In the 1980s and 90s I counseled thousands of patients. I gained confidence and satisfaction in helping many of them reduce cholesterol levels, lose weight, and manage their diabetes. If they returned for their follow up visit, I knew they were ready to learn, and would be successful using the knowledge and tools I shared with them. There was nothing heroic about it, and there was no social media at the time for me to broadcast my accomplishments. Their progress would simply be reported to the patient’s primary care physician who would reinforce what I was doing when he or she saw the patient in the office.

Listening to the constant “good-food-bad-food” chatter circulating in today’s media, you may be surprised that I achieved these results by suggesting people switch to low fat milk, use less butter, eat more fruit in place of junk food, cut back on the portion of meat they were eating, add vegetables to their diet, and set new goals for physical exercise. I didn’t focus on “eliminating toxic food” or ingredients, but worked around their lifestyle, taking into consideration what they enjoyed eating, and what could still fit, while achieving the goals of weight loss, blood sugar control, or lowering blood pressure and cholesterol.

I didn’t judge their grocery shopping habits, I suggested how they could modify a few things, reduce portions here or there, and add in some new foods. People are typically very receptive to this approach.

It’s what makes dietitians unique: Personalizing realistic meal plans for people that achieve positive health outcomes over time with follow-up support.

Nutrition Counseling Isn’t a Soundbite

Nutrition counseling delivered by qualified health professionals is an effective way to improve the diet and health of our population. It’s been one of the most underutilized care services in medical settings. Why? Mostly because there is inadequate reimbursement for it (i.e., the hospital doesn’t make money from it), there isn’t enough advocacy for it, and there isn’t consistent insurance coverage for nutrition counseling services.

In today’s media storm of self-proclaimed diet experts, there seems to be a constant battle for who has the right answer as to proclaim to be the health hero of this century’s obesity and health crisis. I’d say that this phenomena is fairly new, a 21st century (western world) problem. What’s has been happening over the past 10 years has been a hijacking of the profession of dietetics, and it is not doing public health any good at all (not to mention I do not like being lumped in with pseudo-professionals or quacks).

Stuart Miles

Stuart Miles

Instead of leaving dietary counseling and diet prescriptions to the registered dietitians, there is now a public argument going on 24/7 on social media about what the “cure” is for our health decline. A few loud voices hammer on and on blaming the food industry – soda, sugar, meat, dairy, “big Ag”, and a plethora of other players – for the nation’s health decline and rise in obesity.

I wish we could just get back to basics, quit arguing, and let dietitians do their job. There is no need to eliminate some favorite American foods – hamburgers, French Fries, a cold beer or fizzy drink. It’s a matter of offering counseling and support to people who need to make lifestyle changes.

Counseling and support. Not, “eat this not that” messages.

Hero Syndrome

During the 80s and 90s, most people didn’t know what a dietitian did (some still don’t), but as the topic of food politics became more mainstream discussion, more people wanted in on the scene. As the need for preventive care became extremely evident in the 90s, maybe some people thought it could be a worthy business deal. I question how much they are really in touch with the people they are aiming to help however. Who are these people?

  • High Profile Doctors
  • Television personalities
  • Journalists
  • Food Activists
  • Gym owners and fitness trainers
  • Other allied health professionals (nurses, physical therapists)
  • Naturopaths
  • Self-proclaimed health coaches
  • Chiropractors (who have always made nutrition recommendations to patients, and often included a supplement program as part of their practice)

So why have so many been so interested in changing people’s diets? I’m not really sure. Perhaps, unlike registered dietitians, they were unaware of how diet impacted disease?

Perhaps they want to take credit when something works? Well, it can’t be about taking credit. It has to simply be about helping people continue making healthy diet and exercise choices through their lifetime – and this takes ongoing support.

Dr. Oz, and the Food Babe know nothing about actually evaluating nutrition risk or what a nutrition assessment entails. High profile celebrities (Oprah had a personal trainer, who did get famous, but she never had a “personal dietitian”) dish out advice on television, but the people watching actually need dietitians to guide them through the changes they need to make.

Diets Should Be Individualized by a Health Care Team

Registered Dietitians are the most qualified health professionals to address any aspect of how diet fits into wellness or disease management. Success doesn’t happen with the dietary prescription, it happens with long-term follow-up. The field of nutrition and dietetics is vast, and there are many different specialists available. Ideally, every medical center and physician office in the country should hire a dietitian to fit the specific needs of the population they treat.

In addition to the primary physician, psychologists, counselors, and exercise specialists can be an important part of the team.

Let’s stop fighting over whose battle it is, who should help treat it, or who caused it….let’s work on creating effective health care teams that include a registered dietitian.

Who’s in?