In the FAQ section, I touch on why the “just tell me what to eat” approach to counseling is often unproductive.  In fact, many of my clients are people who previously tried this technique with other dietitians and came away dissatisfied.  Oftentimes the patient blames the practitioner when really neither one of them, but rather the approach, is at fault.

Yesterday, a new patient and I fell into the “just tell me what to eat” trap together.  After she told me about her issues and goals, we discussed different options for moving forward.  I suggested a collaborative approach, but she felt she could benefit from starting from scratch and having me create a meal plan for her.  In other words, she wanted the “just tell me what to eat” approach.  We discussed the pros and cons of this method and eventually went ahead with it.

As soon as she looked at the menu I created for her, I could see the disappointment and frustration on her face.  “Do you have kids? she asked me.  She continued on that the meal plan I created would not work for a mother of young children like herself.  The irony is that I created her plan using meals and snacks that I know from experience have worked for other busy parents, but the point is not whether or not they work for other people but rather that they did not work for her

I take the blame for this.  While I agreed to the “just tell me what to eat” approach because I wanted to respect the client’s wishes and because I wanted to give her the benefit of the doubt that she might be the rare exception of a patient who responds well to it, in hindsight perhaps I should have tried to be more persuasive about taking a different approach.

The problem with the “just tell me what to eat” technique is that everybody is indeed different and what works for one person is not automatically going to work for another.  After all, we are dealing with real people, not homework case studies in some nutrition textbook.  Real people have likes and dislikes, time constraints, children and spouses with their own food preferences, etc.

The client is the expert in his or her own life, not the practitioner.  Therefore, a much more effective approach is for both the client and the practitioner to bring their expertise to the table and figure out together how to create change.  I would welcome the opportunity to sit down with this woman again and this time collaborate on a plan that will not only help her towards her nutritional goals, but also work in her life instead of just on paper.

One of my patients recently told me the story of when she began yelling at her pregnant friend, “You are killing your baby!”  What had the friend done that was deemed so horrible that it warranted such a harsh reaction?  She had ordered a smoothie in the mall food court.

Dr. Steven Bratman coined the term “orthorexia” to mean an unhealthy obsession with healthy eating.  While orthorexia is not an official medical diagnosis, a movement exists among practitioners that perhaps it should be.  Being a dietitian and not a doctor, I have no business diagnosing anybody with anything, let alone with a condition that does not officially exist.  Having said that, I do occasionally get concerned that a patient’s well-intentioned pursuit of healthy eating has crossed the line from constructive to destructive.

In such cases, the patient usually recognizes, on some level at least, that something is amiss.  Consider the woman in the preceding example.  She used terms like “fear” and “obsession” to describe her relationship with food and admitted that her attitude towards food was negatively affecting her friendships.  Because she was so forthcoming about her concerns, we were able to have an honest talk about the matter and discuss what she wants to do about it.

Unfortunately, not all “orthorexic” patients realize they might have a problem.  I find that these patients tend to have an expectation that I share their black-and-white views regarding nutrition, and when they discover that I do not they are stunned.

The way I look at it, humans often risk their health for the pursuit of pleasure.  Smoking is a blatant example, but plenty of more subtle examples exist.  Consider somebody who drives to the movies, thereby risking a debilitating or even fatal car accident for the sake of enjoying a film.  Consider those who love the bustle of urban life so much that they forgo the better air quality and lower crime rates of the countryside in order to live in the city.  Countless other examples abound.

Why, then, is it so hard to understand that the vast majority of us choose to sometimes eat less healthy foods for cultural, social, or financial reasons, or simply because we like the taste?  If I took the stance that these factors should have no bearing on food choices, then I would be out of touch with the vast majority of my patients and therefore an ineffective dietitian.

When the pursuit of healthy eating becomes so all-consuming that the pleasurable aspects of eating are shunned as second-class citizens, other areas of the patient’s life can suffer.  Whether orthorexia is ever adopted as an official diagnosis or not does not change the fact that this phenomenon exists.

The good news is that help exists too.  If you are reading this blog and saying to yourself, “I can relate to this,” consider speaking with your doctor about it and asking to see a dietitian who can help you to find a better balance in your relationship with food.

Intuitive eating, the practice of eating when you are hungry, stopping when you are satiated, and honoring your body’s innate wisdom, seems like such a simple concept, but it can be very difficult for many of us to practice.  When we were little, we knew when we were hungry. As babies and toddlers, when we would feel physical hunger, we would ask for food.  Likewise, when we had had enough food, we would push it away.

But somewhere along the way, many of us began to tune out our bodies’ hunger and fullness signals. Maybe your parents insisted that you “clean your plate” at dinner, pushing you past your feelings of fullness or perhaps you learned to ignore your hunger cues and skipped a meal because it wasn’t “time to eat” yet.  Or maybe you’ve been bombarded by the media’s messages about dieting and how eating less and especially not eating even if you are hungry are the keys to weight loss. Over time, as we continue to ignore our bodies’ signals, we begin to not recognize them anymore.

The majority of my patients look at me with complete disbelief that they would ever be able to regain their hunger and fullness cues again and trust their bodies to tell them when and how much to eat.  But, with practice, many of my patients soon realize that they recognize what it feels like to be hungry before a meal and how much food it takes them to feel physically satisfied.  It takes time and patience, but eventually you can begin to trust your body to tell you what it needs.

Intuitive eating does not happen overnight, and it takes a lot of time to “unlearn” certain habits and behaviors, such as skipping meals or cleaning one’s plate regardless of hunger or fullness. But when you learn to trust your body’s innate wisdom and be kind to yourself, you will be amazed at the progress you make.

This blog entry is inspired by one of my patients who recently told me she is afraid to eat canola oil because she heard it is genetically modified. Because many rumors are circulating these days regarding canola oil that are not quite true, I want to take a moment to share some facts.

Canola oil was developed from mustard rape, or rapeseed. The developers used a natural process of plant breeding that entails selecting certain plants that display a desired characteristic, breeding them to produce more plants with that trait, and repeating this over many generations in order to increase the percentage of plants with the desired characteristic.

It would be like a rabbit breeder who desires rabbits with really long ears and to that end selects only the bunnies with the longest ears from each generation for reproduction. As the generations go by, the resulting rabbits would tend to have very long ears. Are these bunnies genetically modified? No. Their ancestors were simply selected for reproduction because they naturally contained the genetic predisposition to have the desired trait: huge ears. Because this trait has been passed down over the generations, the offspring also have big ears.

In the case of canola oil, the desired trait was low erucic acid. Rapeseed naturally has an abundance of erucic acid, which in large amounts can be toxic to humans. The canola developers wanted lower erucic acid so they selected the plants with the lowest amount of erucic acid for breeding. After many iterations, the result was the canola plant, which has very low levels of erucic acid.

The development of canola oil preceded the rise of genetic modification techniques by decades. Since that time, some canola plants have been genetically modified for such purposes as making them more resistant to pests. While I was unable to find any credible research showing genetically modified canola oil to be dangerous, I understand that some people are not comfortable using it. For those who wish to avoid genetically modified canola oil, consider buying organic canola oil. By law, organic products have not been genetically modified.