick to them long term.
And they are sustainable.
I mean, that's just the right thing. I talk about diets a lot with the patients
that come to me and the fact that they do work in the short term.
But I have this phrase that I say to everyone, the best way to get fat is to go on a diet.
(09:01):
Because over the longer term, you get this J-shaped curve that appears.
And when you meet someone that's had, say,
30 or 40 years of diet history behind them you can virtually guarantee that
their weight is much higher now than it was when they first went on a diet age
16 or something like that so it's really important not to go with that restrictive
(09:24):
eating plan where people are going to feel,
really deprived really hemmed in and then they're going to feel so sorry for
themselves that they feel that they have to break out of that pattern and and
go the other direction and overindulge Yeah, that's right.
And that's with calorie counting as well. So it can also lead to that restriction.
(09:44):
If they feel like they have this set number of calories that they need to aim for each day.
And yeah, they could potentially be restricting themselves by following that.
And it's time consuming as well, counting calories. And so it's normally something that
we wouldn't necessarily recommend. We kind of do that counting of calories on
(10:05):
our side of things rather than get the patient to actually count calories themselves.
But I think in saying that, I've had patients come to me that that's something they enjoy.
They're quite up to date with all the latest apps that count calories and they're really keen to do it.
And so, look, if I've screened them for any disordered eating and they're all
clear and, yeah, I may say, okay, yeah, yeah, we'll support you with this.
(10:29):
But normally it is only for about a short term thing.
And then eventually we transition them off counting calories and focusing on
just the food on itself rather than the numbers.
When you think about it, Michael Mosley's making a fortune off calorie counting
at the moment with the fast 800.
Do you get people in that have tried all these different diets,
the latest book that's come out?
(10:50):
Because sometimes people get so indoctrinated into a like a certain method that
they've read about, it's almost like a sort of a cult-like thing and that they
get really enthusiastic about this particular method that they've found.
How difficult is it to deprogram people from that, do you think?
Oh, it takes a lot. It can.
(11:11):
It's tricky. Yeah, you see this all on social media, you see it on television,
you see it on news articles, the friends are doing it, the family's doing it.
It can, it can become so ingrained in their heads and that's
what what they think is right so it does I think once you've really built that
rapport with the patient I think it's taking the time to really sit down and
explain explain it all to them give it that education with how yeah a different
(11:35):
approach may potentially suit them better in that long term I think I'm definitely
all for that long-term sustainable results.
And it's much more individualized, the approach that you have as well.
I mean, what those diets are sold on, particularly, I mean, it says it in the
title, the fast 800, the idea that this is going to be quick.
(11:55):
And quite often when people come to us, they want that quick solution that they've
been kind of led to believe is attainable.
You know, there's hundreds of books and methods out there that tell you you
can do this in 10 days or you can do a 12-week challenge and it will change your life.
Whereas the reality is to make a proper change, a sustainable change,
(12:20):
you've got to adopt a completely different mindset towards it.
Yeah, I definitely agree with that. Very true. True.
So you take your time to actually look at the individual, their lifestyle,
what they're bringing into the room before you decide sort of where to go with
them, which none of those books do any of that. It's a one size fits all approach.
(12:42):
So what can people actually expect? Let's say I go to my GP and the GP says
to me, I'm going to refer you to a dietician.
Give me an idea of what what I can expect in that first session with a dietician.
Okay, so normally the patient would come in and see me.
I may have some information that's been sent to me from the doctor.
(13:04):
That might have some information on medical history, medications,
and then sometimes we don't receive any information at all.
So it's more straight away just asking the client why they are coming to see
me today, what their goals are.
And then we go into nutrition assessment.
So the nutrition assessment is quite comprehensive. It does involve quite a lot of questions.
(13:24):
So I do tend to give the heads up at the start, but I will be asking quite a
few questions today. day, but it's all just to make sure that the recommendations
I give, yeah, as we've talked about, tailored to them and their individual needs.
So I will explore medical history, medications, if that's not already given to me.
I'll look at social history. So who lives at home, who does the cooking,
(13:46):
shopping, work, lifestyle, involved in any sports, yeah, physical activity levels.
I'll then go on to explore any nutrition impact symptoms.
So what that means is I'll most Most likely ask about bowels,
do they experience any constipation, diarrhea, so anything that can really impact their food intake.
(14:08):
So if they're quite constipated, potentially that might be affecting the types
of foods they eat or how they eat.
We'll then go on to explore food intake. So we do a diet history,
see what they're eating on a typical day or a not so typical day.
And then from there, we set individual goals, yeah,
that the patient's keen to achieve, set some strategies give some education
(14:31):
and then organize a follow-up review and how many times are they likely to have
to come and see you do you think or is that wildly different with everybody.
