And the story of why we, as dieticians, are struggling to use the right tools to help our patients change the way they eat.

Last week I had the opportunity to work with more than 70 dieticians in Mexico, to write a series of dietary recommendations, specific to the COVID-19 pandemic. My personal contribution was the section, ‘Attention and Recommendations on Food and Nutrition in the Healthy Population’.

In summary, the nutrition recommendations proposed were:

1. Consume fresh food: fruits, vegetables, whole grains, legumes, and seeds.

2. Consume at least a portion of different colour vegetables and fruits.

3. Include herbs and spices in your preparations.

4. Consume moderately other foods of animal origin, canned and packaged foods.

5. Do not buy excess food, as it leaves other people unable to buy the food they also need. Do not panic buy.

6. Plan menus weekly or biweekly.

7. Consume food at established times and with the family.

8. Follow good hygiene practices in food handling.

9. Don't waste food.

10. Take care and maintain digestive health.

11. Avoid consuming foods that contain excess sugar and fat.

12. Cover the water requirements daily.

You may be wondering, “how does this translate to what I have to eat?”.

Dieticians are well known for handing out diets. I define being on a diet as: “removing things from our daily eating or restricting what we eat, because they are things that harm us”. In other words we become the ‘food police’. However, I am one of the few dieticians I know, who does not believe in diets, I do not like to restrict someone’s way of eating or calculate mathematically rigid regimens, which nobody will follow. It seems to me a very reductionist way of approaching a person's way of eating, which, after all, is surrounded and influenced by so many tangible variables. For example, diets do not take into account our work or social environment, our relationships with others and own cultural relationships with food. Diets, with their intrinsic and powerful sense of restriction, lead us to failure and this is what we associate them with.

Now, as dieticians we are supposed to take all this into account when we formulate diets but in my 25 years of experience in Nutritional Education, I have seen the opposite of this. Even talking with   students in the initial semesters of their degree, they have already been taught or rather, programmed, to calculate square, restricted and unpalatable diets. These diets have been handed down, through generations of teachers as if by some magic wand of unknown origin (nobody can give me a proper reference as to why we portion them into 60% carbs, 15% protein and 25% fats), ever since Nutrition Degrees first began, at least here in Mexico. As Nutrition Educators, if we do not question this, the only thing that we nourish is a vicious cycle. Our students become stereotypical dietitians, inadvertently pedalling time-honoured diets of failure and shame, in due course, becoming teachers themselves, ensuring that the cycle continues into the next generation.

But eating is a pleasure, it is life, and as dieticians if we take away people's food, if we restrict what they can eat, we take away some of the joy from people’s life. Are we really surprised that people don't like dieticians and nobody follows our diets? We are missing the opportunity to help our patients by maintaining the rigidity of classifying foods as those that we CAN eat, and those that CANNOT eat. We fall into the trap of putting food into groups of the good against the bad. We generate in our patients imaginary lists of what we can and cannot eat, according to social patterns that we help establish in their heads. If you are the daughter of a mom who grew up in the eighties/nineties, you will automatically see life from the perspective of "fats are bad for you".

There is no doubt that there are scientifically proven situations that require restrictions. A diabetic or nephrotic patient requires restricting their consumption of sugars or salt. If you are in intensive care, you will need to have very strict specific control of your diet. However, for most of us, it is an awareness of what we eat that is required. The real task is in analysing a series of recommendations that nutrition experts point out, and then making them accessible and applicable to real world people, in their day to day life.

My belief is that we all have an innate capacity, which must be explored, to self-regulate our way of eating. To find and know in oneself, what is the motivator that each of us has to change our way of eating. For example, is my motivation “I want to decrease one dress size so that I can fit in a certain dress at my daughter's wedding”, or “is my motivation to want to maintain my health and that of my family’s during this forced isolation”. It doesn’t matter which one it is, so long as I know what my motivation is.

The idea is that we all have something that we can modify in the way we eat. The help that we, as dieticians can offer to our patients, is that of being able to translate ‘scientific’ recommendations into specific steps that can be carried out to modify or improve our diet and not turn this into a diet that becomes a restriction. The idea is to follow some steps that imply that we become aware, in order to help us modify our eating behaviour in a direction that leads us to satisfy our motivation.

Here are some suggested steps to make towards achieving a change in your eating behaviour, when faced with dietary recommendations.

1.       Find your motivator. Clearly write down what motivates you to want to make a change in your diet. Without a motivator, you can never continue with the change you want or need to make for health.

2.       Decide which of the recommendations to improve your diet you want to carry out. Choose one or two. If you try to do all of them, you will become very frustrated when you can´t carry them out. Baby steps.

·       Say you choose: "Consume fresh food: fruits, vegetables, whole grains, legumes and seeds."

·       I will eat legumes (beans, chick peas, lentils, beans) every day.

3.       Choose a simple action that you can do daily.

•         Plan a weekly menu containing a different legume every day.

•         Be sure to buy a variety of legumes to have in your pantry.

4.       Plan when and where you are going to carry out the chosen action.

•         I will eat a legume every day at lunch.

5.       Every time you reach that particular time (lunch time in this case) or that place, carry out the action.

•         Eat your legume during lunch every day (and prepare lentils, beans, beans, chickpeas in advance and in different ways).

6.       Ignore myths. e.g. that habits change in 21 days; they don’t, it takes about 10 weeks to make a change, achieve a change and form a new habit.

•         Monitor your progress. Write down on a calendar if you ate what you set yourself to achieve every day.

•         If you notice that you are not carrying out what you set out to do, modify your actions.

o   Example: Find new recipes with different legumes, ask a friend for recipes, ask others in your family to help you carry out your purpose

7.       Repeat, repeat, repeat the action. Only repetition will lead you to change your habits.

•         Be consistent. It takes effort and brings its benefits. Remember what your motivator was. Eating legumes at mealtime can lead you to stop eating so much meat.

8.       Congratulations, the isolation period can help you make a beneficial change for your health!

Changing our way of eating requires us to become aware of what we eat and how we eat, it is a journey towards self-knowledge and better physical and mental wellbeing. I invite you to take this journey with me.

 

References:

Gardner CD. Tailoring dietary approaches for weight loss. Int J Obes Suppl [Internet]. 2012;2(S1):S11–5. Available from: http://dx.doi.org/10.1038/ijosup.2012.4

Gardner B, Lally P, Wardle J. Making health habitual: The psychology of “habit-formation” and general practice. Br J Gen Pract. 2012;62(605):664–6.