Dietitian on a background of weight scales, calorie tracking and food
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Our approach to nuanced situations

Where we work in the area of sport, I think sometimes it can be really unhelpful when dietitians or health practitioners take on a really strong or black and white opinions.

However, navigating somewhere in the middle, in the grey, is really really hard and takes a lot more effort. Here I’m thinking of situations likes:

  • When it might be appropriate for an athlete to cut weight or change their body composition.
  • Where calorie counting might be helpful vs unhelpful. 
  • Where trying an elimination diet might be helpful vs unhelpful.

Honestly the list is endless, especially in the nutrition space. So the idea of this podcast is to explain our framework for navigating these nuanced situations. And to do this, I want to introduce the idea of an individual’s ‘limits’.

What does limits mean? 

I think of our ‘limits’ as the boundary or the extent to which a person can lean one direction without their values or quality of life being compromised. 

So already we can tell that this is all very individual, there isn’t one single limit or stopping point for every single person in the world and there isn’t one single way a person wants to live or set of values that everyone holds.

So working to find an individual’s limits can take a bit of time and involves a lot of collaboration

So how do we go about finding an individual’s limits?

Step 1: Understanding our values

When our lives aren’t aligned with our values, we feel it. There’s no escaping it, we don’t feel happy, satisfied or fulfilled. 

And when we say values we are meaning things like creativity, mindfulness, curiosity, discipline etc Like the list goes on and endless. 

Now we borrow the idea of the importance of living to our values from Acceptance Commitment Therapy and you can learn more about ACT online by checking out some of Russ Harris’s resources and videos. But essentially, where we are often told that we will be happy when we achieve our goals and outcomes, but when we achieve these goals, we feel happy for a short period but then feel like we are in a constant rat wheel. 

Road tip analogy

I like an analogy that Russ Harris uses in one of his videos where there are two kids in a car on a road trip.

One of the kids is all about the destination. They are constantly asking, ‘Are we there yet?’ and are impatient and restless.

The other kid is aware and in-tune with the things they value. One of these values might be relationships and so they are soaking in time with their family. Another value might be curiosity and so they are loving looking out the window and considering a part of the world they haven’t seen before.

These kids are both in the same situation but feel very differently about the road trip.

Russ argues that when we are living in-tune with what’s really meaningful to us ie our values, we feel happy and fulfilled. 

It’s Important for Practitioner’s to Understand their Values

Values are important and it is important to have an understanding of not just our client’s values but also our own and also I think an understanding of the world views that have formed our values. And why I think that it’s important for myself or your practitioner to have just as much clarity over their values and beliefs and worldview is because we all have biases and if we don’t know what they are, we cannot be neutral and we can’t properly create a neutral space for you to explore yours. 

Now you might be thinking that well, Han, does this matter because you’re not a psychologist, you’re a dietitian. And my answer is yes it does. I’m not here to work with you to align your whole life with your values but I am here to help you align how you eat to your values and anytime we talk values, we need a neutral space. 

The whole idea here is that we are trying to navigate the grey. Based on my experience, when practitioners haven’t explored their own biases, myself included, this is were we can because very black and white and expect our clients to act in a particular way. Most pratitioners in health have good intentions, but the outcome can still be unhelpful. 

So practitioners do the work. Clients ensure you have a space to explore neutrally.

When you have a neutral space and can explore curiously, you can then work out how that relates to food.

For example, if you really value relationships and a bit part of spending time with your friends is eating out, and that brings you a lot of joy, telling yourself that you need to count every calorie and cut out all sugars will probably make that part of your life really difficult. 

Step 2: Recognising the benefits and the risks

Very rarely is something all bad or all good. So when it comes to considering a certain question around your health or performance which doesn’t seem like a clear cut choice, it makes sense because it probably isn’t. 

There’s likely some very valid and real arguments for both sides and so as we go through this process with our clients, we like to explore this curiously!

I’ve seen this done with a table – like ‘for’ and ‘against’ points for each option or also in acceptance commitment therapy it can be presented as a choice point. What choice feels more in line with your values. 

However, we do it, we are essentially just mapping out the benefits and the risks. 

We might think that this is really obvious – that of course any decision will have benefits and risks. I like that you’re thinking that way because you’re already coming at this with nuance. However, sometimes it isn’t clear. 

A Nuanced Example – Fat Loss & Athletes

Take fat loss in sport for example. There are 2 strong camps of dietitians out there – one camp might be set on the more traditional idea that leaner is faster and therefore better performance therefore, if their athlete wants to lean down, there will be down no questions asked or they may even be the one bringing up the idea with the athlete. 

On the other hand, we have another camp of dietitians who see only the risks of any form of weight loss or fat loss and won’t engage fat loss goals due to these risks. 

I feel that I can speak to this scenario as it is one that I navigate in clinic nearly each week and I have practiced in both camps at different times in my career.

What we try to do here at All Bodies is work with our clients to understand how changing diet for fat loss or not making dietary changes may impact how our clients lives align with the things they value. 

For example, one my clients is a track and field athlete. They have been come through the other side of an eating disorder and are hoping to go back to competition. The pressures of the sport and their coach tells them that they need to lose weight. In discussion with this client, they said that for them, trying to fit the body ideal for their sport was one of the things, if not the key thing, that contributed to their eating disorder and that the risk of going back outweighed any performance benefits they may notice. 

Now what about those times, where the risks don’t seem to outweigh the benefits? 

How do we move forward? I think the key here is to acknowledge that there still are risks. I think the issues come when we see net positive and think only positive. 

So the question is how do you move forward while managing the risks?

Well here we are looking into the specifics of the situation. What makes the risks risky? Are there ways that can be navigated? Are their boundaries we can put in place to protect us?

I see these boundaries like a ‘stop-loss’ in investing where say you invest in a company but then proceed to lose money. You’ve already agreed with yourself that if you lose more than 15%, you’ll cut your loses and take your money out. 

I think navigating risks can be the same and this is where we get to know our limits. 

Here’s an example – 

I had a client who also recovered from an eating disorder and was back into training and competition. They also wanted to explore the idea of fat loss. As we explored it together, we acknowledged that the there are real risks of weight loss. 

The research is pretty clear that weight loss is one of the biggest risk factors for developing an ED and they related to that in their own personal experience. 

However, what exactly was it about weight loss? Where there other things also going on? How much did they contribute? 

As we worked together we formed a bigger picture and found that anxiety, among other things, was a key risk factor. It seemed that when anxiety + weight loss were present, then the risk was quite high. 

So we set boundaries. One of those was that we would wait until anxiety had been low for a while (I can’t remember how long) before we’d approach fat loss. Then while in the deficit, if anxiety began to increase, we would call it there and go back to fuelling. 

Of course, there were other boundaries, metrics and support in place but I’ve use that example to keep it simple and give you an idea. 

Other things we may consider in this case could be did the rate of weight loss contribute to the risk? What about the method eg tracking or flexible? What would be the signs that things were heading in the wrong direction etc

Wrapping Up

So we’ve focussed on fat loss in sport because thats a really common one and one that can be tricky to navigate. But we use this framework for anything where there isn’t a clear cut way forward and there are very likely some risks to consider. 

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