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I started working in private practice right after graduating, in 2008. Everyone warns new grads against going straight into private practice. It's hard work, can be lonely, and there's no-one to mentor you. All very good reasons, but I've never exactly been great at following rules for the sake of it, and I was so eager to get out there and share my knowledge, so in I jumped!

I loved private practice straight away, but soon realised that being a dietitian is actually way less about sharing information (because most people know waaay more nutrition theory than they'll ever need), and far more about helping people navigate the realities of their lives, and the logistics of steering themselves towards the health habits that will make all the difference. So to really help people, I felt like I needed more training in things like counseling and behaviour change psychology than I’d learned in my Masters degree. As luck would have it, I found a part-time job in health coaching, doing exactly what I needed to upskill in! What better way to get trained than by taking a job and practicing day after day, right? And I could keep my clinic running part-time. Perfect!

The health coaching job was great, but the best thing about it was the fact that each client was followed up for 6 months or more. When you keep talking to the same people week after week, month after month (and year after year with some awesome clients), you get a feel for what approaches work, and which ones really don’t! That’s when I really started questioning the value of any prescribed meal plan, macronutrient balance, or even something as gentle as suggesting a meal idea. It seemed like the more I (or other health coaches) gave prescriptive advice, the more ‘relapses’ clients would have into their old habits…

… cue lightbulb!...

Now here’s the issue: We live in a diet pushing, thin obsessed culture, where we’re repeatedly sold on the idea that we just need to

• Find the ‘right’ meal plan. Don’t ‘cheat’ and eat ‘bad’ food.
• Hit the gym whether we want to or not, to ‘burn off’ enough food to lose weight, or ‘make up’ for over eating.
• Have someone to be accountable to because we ‘don’t have enough motivation’.
• Get down to the ‘correct’ weight and all our health and self-esteem troubles will disappear.

This means that for anyone who’s looking around for ways to improve their health, these are the things they think they need to do. So when a new patient booked themselves in to my clinic, what they expected from me was something along the lines of ‘here’s the right diet for you- OK, go!’

But of course, what I’d learned along the way was that giving prescriptive (‘thou shalt and thou shalt not’ style) advice doesn’t actually solve any of their issues. It actually keeps people in the dieting mentality. It maintains those feelings of guilt and being ‘out of control’ when you inevitably ‘break the rules’, which further damages self-esteem. I learned that people actually know far more about what is best for them than any health professional could, and I discovered, mostly by trial and error, and thousands of hours talking to real people, that teaching people the skills to make their own informed health decisions was far more valuable. I kept health coaching for a few years, but left when I’d learned all I could from that job. I’d also started to feel more constrained than supported by their rigid procedures for counselling clients, so it was definitely time to move on!

If it’s bad for someone with an Eating Disorder, why is it OK for others?

In my own practice, I started working more and more with people who have eating disorders, and it lead to some troubling questions. For many people with an eating disorder (or history of one), it’s not appropriate to focus on losing weight, including when recovered. For these patients, I would always explain the ‘set point theory’ of how the body will naturally regulate its weight within a ‘happy range’. Attempts to supress weight below this range will be fought- with the end result being that your body will lower metabolism as far as needed, and claw its way back up to its set point eventually. Dieting episodes raise the set point, which means that the minimum weight that your body will allow itself to maintain is HIGHER after a diet. This is very well established scientific fact. It’s one of the main reasons for our evolutionary success! No-one in the academic world seems to be questioning the effects of starvation on weight set-point (whether from famine or intentional dieting- your body doesn’t know the difference), yet it's just not talked about in health or medical degree programs.

But, I was still teaching patients without eating disorders how to minimise their calorie intake so they would lose weight. Maybe their doctor had referred them for help with weight loss, and I obliged. Or, they wanted to lose weight for a wedding, or to suffer less with arthritic pain, or any number of other seemingly valid reasons. As time went by, I started to struggle more and more with the rationale for helping people to lose weight, when I was starting to realise that it would likely be temporary for most people because of the changes to metabolism and set-point. Sure, I was confident that I was teaching my patients a far more moderate and balanced approach to food than they had previously known. But the more I read research about the effect of calorie restriction on metabolism, the more I realised that it didn’t matter HOW you do it. You could do an expensive juice-fast, you could do whatever diet a Kardashian did last month, or you could eat a well balanced low energy diet that I’d prescribed… but the negative outcomes of dieting would be the same.

Here are some of those negative effects of dieting that are strongly supported by research:

• For 95% of normal healthy people, weight will return to pre-diet level within 2-5years. This has nothing to do with willpower or adherence to the diet. It’s due to, often permanent, drops in metabolism. This is how a healthy body adapts to survive famines.
• Because dieting increases weight set-point, most dieters will end up heavier than they started.
• Newer research is starting to show that weight cycling itself causes worsening health. It does things like worsening insulin sensitivity (which increases risk of diabetes), and increasing risk of heart disease.
• The social issue of weight stigma directly causes worsening psychological health, and can lead to physical health issues like heart disease.
• Dieting increases body dissatisfaction (which is tied to lower self-esteem and confidence- regardless of whether you lose weight. Hang on- don’t people diet because they want more confidence? Very ironic).
• Dieting leads to preoccupation with weight and shape, and increases risk of developing an eating disorder. Eating disorders are far more destructive to health and wellbeing than being a heavier person (including the health and wellbeing of a sufferer’s family, and extensive time off work that might be needed to care for your loved one).
• The feelings of deprivation while dieting- or even thoughts about planning to restrict your food in future- directly lead to difficulties with binging and over-eating. Again, this is a normal physiological reaction, not an issue with willpower.

