Nutritionists: It's More than Just the Food
“I was destined to be a victim of death by food.” That’s how Beth Armstead (name changed) described her outlook prior to working with local Seattle nutritionist Sally Pechstein, MPH, RD, CD, CDE. As a morbidly obese woman, Armstead says she suffered the misguided admonitions of countless practitioners who urged her to “eat carrots instead of chips,” while never investigating the reasons she used food in an unhealthy manner in the first place. It took two years of steady work with Pechstein to learn to change her relationship with food … and it started with understanding herself first.
“When I first met Sally,” she explains “she told me that it was all OK — the food, my life and me. I had to accept where I was before anything could change.” Now, almost 150 pounds lighter, Armstead says that her experience working with a nutritionist has been integral to her weight loss and maintenance plan. Pechstein, a registered dietitian and certified diabetes educator, worked for years in a Seattle medical center, treating women with chronic illness and disordered eating. Now in private practice, she strives to “help others create health for themselves by nurturing body, mind and spirit.”
WHAT CAN A NUTRITIONIST OFFER?
With over 65,000 members, the American Dietetic Association (ADA) is the nation’s largest organization of nutrition experts. Promoting more than just good food choices, these practitioners help inform clients about lifestyle modifications that make significant differences in their overall health. According to the U.S. Bureau of Labor Statistics, the employment of dietitians and nutritionists is expected to grow because of increased emphasis on disease prevention, a growing and aging population, and public interest in nutrition.
Judy Simon, MS, RD, CD at the University of Washington Medical Center, sees clients seeking assistance with a variety of health concerns. “One of the common reasons that cause women to seek the care of a nutritionist might be weight issues of course,” says Simon, “but also, I see clients that have disordered eating patterns (anorexia, bulimia, binge eating); metabolic disorders (diabetes and polycystic ovary syndrome); chronic disease; infertility and osteoporosis.” Simon stresses that the field of nutritional “experts” can be confusing, so she suggests women seek a nutritionist with strong credentials and experience. “The state of Washington,” she adds “grants the titles of certified dietitian and certified nutritionist based on very solid academic degrees. A registered dietitian has completed a minimum of a B.S. degree, an extensive internship, along with a requirement for continuing education.”
As a member of the American Association of Diabetic Educators, Doris Piccinin, MS, RD, CDE at Bastyr University, sees her work with women who’ve been diagnosed as pre-diabetic as extremely important. “We see more and more patients who are referred by their medical doctors; with proper nutritional support they can prevent the disease from progressing and can prevent many complications from occurring,” she explains. Like Simon, Piccinin also treats women with polycystic ovary syndrome (PCOS) and infertility issues. “As nutritionists, we can assist women in making food choices that can decrease the symptoms of PCOS and support their treatment of infertility,” Piccinin says. “With any medical condition, it’s important that women seek the specific type of nutritional support or treatment they need.”
In order to understand those needs, expect a nutritionist to complete a thorough nutritional history — including past and current eating habits, physical activity levels, physical and emotional health status and a review of medications, pertinent lab work and health history. Simon and Piccinin both use diet diaries; clients track their current eating habits, recording the foods they eat, the times and places eating occurs, and even their emotional state while eating. “It’s important for a woman to understand why she’s eating,” explains Piccinin. “What she’s feeling — stressed, bored, and angry? Most chronic diseases have an emotional component to them and it’s something we can help our clients understand.”
After the initial consultation, most women are presented with an individualized plan that will include healthier food choices and some lifestyle changes that can positively impact their treatment. Adding small but significant changes — Piccinin suggests to working women who can’t find time to exercise that they keep their water bottle only half full, requiring them to walk several times a day to fill it up — can have a lasting effect on a woman’s health. Simon uses pictures and models as a way to review food choices, and both nutritionists agree that it’s extremely important for a woman not to feel judged based on what she eats or weighs. “There was so much judgment going on in years past,” says Piccinin. “Now we concentrate on the good parts the client already has in place — and make some simple changes.”
“It does sound simplistic,” adds Simon, “but sometimes one of the changes we suggest might be just eating all meals and snacks in a designated eating area (e.g., at the table) instead of in the bedroom or home office.”
SMALL CHANGES EQUAL BIG RESULTS
Over time, these modifications can achieve significant results. Mona Fahoum is a naturopathic physician who uses nutritional counseling in her practice on a daily basis. She believes that in seeking nutritional advice, women are attempting to enhance their overall health — and lower their future risk factors for disease. “I see women who want to maintain their health by continuing certain practices, women approaching menopause who want to transition gracefully, or women who are tired of being unhealthy or overweight,” explains Fahoum. “They’re ready to stop ‘dieting’ and learn good, healthy habits that are sustainable.”
She sees three small changes making a big difference in her clients overall health: adding fiber, drinking plenty of water and increasing movement. “Whatever it is, find something you love,” Fahoum exhorts. “Find something you enjoy and move.”
Simon concurs. “Be active on a daily basis,” she says. “Also, whole grains and foods of color will improve any nutritional plan.” She encourages women to add texture and color when making food choices — keeping the diet simple and whole-food based. Piccinin agrees, adding that healthy alternatives can be substituted for any food craving. “Many of my clients really don’t know how to cook from ‘scratch,’ so we can help them with that as well. We have file cabinets full of recipes that are delicious and easy — we can teach our clients to prepare healthy food that tastes good!”
All of the practitioners interviewed for this article stressed that understanding the emotional aspects of a woman’s eating and activity habits is crucial to changing unsuccessful patterns. Encouraging mindful eating, they urge clients to think about what’s going on within, and to discern the difference between emotional and hunger cues. Stress reduction, ongoing consultations and support, and learning portion control can have a meaningful impact on a woman’s nutritional plan. “In the 13 years that I’ve been a practicing dietitian, I’ve seen such amazing changes,” concludes Piccinin. “We have evidence-based information that supports a natural perspective on improving lifestyle and health. Sound nutritional plans are so important. Prevention is so much better than treatment!”
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