Guest piece by Dietitian Pascale Flematti

When people ask me what I do, I’m often met with the same response: “… What’s a Dietitian?”

In short, Dietitians are tertiary qualified healthcare professionals with the skills to provide evidence-based advice and counselling on food and nutrition. In university we study chemistry, human biology, physiology, biochemistry, food science and nutrition science (and more!). During this time, we develop a comprehensive understanding of how our bodies work, and how food and nutrition can play a role for a range of different bodily and medical needs. We can then translate this scientific information into practical advice on how to improve your health.

But what does “improve your health” even mean, and how can a Dietitian help you achieve this? Given that this concept is so broad, I broke this down into what I think are the top 5 things a Dietitian can help with (with particular reference to non-diet Dietitians!).

1. Improve your relationship with food

Many people come to a Dietitian thinking they will be told what they should and shouldn’t eat. In reality this is quite the contrary! From my experience, the people who are LEAST likely to tell you to eliminate specific foods are Dietitians. We want to show you that all foods have a place in our lives, and help eliminate ‘good’ and ‘bad’ labels for foods. We want to support you in allowing yourself permission to eat what you feel like, without consequence. Food is meant to be enjoyed! And we want to help you enjoy it.

2. Gentle nutrition management of health conditions/chronic disease

Helping individuals to manage health conditions is without a doubt an important part of a Dietitian’s job. We can offer guidance and support for medical nutrition therapy across a range of different health conditions, with different Dietitians generally specialising in different areas. We hope to provide nutrition advice that can help manage symptoms and underlying illnesses in a way that is practical, sustainable and fits within your lifestyle.

3. Shift focus away from weight and body image toward health and wellbeing

This one is particularly relevant to the non-diet space. Diet culture has conditioned us to believe that weight is often the most important determinant of health, and many individuals have learned to over-emphasise how we look determines how we feel about ourselves. As non-diet Dietitians we want to break down this notion. All bodies deserve care and respect, and we want to support you in learning to treat yours in this way. We practice in a way that is inclusive of all shapes and sizes, with a focus on developing healthy behaviours, thoughts, feelings and attitudes. We do not use weight as a primary marker of health, as we know health means so much more. It could instead be about feeling less stressed, getting outdoors more, waking up fresh in the morning, or having more energy to do the things you love.

4. Identify and work through an individual’s barriers to achieving health (what ever health means to them)

As Dietitians we recognise that health means something different to everyone. On top of this, different people experience different roadblocks on their journey to health, and this journey rarely takes a straight line to its destination. Dietitians will listen to you and provide a space to identify obstacles you might be facing along the way. We take a person-centred approach to help find solutions that work for you.

5. Help you make nourishing food and nutrition choices that fit in with your life

Nourishing your body can help improve your overall wellbeing, however there is no simple picture for what that looks like, and no one-size-fits-all meal plan – how boring would that be? We all have different likes, dislikes, schedules, budgets, household dynamics, desires and lifestyles. A Dietitian can work with you to improve your nutritional health by helping discover food choices that are personal to you. Whether it be meals you can have on the go if you leave for work early in the morning, or ways to incorporate different food groups into your cooking that your whole family will enjoy, we will take the time to work out what works for you.

The Holiday period is a time that can have a different meaning for everyone. Typically some core values of this season (for most) are enjoyment, celebration and being connected to those around you.

Unfortunately, over the years this has become a challenging time thanks to the powers of diet culture. So if you are one to struggle with your relationship with food, particularly around the holidays, then perhaps this list is for you.

Helpful Reminders for the Holidays:

• Prioritise food satisfaction, and satisfaction of meal occasions.
• Be aware of your inner critic or food police who may appear more than usual.
• Where possible, try to challenge your food police thoughts and break away from these food rules.
• Remind yourself that it’s OK not to eat according to her hunger and fullness cues all the time and still be an Intuitive Eater.
• Remind yourself that there is no advantage to skipping meals or “saving yourself” for the main event of the day. This will only set you up to eat for survival, rather than enjoyment or satisfaction.
• Remember that you have the right to satisfy your needs whether they are food or other.
• You also have the right to set boundaries around food and or body talk during such events. Whether these a verbal boundaries (e.g. changing the topic, politely asking to not participate in the conversation) or physical (e.g. removing yourself from the situation).
• Prioritise self-care if you are able to, and as you might need throughout this time.
• Finally, know that you are not alone but you are doing your best and you are worthy.

If the holiday period is a time that you may find extra challenging for whatever reason, it could be helpful to reach out to your therapist, counsellor or trusted health care practitioner.

Otherwise, take a moment to sit with yourself after reading this list. Does it sit well with you or do you think you’d need help applying it to your life? Or are you not sure where to start just yet?

Might be worth considering reaching out for support from a Health at Every Size® aligned Non-Diet Dietitian like us at Glow Group, to support you through your journey.

Best wishes this Christmas and have a safe and wonderful new year.

The 1^st of November 2019 marked the release of a very important and welcomed change to the Medicare Benefits Scheme (MBS). Now, 64 new MBS items have been introduced as per a model of best practice evidence-based care to support people living with a diagnosed eating disorders (recommended in 2018 by the independent clinician-led MBS Review Taskforce).

It has been so great to see the Australian Government get behind this change. Eating disorders are a serious mental illness that have the highest mortality rate of any psychiatric illness. Currently around 4% of the Australian population is experiencing an eating disorder. This is close to one million people. Eating disorders do not discriminate and not only impact the person experiencing the disorder, but also their family, friends and community.

This will mean that eating disorders are now the only specific mental health diagnosis receiving dedicated funding through the MBS. Eligible patients with a diagnosed eating disorder will be able to receive a Medicare rebate when they see an eligible provide under an Eating Disorder treatment and management plan. This will include support from:

• Up to 40 evidence based eating disorder psychological treatment services in a 12 month period. (Limited to a defined list)
• Up to 20 dietetic services, in a 12 month period, depending on their treatment needs.

There is good intention to make sure the health care practitioner providing support is suitably trained in providing such treatment. A list of such experienced professionals can be found on the website of the Australia and New Zealand Academy for Eating Disorders. This is a list of practitioners who self-identify as having experience in the field of eating disorders, and as members of Australia’s leading body for health professionals (ANZAED), these members are likely to participate in ongoing professional development in the field of eating disorders.

Patients who do not fit the eligibility criteria for the MBS Eating Disorders Treatment Pathway may be eligible for treatment under the Better Access to Mental Health treatment pathway. There will be an evaluation of the new items after 12 months to assess if the items are operating as intended for patients, providers and the Government.

Other helpful links for information also include:

http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-EatingDisorders

https://thebutterflyfoundation.org.au/about-us/media-centre/media-releases/major-medicare-reform-makes-history-for-eating-disorders-treatment-in-australia/

http://www.anzaed.org.au/newmbsitems/