Thursday, August 6, 2015

The 'Secret' Life of a Dietitian

I had a patient the other day tell me that I couldn't possibly understand the challenge of getting seven fruits and vegetables in my diet because, most likely, I had double that on any given day. I wish. As we went on in the conversation, I actually started to count how many I had consumed the day before -- it was three, total. Sometimes, even for a dietitian, life can get in the way and meeting the mark on diet doesn't always happen. The perception, however, is that dietitians are perfect eaters, they exercise for 60 minutes, seven days a week and they would not dare touch a piece of candy -- ever. It's probably our fault that this persona has prevailed. Go to any dietitian's website, including mine, and you'll find at least one picture with the expert holding colorful produce or cooking with organic vegetables. It's really no different than a Doctor who takes all of his or her photos in a lab coat with a stethoscope around their neck or a teacher that takes a picture in front of a chalkboard. As a society, we've stereotyped what certain professions look like and how professionals must surely act from day to day. As nutrition professionals, I'd like to believe that the majority of us do in fact eat better than the average American. But the secret is, we are human, and we have our slip ups as well. That's actually what makes us great agents of change in others. I surveyed 15 of my colleagues from around the country to find out exactly how they defy the perception that their patients have put upon them. Here are seven points that stood out:

1. We don't count calories or "diet"
There are two numbers that I found most dietitians don't know: Their weight and the exact number of calories they eat in a day. I strive to eat nutrient dense every day. That means I'm getting foods that actually nourish me, fill me, and satisfy my desire to improve my health. Most of these foods are either low in calories (like vegetables) or high in healthy fats, fiber or protein to make me fuller, quicker (like nuts or eggs). It's truly the low nutrient dense foods (like candy, cookies and white refined flours) that fill up our bank of calories without actually filling our bellies. I practice this way of eating at least 90 percent of the time and preach it to my patients as well. I do, however recommend recording food either in a diary or on the computer or phone, especially if you're in the midst of trying to lose weight. Doing so may increase accountability and actually having to record what you eat makes you more aware of your overall choices as well. Most dietitians' I spoke with tell me it's their pants (too tight or too loose) that indicate changes in weight. Most of us also know that "dieting" doesn't work either, and so few of us actually put our patients on diets.

2. We have to work to maintain our weight too
My friend Laura is hands down one of the smartest Dietitians I have ever had the pleasure to work with. She knows how to handle the most complex cases and is always up on the latest research in the field. She's run almost 30 marathons (29 to be exact), and is great with patients. She also used to be obese. Laura's struggles truly formed her into the Dietitian that she is today but she has to work -- every -- single -- day to keep her weight within a normal range. I've heard many people say that Dietitians are all super skinny and could not possibly understand the struggles and challenges associated with being overweight. I'd argue that this is simply not true 100 percent of the time. In fact many RD's (myself included) went into the field because they struggled with weight and diet at a young age. Many of us personally know how hard it is to lose weight, how hard it is to keep it off, and how easy it can be to fall back into bad habits.

3.We're not all vegan
While I don't know many Dietitians who eat greasy cheeseburgers every night, a lot of the men and women who I surveyed do enjoy meat from time to time. It's the type of meat that's important, though. Grain fed beef is not the same as grass fed, farmed fish is a world away from wild and chickens (and their eggs) should be free of hormones, antibiotics and tight cages. This view on meat probably fits in with the nutrient dense goals that many dietitians are following. It's OK to eat meat, just choose responsibly and stick with forms that are closer to what actually occurs in the wild.

4. Not all of our kids love their vegetables
Last month, I had the opportunity to have dinner with ten of my Dietetic school friends. Most us are married now and have at least one child and therefore, the topic of our children's eating habits took center stage. I found at that dinner that most kids under the age of three didn't eat the vegetables that mom or dad put on their plates every day. I also learned that mom and dad were bribing; or rather, enhancing with tactics we didn't learn about in dietetic school. One mom put sprinkles on mixed vegetables, another offered one chocolate coated candy for every piece of broccoli eaten and yet another put cheese on any food that was green. Dietitians have the knowledge on rational approaches to eat better, but you can't always force a 3-year-old to eat more green on their plate, despite the most valiant efforts. A 2015 study suggested that choosing foods that are not necessarily healthy but taste good is actually a very rational decision for kids to make and that Dietitians should recognize that kids may not always eat something they find distasteful just because you tell them it's "good for them." Dietitian parents struggle just like any other parent, but we keep working to find ways to make fruits, vegetables and other healthy foods appealing to our kids. Many of us take our children shopping and allow them to help pick produce and even help in preparing it. We have also learned that pairing with dips for example (like hummus and cucumber) works as well. Additionally, so many of the parents I spoke with bought books that focus on innovative ways to hide vegetables in everyday meals. But when you're desperate, and your child's arms are crossed, sometimes sprinkles work too.

5. We eat fries
Many people whom I have counseled find it effective to incorporate a 90/10 rule where most of the food (90 percent) they are eating is nutrient dense. Many of my Dietitian friends do the same. We're not all sitting around chomping on carrots, and we do allow ourselves the occasional treat. The difference is, we usually save these treats for the real stuff. I love ice cream for example, but instead of satisfying my craving every day with a fat-free, sugar-free fudge bar, I'll head to my local creamery and get the real deal twice a month. I eat it slowly. I savor it. And I don't feel guilty afterwards. Few dietitians starve themselves or skip meals.Most of us know that doing so is usually a recipe for weight gain, not weight loss.

6.We don't judge people that are overweight or who have really bad eating habits
There's a look I get when a patient of mine is about to tell me that they've eaten something they feel they shouldn't have. It's the same look my dog gives me when she's eaten the heel off of my favorite shoes. The eyes look to the ground, ashamed and afraid of what comes next and there is hesitation. Most of the time, before the food is announced, it's preceded with "you're going to be mad at me, but..." Guess what, I'm not mad, and I'm not judging, I'm proud that you came to me in the first place, that you told the truth to so that you could get help and that you recognize a need to alter your diet. I chose this profession because I want to be a coach, a motivator, and an ally. I'm not here to ridicule and judge. Altering the way we eat is perhaps one of the hardest changes to make. There are so many factors influencing both our weight and why we choose to eat certain foods, including genetics, stress, sleep duration and even events stemming from our childhood. Any dietitian that tells you "it's easy" to change what you eat most likely never made that change themselves.

7. We value physical activity
Of all the Dietitians that I surveyed, every last one did some form of exercise at least five days a week. It may not have always been a full 60 minutes, and we may not have lost our breath, but we did it. We moved. Most of my colleagues value those most basic principles of healthy living. While food is our focus (and our bias precludes us to thinking it is probably THE most important aspect of healthy living), we know that stress management and moving are key indicators of health as well.

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