Many years ago, someone from my personal life sent me a message asking for some exercise advice. They told me they had been doing a lot of walking but felt ready to try some other modes and asked for suggestions. In my response, I asked them what types of exercise they have enjoyed in the past or have been curious about possibly trying. My reply marked the end of what I thought was a budding conversation, as they were seeking a direct and concrete answer, not collaboration. This brief story exemplifies one of the challenges I face in nutrition counseling. Some people – not everybody, certainly, but a lot of people – just want me to tell them what to do, but nutrition is more complicated than that.
Sometimes I think about one of my personal training clients from 20 years ago and an important lesson that she taught me. As we were going about her workouts, I used to explain to her the rationale for her exercise regimen because my assumption was that she wanted to understand so that eventually she would feel educated enough and confident enough to ditch me and train on her own. Wrong. During one of her sessions, she interrupted me and bluntly explained that she did not care and did not want to know. She said that when she goes out to eat, she just wants to enjoy her meal without the chef coming out from the kitchen to explain how they made the food or why they constructed her entree in a certain way. In essence, she hired a personal trainer to deal with matters of methodology so she would not have to do it herself, which is a completely valid choice to make.
In a way, I can appreciate the desire to lean on someone else for making a decision. A while back, I was looking to buy a new graphics card for my computer, but some of the jargon was unfamiliar to me, some of the factors I had to consider felt confusing, and I struggled to weigh the pros and cons of the options. I felt overwhelmed and uninterested in investing the necessary time to get myself up to speed, and I just wanted someone to tell me what to buy so I could make my purchase and get on with my day.
So, I think I get it, but making a rare purchase of a computer part or deferring to a personal trainer are different than asking a dietitian to dictate eating behaviors. As long as my aforementioned client continued to have the financial means, she could isolate all of her exercise to biweekly sessions with a trainer indefinitely and live out the rest of her life without ever learning anything about exercise science. In contrast, someone may eat approximately 20 to 40 times per week, and most likely none of those meals or snacks happen with a dietitian standing over their shoulder.
Ultimately, people have to make their own decisions regarding what, when, and how much to eat. We make these choices based upon factors that are static, such as self-imposed dietary restrictions or food allergies, and others that are dynamic, such as available options, transient health conditions, and personal preferences. Every food has its pros and cons, and even an attribute that qualifies as a pro for one individual in one context may very well be a con in a different scenario, and vice versa.
One day back when we were still working in our former Wellesley office space, an exasperated patient asked me to just tell him whether he should buy white or whole wheat bread, but even a specific question like that requires a conversation rather than a concise answer. What if I just went with diet culture’s eat-this-not-that response and said whole wheat? After all, that is probably the answer he expected to hear, and he would have appreciated the clear-cut response, but would I really have been helping him? What if the slightly higher price of whole wheat strained his budget? What if its shorter shelf life mattered? What if the extra fiber or higher FODMAP content triggered gastrointestinal issues? What if he found the flavor unappealing? You get the idea.
I want to give my patients what they want. People spend time and sometimes money to meet with me, and my hope is that they leave feeling that the experience was worth their expenditure. Yet sometimes giving them what they want would be doing them a disservice. When this happens, I ask questions and listen so I can learn more about where they are coming from, and I explain the rationale for my approach so they can better understand my point of view too. Sometimes we go our separate ways, but other times we wind up on the same page and move forward together.