Nutrition counseling: I'm actively listening, but what do I say?
I will never forget my first experiences in nutrition counseling. As a registered dietitian nutritionist, I pored over patients' charts before meeting them, piecing together their diagnoses, lab values, and medications to determine the nutrition guidelines that would apply to them. When they arrived, I leaned in, made eye contact, and listened actively. I carefully worded my inquiries, keeping them open-ended and avoided yes-no questions. And then, despite all of my knowledge and training in medical nutrition therapy and motivational interviewing, the unexpected happened:
They asked me questions back.
And the questions were not about recommended dietary allowances, dietary guidelines, or the pathophysiology of disease--all the things I learned in school. Instead, to answer their questions, I had to step back from my nutrition expertise and draw from a different experience: Life.
What to Expect in Nutrition Counseling
Patient questions are more practical in nature, such as "What can I have for breakfast?" Or they have questions about the latest popular diets. Or supplements. Or how to handle sugar cravings or night snacking.
While these questions are straightforward with seemingly simple solutions, I had to learn how to respond effectively. An easy solution for one person could be a significant lifestyle change for another. Explaining the why behind recommendations requires an ability to relate information that is easy to understand and personally relevant. Delivering the why not requires a respectful, tactful, and diplomatic approach. Providing the how requires compassion and empathy to recognize their personal barriers. And the entire process requires collaboration, not prescription.
Needless to say, as a new professional, I was not yet prepared for the range of questions and circumstances that I would encounter. Learning the ropes took time, resulting in a less than smooth start, for both me and my patients.
Over time, I picked up on frequently asked questions, common eating patterns, and the everyday barriers that patients report. I learned what they expect from a dietitian, and what information they appreciate most. With experience, I was able to develop the strategies to connect with a patient and answer their questions in ways that resonate and motivate--as well as strategies for the times when I cannot.
Today, as a dietetic internship preceptor in a diabetes clinic, I recognize the same apprehension in our students. When one of my interns said, "But what do I say?" I understood exactly how she felt.
Special Challenges for Experienced Professionals
After 10 years, however, I have also discovered that learning is dynamic. After working with hundreds of patients, the ability to communicate compassion, nurture empathy, and tune in to implicit biases requires continued mindfulness. Cultural competence needs continued development as the term "culture" applies not only to race, ethnicity or religion, but also to regional differences, LGBTQ perspectives, and other social factors that affect nutrition, lifestyle, and access to food and healthcare.
Balancing the needs of patients with the fiscal demands of the healthcare business is a great burden to bear for practitioners. Healthcare burnout is a reality that worsened during and after the pandemic. Furthermore, while technologies like telehealth are expanding access for many people, such innovations often come with an expectation of increased productivity, and therefore, increased pressure for practitioners.
Speaking of telehealth, for those of us who spent years using whiteboards and food models, learning how to provide effective nutrition education online requires continued skill-building.
The learning never stops.
New Book Has Something for Everyone
While I continue to grow and develop as a dietitian, I share my experiences, tips, and tools in the new book, Think Like a Dietitian: A Nutrition Counseling Starter Kit. The book reviews some approaches to mindfully interact with a patient, while providing a preview of the most common questions and scenarios that dietitians encounter in outpatient counseling, as well as the strategies and tools to address them.
The book also covers the most common reasons for referral to a dietitian, including prediabetes/type 2 diabetes, hypertension and lipid management, chronic kidney disease, IBS and the low FODMAP diet, and weight counseling. These chapters are divided into three distinct sections:
What dietitians need to know.
What patients want to know.
What patients need to know.
The book also includes downloadable patient education materials for these topics that can be used in telehealth, group classes, and individual counseling.
In Teaching, We Learn
For me, the process of writing this book allowed me to examine what I was doing right and what I could improve. It helped me to protect the compassion and empathy that drew me to the field in the first place. And it reminded me to be compassionate with myself in the process. Every chapter is a reminder that mindfulness is not just a nutrition strategy, but a counseling strategy as well.
Excerpt It took several years in the field, hundreds of patients, a pandemic, and my own cultural awakening before I understood the intricacies of nutrition counseling, including:
How to get a person to open up and engage.
How to bridge the complexity of nutrition science with the equally complex realities of life.
How to keep myself present for each patient—even for those who do not make it easy.
As I continue to learn and grow, I hope others find this book helpful in their development as nutrition counseling experts.
Wherever you are in your nutrition career, keep this book handy.
Your patients are in it.
Think Like a Dietitian: A Nutrition Counseling Starter Kit
By J. Barretto Patterson
Paperback $39.95 / Hardback $89.95 / eBook $29.96
Available for pre-order March 7, 2024 from Routledge, Amazon, Barnes & Noble, and other booksellers.
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