Tuesday, February 10, 2015
6 things you should know about working with a nutritionist
By Cynthia Sass, MPH, RD
Up front I have to say that I’m a nutritionist/RDN with a private practice, so I’m biased on this matter, but I’ve seen one-on-one counseling work wonders for my clients, from breaking weight-loss plateaus to improving athletic performance, upping energy, boosting immunity, digestive health, sleep and mood, and transforming skin and hair.
If you’re thinking of working with a nutritionist or dietitian, here are six things you should know.
It’s more complex than it seems
Nutrition is far more involved than calories in versus calories out. I often see clients who aren’t getting results because they aren’t eating enough, or the timing and/or balance of their meals isn’t in line with their body’s optimal needs. Others are eating healthfully, but are unknowingly taking in more than they need to get to—and stay at—a healthy weight. After assessing your eating routine, an experienced nutritionist or dietitian will probably know right away what’s holding you back from reaching your goals, and can guide you in the right direction. In terms of a strategy, I talk with my clients to determine what’s best. Some want a structured plan, complete with personalized meal plans, recipes, and grocery lists. Others do better with simple, concrete goals to work on, such as making specific changes to their usual meals, or modifying their meal timing. Be clear about what feels right for you: if you don’t respond well to structure, a structured eating plan isn’t going to work.
Follow-up is critical
In my private practice, if weight loss is the goal, I ask clients to commit to working together for a minimum of one month. For some, follow-ups involve weekly check-ins, while others send me a food journal every day for 30 days. Your nutritionist or dietitian needs to ensure that the strategy you’ve agreed upon is right for you. For example, if you dine out or travel often, or you have very limited free time, a plan that requires you to cook at home won’t be a good fit. Also, he or she may need to tweak your plan or approach based on feedback from you regarding your results and how you’re feeling. Follow-ups are also an opportunity to ask questions, prepare for challenging situations, learn about new tools, resources, or products, and feel supported. A one-time visit can’t possibly offer everything you need to succeed.
Sessions may not take place in an office
Many nutritionists and dietitians work in an office setting, but the new norm also involves real-life situations. I often meet clients at their homes so we can go through their fridge and cupboards, and talk about what they eat where they eat. I also take many of my clients on grocery trips, so we can walk the aisles together and discuss products with dozens of examples at our fingertips. I’ve even gone to restaurants with clients—particularly those who dine out often—because they wanted to have the experience of talking through ordering from a menu with me present. I’ve cooked with clients, which is really fun, and I also work with clients by phone, email, and even text. Sometimes they’ll text me a photo from the supermarket or a restaurant with a question, or text from a get-together to ask which party fare is best. Not every nutritionist or dietitian may be open to this kind of communication, but if that’s what you’re looking for, be sure to make it clear before you start working together.
It goes beyond food
As part of my master’s degree in nutrition science, I completed 21 credits in counseling psychology, and my master’s degree in public health included an emphasis on how families and communities impact the ability to make healthy choices. I’m not a therapist, but I often find myself talking to clients about issues related to food that go beyond nutrition. Some encounter a lack of support, or even sabotage, from their significant other, friends, or family. Others feel that their job, workplace, or community get in the way of following through with healthy changes. And many of my clients struggle with emotional eating. In many cases, a nutritionist or dietitian’s role is to help coach you through what gets in the way of following his or her advice. In other words, if you were “good” all day, and wound up binge eating while binge watching Netflix, don’t be afraid to talk about it. A nutritionist or dietitian worth their salt is going to empathetically coach you, not judge or scold you.
Credentials are key
In many states the nutrition profession isn’t regulated, so literally anyone can call him or herself a nutritionist and charge clients for services, even with no formal training. Before hiring someone, no matter how healthy they look, ask about their education. The letters RD or RDN (registered dietitian or registered dietitian nutritionist) after someone’s name indicate that they have, at the very least, earned a bachelor’s degree, completed a 1,200-hour supervised internship, passed a national credentialing examination, and they complete ongoing continuing education. An RDN’s education involves extensive coursework in the science of nutrition, including biology, chemistry, biochemistry, anatomy and physiology, food science, metabolism, courses in vitamins and minerals, nutrition through the life cycle, and medical nutrition therapy, which involves the nutrition-related prevention and treatment of everything from digestive disorders, to heart disease, cancer, diabetes, and other health conditions. In other words, it’s thorough, standardized training in how the human body works and the understanding of nutrition science.
If the nutritionist you’re thinking of hiring isn’t an RDN, ask about his or her credentials—do they have a degree, where is it from, what is it in, how long did it take to complete, and what type of coursework did it include? I bet you wouldn’t want to go to a dentist or veterinarian who wasn’t thoroughly credentialed, but those professions are regulated to ensure proper training—in this case, you have to do your own homework.
It may or may not be covered by your insurance
Nutrition counseling may or may not be covered by your insurance. Some nutritionists and dietitians are set up as providers under various plans, just like physical therapy, acupuncture, or mental health counselors. And in some cases your insurance company may reimburse you after you’ve paid out of pocket, but there may be a dollar limit, or stipulations—for example, they may require the RDN credential or a physician referral. If you’re looking for coverage, call the number on your insurance card and ask about your options. If it’s not covered, consider the cost carefully.
I’ve had clients tell me they wish they would have contacted me sooner, because they spent money on products or gym memberships that didn’t give them results. Others have told me that the while they first thought nutrition counseling was expensive, they realized the value after considering the cost compared to other things they spend money on, like beauty treatments, dinners out, exercise classes, and clothes. Only you can determine if it’s right for you, but if you do decide to work with a nutritionist or dietitian, don’t be afraid to ask a lot of questions, and take the time to find the best practitioner to match your needs.