You may have heard diets do not work. Prescriptive, restrictive and fad diets help you lose weight quickly, but have minimal long-term success. The weight comes right back, and sometimes you regain more than you lost. This poses a dilemma for dietitians. After all, we have the word “diet” right there in the name of our profession. What role can we play as health practitioners, if diets do not work?
To answer that, we need to look at a very different meaning of the word “diet.” In our North American lexicon, the word usually refers to weight loss. But that is not the definition of “diet” that truly informs what dietitians do. The second definition of diet is simply “the food you consume.” And that is the sweet spot where dietitians want to provide education and help you.
“To me, ‘diet’ in the simplest of terms is a way of eating,” dietitian Lauren Harris-Pincus says. “But society perceives the word ‘diet’ negatively. When someone says, ‘I’m on a diet,’ it’s usually to lose weight versus a way to improve health.”
Dietitians are practitioners who guide healthy choices. And in this context, I am writing specifically about private practice or consulting dietitians (as opposed to dietitians in hospital or public health settings — they were not interviewed for this piece).
Many dietitians dislike being thought of as someone who puts people on weight-loss diets, so they have coined a new term: the nondiet dietitian. Sounds counterintuitive, right? Like a non-law lawyer? But it actually makes a lot of sense.
Nondiet dietitians will not give you a detailed meal plan or focus specifically on calories or the number on the scale to determine your success, because they believe a healthy lifestyle involves more than just measuring your body weight. They focus on “diet” as the foods you eat and look at your entire lifestyle. While some dietitians have been counseling this “healthy lifestyle” approach for years, it is the term that is new.
“People still think that going to a dietitian means you get a meal plan with an exact number of calories. Any dietitian who has ever spent time creating one, or any client who has ever received one, knows that this is an exercise in futility,” Harris-Pincus says.
Nondiet dietitians help clients learn to listen to their appetites and eat what they need, instead of what’s been prescribed. “A lot of people still think of dietitians as the food police, and some clients feel fear when they come to me that I’m going to judge their diets,” says Alissa Rumsey, who uses the nondiet term. “I want people to know that I’m not going to tell you what you can and cannot eat. My goal is to take clients to a place where they are in the driver’s seat, and they make decisions that feel good for their body and honor their health.”
Unfortunately, many people never see a dietitian, and their eating advice is garnered from a mix of magazine articles, fad diet websites and advice from well-meaning friends. But the advice is not tailored for them and, in fact, may be the exact opposite of what they need.
Dietetic advice used to focus on rules and restrictions. Heart disease? Cut out butter, meat and cream. Diabetes? Cut out sugar. But now dietitians focus on the positive side rather than restrictions.
“It used to be more about what not to do versus how to consume the most nutrient-rich diet. I switched from ‘avoid’ mode to ‘include’ mode many years ago,” Harris-Pincus says.
“A lot of nondiet dietitians also call ourselves nutrition therapists,” Rumsey says. In her practice, Rumsey looks more broadly at eating behaviors and the psychology behind them. And there is merit to this direction.
“Focusing on wellness instead of weight is linked to people making better lifestyle choices, which can lower triglycerides; improve cholesterol; reduce rates of disordered eating, binge eating and emotional eating; and boost self-esteem and body image,” Rumsey says.
When you hear the statement “diets don’t work,” it refers to the impossible, unscientific weight-loss plans, not the job dietitians can do. If you saw a dietitian before and it was not helpful, perhaps you saw the wrong dietitian. Find one who, with a holistic lens that looks at your whole lifestyle, will focus on your individual needs, based on your life, your history and your preferences.
Cara Rosenbloom is a registered dietitian.