I was chatting with a local GP recently about a client she had referred to me, and her feedback was along the lines of “they liked you, but didn’t understand why seeing you was a long term thing; they thought that it would be a few education sessions, and that was it.”
She wanted to know more about how I practice, so she can explain to her clients better what to expect when they come and see me.
So I decided to answer this question; what does a dietitian do? Or, more specifically, what can a dietitian do for you, especially in the long-term?
Fair enough question, and one that I find very easy to answer.
Some clients come in with concerns that do require shorter term care, however for others, building a long-term relationship is of the utmost importance when it comes to success. This isn’t truer than for those people who are aiming to lose weight. It is not just about losing weight, it is about the long term behaviour change, and accountability, that helps to keep it off.
From my perspective, the dietary and lifestyle changes have only ‘worked’ if they are maintainable in the long term, not because it worked for six weeks.
To help set up expectations in the first one or two consults, I will often explain a plan of what I think will result in the best outcomes for the patient, particularly if I believe they will require longer term care. I’ll usually split this up into three parts:
- The initial phase, or the ‘foundation’ stage, which is mostly about education, and getting some intensive sessions in to assist with motivation. The number of sessions here varies, depending on what the client requires, how much they already know, and how much needs to change.
- The second phase is the ‘consolidation’ phase; this is where we really focus on building on the changes that have already been implemented, possibly returning to any areas that still need improvement or have been more difficult to tackle.
- The final phase is ‘self management’. I like to explain this stage as the time where the client starts to take back more responsibility, and will see me less, however the reason the visits do not stop is due to the way behaviour change works. Yes, it does only take three weeks to develop a habit, however it takes years to change your ‘default mode’ – being the way you do things when life doesn’t go to plan, or when there is a lot of social occasions, being flat out at work, a holiday, or even a change in season. Knowing you have that appointment coming up, even if it is in 3 months time can often help things stay on track.
These 3 monthly appointments are particularly important for the first year after weight has been lost. Strategies to manage summer (often alcohol intake/Christmas/more social events), or winter (richer food, often less active) after having lost weight and now being in the maintenance phase is very different to when in the weight loss phase, and when it is often easiest to tell yourself that those couple of Tim Tams won’t hurt now you’ve lost the weight.
Long-term care for clients is more likely to result in long-term positive health outcomes, with health change aims not just achieved, but maintained. One of the most common things clients say to me is
“I know what to do, I just struggle to do it”
I see my role as not just being educator, but also as cheerleader, strategist and sounding board – my job is to make it as easy as possible to not just achieve your health goals, but to maintain them as well.