Wildly different yes so depending on what the
reason why they've come to see me I may see a
client again in about every fortnight until
(14:52):
we start to achieve the goals that we're aiming
for or it might be monthly yeah it really does
depend on on the individual and will
you force them to do a food diary i'm asking on
behalf of the nation because a lot of people think oh i'm gonna have to log
everything that i eat or drink for this woman tell the truth rachel tell the
(15:13):
truth well to be honest i will admit my first year out when i was working in
private practice up in Gladstone,
I did try and encourage my patients to do food diaries and I probably did that
for a couple of months and then I learnt quite quick that that was not the method.
No, so we don't recommend food diaries unless in saying that.
(15:37):
We're looking at gut issues or gut complaints and I need them to really do quite
a big food diary that's detailed to identify any food intolerances or allergies or so forth.
I mean, full disclosure, I use them within eating disorder work,
but I don't, because I'm not a dietician, I'm not really looking at the food.
What I'm looking for is behavioural patterns.
So I'm looking for, you know, does this person crave something sweet at four
(16:02):
o'clock every afternoon?
Or do they eat the majority of their food late in the day as opposed to early in the day?
Or do they always skip breakfast? So I'm really looking at the patterns rather
than looking at the actual food, which you would do because you're more of a scientist than me.
You look at the science behind things, whereas I'm more of a behaviouralist, if you like.
(16:23):
I'm looking at what inspires people to do what they do.
So it's slightly different. But yeah, I think they're just universally hated
and I often have to really sort of sell the idea of a food diary as being.
A good tool to examine your own behavior and
just reflect on it with no judgment that's the
(16:44):
big thing is I always say to people I'm never going to
go oh wow you know what did you do
on Tuesday or you know I'm not going to judge their behavior at
all it's just purely that we can't follow
them around the whole time looking at what they're doing
so it's just a kind of reporting back mechanism I suppose yeah I agree and definitely
(17:04):
helps with awareness I think a lot of the times I won't necessarily recommend
them to do a food diary but they'll do a food diary anyway and bring it in yeah
so yeah the ones that want to do it will do it.
Now, can you think of any, because I mean, I was struggling to think of all
these misconceptions, but do you get any others that I've missed out?
(17:25):
Some people that come to you and go, I thought you would, whatever the gaps
are. Anything else that we've missed?
I think a lot of the times too, I get people assuming we're going to recommend
quite a lot of supplements, expensive supplements, which isn't necessarily the case.
We look more at at food first and then if things can't be achieved through food
(17:49):
that's when we may suggest,
supplementation if that's vitamins minerals protein supplements
and so forth so i do find that that's something
a lot of people assume happens straight away and yeah i think we've covered
quite a lot kyla so far with the other ones definitely people think that we
take their favorite foods away or quite restrictive that's definitely a big
(18:11):
one i've also heard that many Many people assume dietitians eat perfectly.
Yes, yes. I should have come up with that, obviously. So are people peering
into your trolley in Woolworths, that sort of thing?
I have had that happen before and I do get asked on a regular basis what I eat
(18:32):
for breakfast, lunch and dinner as well.
Yeah, yeah. And what do you do when that happens?
Do you just be absolutely truthful or do you kind of do the sort of do as I
say, not as I do approach?
No, I'm definitely truthful.
I was just thinking the other day, well, we just had Easter,
didn't we? And I was thinking, oh, I actually did have some chocolate for breakfast.
(18:55):
I was going to say having some chocolate, but chocolate for breakfast,
yeah. Chocolate before I had my cereal. Yeah.
And to be honest, that's absolutely fine. If you're not doing that every day,
which we're not generally, you know, it's just another different type of food.
You know, I don't criminalize chocolate at all.
(19:16):
It's just another type of food. I've mentioned this a whole load in the podcast
that the way that we separate food into good and bad,
we give those foods that we view or we perceive as bad a lot more power than
they actually deserve, really.
And we create that. We give them the power by calling them a treat or an indulgence.
(19:38):
We make them way more special than they actually are.
So having chocolate for breakfast, completely legitimate in the world of Rachel. No problem at all.
Well,
look, thank you so much for taking the time out to speak to me today.
I really hope we have quashed a few worries from people because I think always
(20:02):
when you get a GP referral to any medical professional, it's always what are they going to do?
Are they going to charge me money for things I already know?
Are they going to make me do things I don't want to do? So I think if we can
just alleviate a little bit of that apprehension around meeting someone and
talking to them about your relationship with food, then hopefully we've done an OK job today.
(20:26):
So thank you so much, Rachel. And we will be coming back next week with more
Change Your Relationship with Food.
Thank you so much for your company today. I would also love it if you could follow this podcast.
It really does mean a lot to me. also we have
a six-week online change your relationship with food
course that you can take just visit www.acfeb.com and click on the ACFEB and
(20:55):
me courses link there's also a journal and a workbook available on Amazon and
you'll find that link in our bio I really hope you can join me again next week.
Music.
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