When you consider that all of these negative outcomes are far, far more likely to occur than lasting weight loss, I realised that it was just not ethical to recommend that patients continue attempting to diet!

Note- this is where many health professionals jump in and accuse colleagues who use a Non-Dieting approach of ‘glorifying obesity’ or ‘ignoring the effects of excess weight on health’. We’re not. Issues that this question raise about weight bias in healthcare, and questions about the how strongly health outcomes are actually linked with weight, as opposed to lifestyle habits, are talked about by other authors/ on other websites. The point I want to focus on here, is that dieting doesn’t fix the health issues that are blamed on weight, it worsens them. It's unethical to recommend a treatment that is likely to make the condition worse. More FAQs addressing concerns about the Non-Dieting Approach will be posted soon.

So, what’s the alternative to dieting?

Well, there are two great alternatives for someone in my position.

The first one is to stand up, and be an advocate for change.

I think that the place we can have the greatest impact with advocacy efforts is with children and teens. Recent studies have been very encouraging and supported the idea that educating kids about key non-dieting concepts can have a huge and lasting effect. Teaching kids about:

• the effects of dieting on metabolism and psychological health
• building media literacy, specifically looking critically at how the ‘thin ideal’ is used as a marketing tool
• supporting them to develop a positive body image, by considering what their body can do, rather than how it looks
• supporting them to view food as nourishment, and activity as enjoyment, rather than tools to control weight
• teaching respect for size diversity in the same way as we respect diversity in hair colour, ethnicity or sexual orientation

…all these education topics directly lead to reductions in BOTH obesity and eating disorders as adults. So, exposing kids to these ideas through talks to school groups, holding workshops, and making sure that kids see a health professional (with specific experience with eating disorders) at the first signs of disordered eating or issues with body image, are the best ways to stop future problems AND curb any rising average weight of people in developed and developing countries alike.

Secondly, we can help adults to shift their focus from weight to health

We can help individuals to stop further diet-cycling. This is the basis of all of the diet-alternative approaches to health that you might read about, including ‘Non-Diet Approach’, ‘Anti-Diet’, ‘Health At Every Size (HAES)’, and ‘Intuitive Eating’. To be honest, it’s been my experience that working in this way is often actually harder than working with a traditional, prescriptive, weight loss approach. It can be hard work for the health professional (and require some extra counselling skills training) to unpack a lifetime of beliefs and habits about dieting, body image, and help people to separate health from weight so we can focus on the important things that we have more control of.

Importantly, it’s not all work that a dietitan has the skill to do. Some people benefit greatly from talking about body image and other issues that might be brought up in our sessions with a psychologist/ psychotherapist. I’m very aware of where my scope of practice boundaries lie, and will let you know if an issue arises that is best looked at by a different type of health professional. It’s then your choice as to if/ when you might seek further help, however if you’re being treated for an active eating disorder, you will definitely need psychological support as well as dietetic.

And there are plenty of ways that our lifestyle can influence health regardless of our weight! When you become a dietitian, one of the first realities you learn is that most people don’t know the extent of your knowledge and skill! Unfortunately, much of the public, AND many doctors, think we’re just weight loss coaches. But in our 4-5 years at university we learn far more than we’re given credit for, and we need to remember that we have a huge repertoire of medical nutrition therapy options for improving health issues. These are research-supported options that will improve people’s health regardless of whether or not they lose weight in the process!

So, while I believe it can be more difficult for practitioners to work from a Non-Dieting approach, the rewards for patients (and the practitioner!) are sooo much greater. I think that a life of truly enjoying food, being able to eat ‘normally’ without rules, binges, and guilt, being able to trust your body’s cues (including cravings), knowing that you won’t spiral out of control by responding to those cues appropriately, and living your best life without worrying about weight, are all things that a huge number of people would desperately love to have. We just need to go about the process a bit differently than we have been.

So now, almost a decade into my career, here’s how I summarise my role in private practice:

"I will model the patience and compassion that you deserve, and approach the process of unpacking nutrition and dieting beliefs or behaviours with curiosity, not judgement. Over our work together, I will teach you the skills, and build your confidence to treat yourself the same way. We’ll approach lifestyle changes as experiments, not as a new set of rules, because you are the expert in your body and your life."

If my story resonates with you, and if you think my approach could help you, I’d love to meet you. You can

• send me an email via the form below.
• call my direct number to have a chat and see if you’d like to work with me. If I don’t answer, please do leave a message with preferred days/ times to call you back (I’m on Mum duty a couple of days per week, and it can be hard to answer the phone!).
• if you’re ready to book, call the practice directly and make your first appointment (1hr). (Southern Districts Sports Physio Practice: 9544 6555)
• OR, if you're not local/ not sure whether you'd like to work with me, please join the newsletter to learn more about how I work, and get Non-Dieting tips.

Thanks for reading this far, and I hope the resources and information on this website help with your nutrition liberation!