Preface
Being diagnosed with a new health condition is scary, upsetting and overwhelming. It is also scary, upsetting and overwhelming to hear that you must drastically change your eating habits or body size to improve your lab values and halt the progression of your illness.
I have worked alongside many brilliant physicians and surgeons during my clinical nutrition days at NYU. I am so thankful for the invaluable knowledge they have taught me around human biology and the pathophysiology of disease, and now know the body better than I ever would have! However, there is another side to this coin for me. For the three years I worked in the hospital, I bore witness to the profound degree of diet culture and weight stigma that infiltrates our health care system: the one liner blanket nutrition recommendations, diet labels, weight blaming and food shaming.
As an Intuitive Eating (IE) and Health at Every Size (HAES) practitioner, working in the clinical space of a hospital was smothering and limiting. It was as if all the harm and suffering was being done right under my nose. I felt like a small fish swimming upstream in a river flooded with diet culture myth, weight stigma and nutrition fearmongering. Don’t get me wrong, I whole-heartedly believe in the power of nutrition when it comes to disease management and prevention, but in this line of work your approach matters, and can make or break a person’s motivation to change.
Over the years I have learned what works and what doesn’t, what is helpful and what is harmful. I have seen the ugly outcomes and the happy outcomes. I have also learned a lot from talking to my patients, learning about their experience, what they think, feel and struggle with.
When giving health recommendations of any kind, I think it is important to consider the experience of the person on the receiving end of your advice. Let’s think about the nutrition advice you commonly receive alongside a new diagnosis:
The delivery might be:
“Cut out carbs.” (eek)
“Eat less sodium.”
”Eliminate processed foods.”
“Follow a high fiber diet.”
“Your BMI is too high, you should lose weight.” (the worst)
The response might be:
“Yea, easy for you to say.”
“How am I going to do this?”
“I am a failure.”
“I will never enjoy food again.”
”My body is wrong.”
“I might as well just give up.”
“I have never been able to lose weight, this is my body.”
These are real responses, by real clients I have worked with. This interaction is happening, and it leaves people with feelings of fear, overwhelm, shame, guilt, doubt and hopelessness. How will a person feel motivated to implement change when their minds are clouded with defeatism before they even walk out the door?
This is not how patients should feel after a visit with any health care professional. This is not the way to help people nutritionally (or ever). This is not the way food should be used to manage disease. Pointing fingers at a person’s wrongdoings is playing the blame game, which is proven to be psychologically unhelpful. Spitfire recommendations like the ones above assume that food or weight is the primary cause of their health condition when there could be (and usually is) more to the picture. It also assumes cutting out carbs or losing weight is easy to achieve. To me, this is doing a huge disservice to the patient. We’ve got to look deeper; we’ve got to do better. Food does not work like medication. A “cause and effect” approach will not work here. There is nuance, grey area, emotion, culture, genetics, environment and social dynamics that influence our eating habits, body size and disease risk.
What Works Best?
I prefer to approach health conditions like diabetes, hypertension, high cholesterol, cancer or gastrointestinal disease in a way that enlightens people about their bodies and leaves them feeling accepted and positive about how food can help. I find it most helpful to incorporate the following three core components, all of which are counseled through the lens of IE and HAES perspectives.
1.Get Acquainted with Your Body and New Diagnosis
Learn about your body, how it works and the processes of digestion and metabolism.
What is the pathophysiology of your illness? What does it mean to have diabetes, high blood pressure, high cholesterol, renal disease, IBS/IBD, SIBO, gastritis, cancer, etc.
How are the inner workings of your body now altered?
How is digestion effected after gastrointestinal surgery?
If you are now dependent on tube feeds, what does that mean?
You are living in this body for the rest of your life, and I have always found that understanding the “why” and “how” of what is going on in there will help you connect the dots, make sense of nutrition information and implement your knowledge in a more healthful and balanced way.
2.Learn About Food
What do particular nutrients do in your body? What are their functions?
How does food effect or not effect your existing health condition?
What does food do once it goes from being whole on your plate to being broken down in your body?
What foods can you add to your eating pattern to help manage your condition?
How can you shift the balance in the foods you eat? What is doable for you?
What information are you getting from the internet, peers or diet culture that is not going to help you, and in the long run might make eating a lot more difficult?
If you can no longer eat and are dependent on tube feeds, how can you still connect to your body in a meaningful way? What should you know to ensure you’re getting adequate nutrition?
3.Improve Self-Care
How are you adjusting to your new diagnosis or change in lifestyle post-surgery?
How are you taking care of yourself in other areas of your life, unrelated to food?
What other factors might contribute to your health outcomes?
How might your physical activity level, body image, stress level, sleep habits, family/friend relationships and occupation might be negatively impacting the health of your mind and body?
My hope is to help my clients find answers and solutions to these questions. They do not follow a certain order. The parts typically overlap as the client and I unpack the complexities, uncertainties and emotions that come with healing their relationship with food and improving their overall health. I think it’s important to recognize that although food is important, health is so much more than what you put in your mouth and as a health care provider, it is my responsibility to dig deeper.
