Should You See a 'Regular' or 'Non-Diet' Dietitian?
For about five years, registered dietitian Rachael Hartley practiced what had been preached to her when she was in training: She taught patients how to count calories and control their portions, educated them on healthy versus unhealthy foods and used the scale as a tool to monitor their progress.
"I viewed someone's struggles with eating [as an indication that] they just needed more education; more information, and then they'd be able to make healthier decisions about food," says Hartley, who was working in a hospital at the time.
But that theory got disproved again and again. When patients made the recommended and often drastic dietary changes, for example, they'd often lose weight, but almost always put it back on. Other patients, meanwhile, would make healthy changes but not see the scale budge, and so they'd return to poor eating habits anyway. "I realized what I was doing really wasn't helping anybody," Hartley says.
Fast forward another five years and Hartley, who now has a private practice in Columbia, South Carolina, takes a totally different approach. Instead of counting calories, she encourages clients to ignore them. Instead of how to read a label, she teaches those she sees how to read their bodies' hunger and fullness cues. Instead of good and bad, she advocates that all foods are morally equal. Instead of a number on the scale, she uses measures like energy level and mood to monitor progress.
"It's amazing to see clients build this healthier relationship with food," Hartley says.
[See: How to Make Healthful Dietary Changes Last a Lifetime.]
Hartley's 180 is not an isolated move among today's dietitians. Plenty of her colleagues are outspoken on social media and in their marketing materials about their "non-diet" approaches, and more young dietitians are launching their careers with that bent. But other dietitians continue to take a more traditional approach, similar to how Hartley was trained; while many combine various schools of thought in advising clients.
Needless to say, it can be a confusing landscape for consumers; one dietitian may teach you how many calories and which food groups to include at each meal, the next may tell you to forget all that. "The mission [of registered dietitians] is to improve health and well-being through food and nutrition," says Robin Foroutan, an integrative dietitian nutritionist in New York City and spokesperson for the Academy of Nutrition and Dietetics, which represents all dietitians -- "non-diet" included. "We each have our own style for how we choose to do that." Her integrative approach, for example, is based on the philosophy that the body can heal itself, given the right conditions. "It's up to the practitioner to figure out what the right conditions are to promote healing and optimal wellness," she says. "Diet is always a core piece of that."
Here are some tips to help figure out whether a non-diet or other type of dietitian is right for you:
1. Understand the training.
All registered dietitian nutritionists, or RDNs -- formerly (and sometimes still) called registered dietitians, or RDs -- must have a bachelor's degree and complete approved undergraduate coursework in areas that may include anatomy and physiology, food and nutrition sciences, sociology and dietary approaches to treating different health conditions. Then, they apply to and complete an internship program, which means spending over 1,000 hours working (supervised) in various settings like hospitals, independent practices and community health centers, Foroutan says. Finally, they must pass an exam to acquire the RDN credential, and take continuing education courses to maintain it. "When you see someone with an RDN or RD, you know they've gone through a considerable amount of training and studies," Foroutans says.
2. Understand the non-diet philosophy.
No additional certification or training is needed for a dietitian to call him or herself a "non-diet" dietitian, but it generally means that he or she believes in "Health at Every Size," a phrase trademarked by the Association for Size Diversity and Health. It represents "a philosophy that essentially says we won't judge someone's health based on their size and that we can promote healthy behaviors at any size," Hartley explains. "It's looking not at the scale as measurement of one's health, but looking at behaviors, health, fitness, social connections [and] stress management."
[See: 7 Ways to Boost Poolside Confidence Without Changing Your Body.]
Non-diet dietitians also tend to coach intuitive eating, a 10-principle process outlined in a book by that name that aims to help people make eating choices from a place of self-care and connection to your body, not self-punishment or culturally-influenced food "rules." Choosing an apple over a slice of pizza because you're only a little hungry and craving something sweet and crisp, for example, is intuitive; choosing the apple over the pizza because you feel guilty about overeating yesterday is not. Many non-diet dietitians have credentials like certified intuitive eating counselor, or have pursued the Health at Every Size curriculum, that speak to these philosophies.
3. Identify your goals.
If you (or your doctor) is dead set on weight loss, a non-diet dietitian is probably not for you. While the approach may lead to weight loss as a side effect, authentic non-diet dietitians will not advertise or promise weight loss since they don't see weight as an indicator of health, Hartley says.
Other dietitians, though, may be on board with helping you lose weight if they think it will result in better overall health; for example, if weight loss leads to lower blood pressure or is caused by eating more fruits and vegetables. "My training was encouraging individuals to eat a healthy, well-balanced diet; my training was helping those individuals who need to lose weight [do so] in a healthy manner," says Keri Gans, a registered dietitian in New York City. For her that may mean helping people choose healthier options 80 percent of the time.
4. Consider your personality and history.
Have you tried counting calories, reducing portion sizes, monitoring your weight and using other conventional weight-loss strategies, only to regain the weight, feel ashamed and start the cycle again? The non-diet approach may resonate most with you. "Most of my clients come to me having gone on tons of different diets and experienced firsthand yo-yoing and shame that comes with each diet," Hartley says. "It's really amazing to see how clients connect with intuitive eating." If you're someone who tends to take things too far -- a "healthy" diet becomes an eating disorder, or a goal to get a promotion turns you into a workaholic who neglects other responsibilities -- a non-diet approach to nutrition may be safer for you, too.
[See: The Eating Disorder Spectrum -- From Pregorexia to Drunkorexia.]
However, if you're someone who craves structure and needs outer accountability to achieve your goals, you may be better off seeing someone who's willing to set some external parameters. "Some people need more order," says Gans, who's never given clients rigid meal plans or endorsed calorie counting, but does help them brainstorm meal ideas and be more calorie conscious. "If they're like, 'How many glasses of wine can I have a night?' I can't just say, 'Listen to your body,'" she says. (The answer is one a night, and two if they really want it during special occasions.)
That said, any good registered dietitian -- no matter what his or her approach is -- should take your history, personality and needs into account to create the plan that works best for you. "A good practitioner will be flexible," Foroutan says. "Part of the training is to start where the person is and to make achievable steps for them."
5. Shop around.
How a professional identifies him or herself is only one consideration when RDN shopping. After all, plenty of dietitians may teach intuitive eating without advertising it on their websites, and others that claim to endorse intuitive eating may stray from the true meaning of the philosophy, Hartley says. What matters more than a label is how you connect with that person, dietitians agree. Like you would a doctor or even a hairdresser, find out what you can about a prospective dietitian online and via referrals, then meet him or her in person. If you don't have a good gut feeling, move on. "In the end," Foroutan says, "it's got to feel right."
