Do dietitians make meal plans? What dietitians do (and don’t do)

 In Feature, Nutrition Business

I’ve been doing a lot of advocacy work for my business, Ignite Nutrition Inc. lately. In doing  so, I’ve discovered a lot of people loosely understand what a dietitian does and doesn’t do, but for the most part people lack an understanding of what a dietitian offers.

1. Dietitians know food

Of course, everybody eats, so everybody knows food. Google and the internet have made it possible for people to gain a deeper understanding of what they eat. The problem with that is, any yoo-hoo can post any THING they want. With enough traction and followers, what they’ve essentially ‘made up’ becomes a conversation piece at coffee dates. The word spreads. It be comes indisputable truth. “I heard it from Fran, and she has a personal trainer, therefore she must have gotten the info from them, and it must be true.”
Dietitians not only have an understanding of food as a whole, but also have an extensive understanding of physiology and biochemistry. How the body uses nutrients. And more importantly, how it doesn’t. Just because something physiologically makes sense, doesn’t necessarily make it true. For example, one you will see there a lot is that B vitamins INCREASE your metabolism. Sure, if you are deficient in B vitamins, your body probably isn’t properly converting nutrition into energy, therefore in theory, you’d have slowed metabolism. So, in the minds of those who purport this, they believe that adding more B vitamins will increase your metabolism. In practice, you’d have to be DEFICIENT in these vitamins to have a change in your metabolism when you add more. In practice, when you mega-dose with these water soluble vitamins, your body responds by excreting the extra through your urine.  And that is what science taught us.

2. Dietitians understand behaviour change

Great. You’ve seen a ‘nutritionist’ for diet advice. You have a list of ‘do’s’ and ‘don’ts’. You start referring to food as ‘good’ and ‘bad’. You feel great on your nutrition plan for the first three days. You SHOULD! It’s not wrong, what they’ve told you. In fact, its probably ‘ultra-healthy’. The idealistic, utopian picture of nutrition. I don’t know about you, but I don’t live in an idealistic, utopian world. So. You go to a friend’s birthday. There is absolutely NOTHING that fits with what the nutritionist told you. You panic. Then you get hungry. You start with chips. Then a hot dog. Make that two. Chase it down with cake, followed by a heavy dose of guilt and resentment.

Dietitians are NOT black and white. You will not hear a dietitian say ‘You ate WHAT?! that is SO bad for you!”. Dietitians work with where YOU are at. They help move you through the various stages of change. They motivate you. They help you recognize what triggers certain eating behaviours and help you strategize to deal with the situation more appropriately next time. They are versed in motivational communication and facilitating behaviour change. They work within your limitations, while helping you to overcome your barriers to change. There is no place for black and white eating – unless you’re colour blind, of course.

3. Dietitians have academic AND practical training

We have our degree, which is great and all – it gives us the basis of critical thinking, an understanding of physiology and biochemistry, and the ground floor understanding of nutrition. a 4+ year degree often requiring a GPA of >3.7 to even be considered. But what makes us GREAT at what we do is our practical training. Over 1700 hours go into our internship, where we not only learn from experienced dietitians, but other key members of a health care team. We work with doctors, nurses, pharmacists, physiotherapists, and many other professions to gain a working understanding of how our work inter-relates to one the others. We get put in situations outside our comfort zone. We get questioned, critically on WHY we practice the way we practice. We use evidence to justify our clinical decisions.

Personally, I LOVE being put in the hot-seat. I don’t pretend to know everything, I can’t possibly be versed on every nutrition topic out there. But the areas I DO practice in, you’d better believe I try to keep abreast of every paper that comes out. I keep on top of the literature. I analyze the studies to make sure they are valid and hold merit in my clinical decision making. And then I use them to refute my position in my clinical decision-making pathway. I’m happy to tell you the evidence behind my clinical decisions. I guarantee you, my justification for practice isn’t just because I came across it on google.

4. Dietitians understand the research

A paper comes out. It touts that if you only eat spinach, you will live twice as long as everyone else. Sounds great. A BIG NUTRITION BLOG posts it. It goes viral. Someone invents the ‘Spinach diet’, involving adding 1 cup of spinach to 3 meals and 3 snacks a day. Spinach smoothies, creamed spinach, spinach salad, spinach omelette, chicken stuffed with spinach… The market price of spinach goes up. Everybody’s poop turns green.

That was ENTIRELY fictitious. But extremely plausible. I’ve seen crazier. It SOUND like a great idea, doesn’t it?

Let’s look at this fictional paper I’ve made up. It was performed in rat models. The rats were fed 10% their body weight in spinach plus their typical feed. Rats studied? 20. No control group – an average life span of the rats was used for comparison. The length of time the rats lived was different, but not statistically significant (P=0.15).  Problems with this study (what, besides everything?) Study size. The fact that it was an animal model. There was no control group. It was sponsored by the spinach farmers of Iowa.

A dietitian would CERTAINLY not go changing their practice based on this (imaginary) study, whereas someone without a research background may say, wow, this study drew THESE conclusions? this is the magic bullet we’ve been looking for! I must tell EVERYONE.

While this is a wildly over-exaggerated example – dietitians can tease out what makes a study valid, and what doesn’t. I’ve seen FAR too many blog posts online that CITE a study, but when you actually go to read the study in its entirety -they’ve interpreted the data ALL wrong, or drawn their own conclusions without even reading the study! It makes me die inside when I see a blog post with citations to 10 different research papers, making them LOOK valid, when you go to read the paper and find out it was the most poorly designed, biased study whose study design could have proven that pigs can fly if thats the direction they had chosen to go… The bottom line is – be careful what you read on the internet, and be even more cautious when the writer makes outlandish claims based on ‘research’. When in doubt – ask a health professional what they think of the study – I’m always happy to interpret results of studies for my readers and clients!

5. Dietitians are regulated

All dietitians practice under regulation of a college. We aren’t allowed to have conflict of interest. We are responsible for what comes out of our mouth. We are accountable for providing safe, efficacious

So, do dietitians make meal plans?

When someone asks if I make meal plans, I hold a shudder back, and explain that there is SO much more to my profession than ‘meal plans’. If it were that simple, everyone could be provided a ‘meal plan’ and the world would be a healthier place. While we DO create meal plans in certain situations, especially when we are starting to educate someone on healthy eating, we understand that a meal plan isn’t what creates behaviour change. A person needs to have the knowledge, and more importantly, the drive, in order to be successful in their nutrition changes. They have to be hungry enough to create a meal plan themselves, with the knowledge they have. THOSE are the clients that will have long term success with nutrition change. Its not only my job to give them the knowledge but, understand the intricacies of moving a client to a place where they are engaged and invested in their nutrition. And that is where my skills lie.

I’m hoping that this article expanded your mind on what a dietitian does, and what our skill set offers.

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