Why you should see a dietitian for weight loss and dietary advice

 

One of the most common questions that you get asked as a dietitian is ‘what is the difference between a dietitian and a nutritionist? Admittedly it is confusing – if anything the term nutritionist sounds far more user friendly compared to the term ‘dietitian’ which tends to conjure up images of a practitioner in a white coat dictating what you should and should not be eating. This is as opposed to nutritionist in which case we tend to imagine holistic health imagery filled with fresh fruit, vegetables and wellbeing.

While a dietitian is always also a nutritionist, this is not the case for a nutritionist. A dietitian is someone who has completed tertiary training, usually with a Master’s Degree at university in the area of nutrition and dietetics – the applied science of nutrition and its application to dietary change in people. To be called an Accredited Practising Dietitian (similar to an accredited accountant) you not only need to have completed this university training but annually complete a certain number of continuing education activities to ensure that your practice is current and up to date with the latest scientific research and its application to humans. The scientific training of a dietitian involves studying biochemistry, physiology, disease states, psychology, supervised nutritional counseling and statistical analysis. Such in depth training not only takes many years but teaches dietitians to be able to interpret scientific data and medical results in order to develop individual client dietary prescriptions based on scientifically proven data ad research. On the whole, the profession is highly regulated to ensure that best practice is ensured for our clients.

Nutritionists on the other hand are managed a little less rigidly – actually anyone can call themselves a nutritionist, and while some people may have studied nutrition at a tertiary level and earned various qualifications, others may simply have completed a course at a private college or via an online course. And for this reason, it is imperative that consumers check the credentials of the health professional that they are seeing. Recommending that those consumers wanting dietary advice or weight loss advice see a dietitian is given not because a nutritionist is not likely to improve the diet quality of any client that they see, but rather because dietary intervention can be a little more complicated.

To demonstrate this, a client story of mine that I will share with you;

A couple of years ago I saw a 32 year old female for weight loss. The female was roughly 90kg and had been feeling exceptionally tired. She has already seen a GP and an endocrinologist who had blamed the fatigue on a poor diet and her insulin resistance. Since these consults, my patient’s symptoms had not improved and she had also see a nutritionist at her gym who suggested she stop consuming wheat and dairy. Initially my client had felt better with this advice but she was still not losing weight and a month later she was still tired. When I first saw her, I simply changed her macronutrient ratios (her carb, protein and fat levels) slightly but had that practitioner sixth sense that all was not well with this girl. I have seen too many other women for weight loss, over many years to know when something is not right. My client appeared grey, low in energy and mood and even with insulin resistance her fatigue was extreme. When I went home I discussed the patient online with some dietitian colleagues – as a profession there is support available from other practitioners online when you are a dietitian. One of my colleagues suggested another endocrinologist simply as this one specialist had much experience with clients presenting with fatigue. While I continued to see the client and managed to help her lose 3kg, she finally got into the new specialist and was diagnosed with thyroid cancer. She has since had it removed and is in full remission.

Now I do not share this story to show off or claim glory but rather to show that simple dietary presentations whether they are fatigue, bloating, irritable bowel, bad skin or unexplained weight gain can be masking significant health issues, health issues which do need practitioners with a certain level of training to deal with. If I was not a dietitian I would not be in close contact with other medical professionals, nor would I have access to a 2000 other practitioners to reflect and discuss cases and refer on when necessary. Luckily in this case we were able to have a patient diagnosed with cancer thanks to these professional interactions and as a result ultimately saved her life. In my 12 years of practice I have seen 5 cancer diagnoses, numerous cases of insulin resistance and PCOS, more than 20 pregnancies and 12 coeliacs diagnosed – and I can guarantee that it was my training as a dietitian that resulted in these outcomes.

Telling someone to eat more fresh fruit and vegetables is unlikely to do any harm but it is always useful to be aware of ones limitations in this space, and when it comes to many dietary issues and weight loss, a dietitian is the best practitioner to manage these.

What is Zotrim and how can it help me lose weight?

As a dietitian you are constantly bombarded with the latest and greatest weight loss supplements and programs, and after more than ten years working in this field my response is generally lackluster to say the least. But I have to admit that late last year when Body Science presented me with the scientific evidence to support the herbal weight loss supplement Zotrim, I had to take it a little more seriously.

 Zotrim has been available in the UK for a few years now, and is a mix of three natural herbal extracts; Yerba Mate, Damiana and Guarana. The mix has been proven to help delay gastric emptying which appears to help keep users feel full and eat fewer calories as a result. Such a response appears to enhance weight loss attempts. For example, if you would usually get ½-1 kg off using a standard calorie controlled diet, in my experience Zotrim helps you to get 2 or 3kg. Users describe a constant feeling of fullness without the nasty stimulatory side effects of caffeine based supplements, and no other side effects.

As a nutritionist, my professional tendency is to always achieve sustainable weight loss results using what I know, and what is proven to work long term – calorie monitoring, high intensity exercise as well as regular movement. In the past I have generally not recommended weight loss supplements as there are none that I know are safe and /or proven to work. In the case of Zotrim, there is evidence to show that it can support weight loss. It does not change what you need to eat to lose weight, nor does it mean you do not have to exercise; it simply helps to control appetite and as a result caloric intake.

So is it for you? There are a few clients that I would support in using Zotrim. For anyone who battles with constant hunger and sugar cravings, using Zotrim in conjunction with a protein rich diet should help manage appetite. It should also be said here that if you need to lose more than 20-30kg, it may also be a good idea to have your insulin levels checked with your GP to ensure that an underlying insulin resistance is not acting to prevent weight loss. For those wanting to lose a little less, say 10-20kg, using Zotrim is likely to help you achieve better weight loss results initially, especially if you use it as part of a diet and exercise plan. If you can lose 2-3kg or even 5kg over a month using the supplement, chances are you are more likely to keep motivated compared to losing just 1-2kg with diet and exercise alone? Finally for those who simply want to lose a kg or two but struggle with portion control, Zotrim too may off you support with appetite, portion size and calorie control.

I have trialed Zotrim with a number of my clients with positive results. If you are looking for something to support your weight loss attempts, it may be worth trying Zotrim to see if you think it helps your attempts. And most importantly, make sure you let us know how you go.

Why I recommend meal replacement products for SOME clients

A few weeks back it was fructose, then gluten and now after posting a reference to a meal replacement product on Facebook there is lively debate on why a nutritionist would recommend a meal replacement product. So, here are my reasons given that a science degree and 10 years clinical experience working in weight loss does not seem to be enough.

For the record, a meal replacement is not a ‘protein shake’ – a meal replacement is a scientifically formulated product that contains similar macronutrients to that of a meal (20-30g total carbohydrate) as well as a full micronutrient profile with far fewer calories than that of a meal. Meal replacements were originally formulated and used with patients who were in need of rapid weight loss prior to surgery, when completely replacing all meals controlled calorie and carbohydrate intake to such an extent that the patient was put into ketosis and were able to lose weight rapidly.

While still used for this purpose, meal replacements are also commonly used on many ‘diet’ programs with the same goal, helping individuals to control calorie intake as well as being used as a meal option for meals which are commonly missed, such as breakfast.

Being trained as a dietitian, I was of course taught by academic types that as a nutritionist the focus should always be on fresh, healthy, natural food and using such products was really only a good option for those who were in desperate need of weight reduction under medical supervision ie as a dietitian always promote ‘real food’.

It was not until I began working at The Children’s Hospital almost 10 years ago solely with overweight and obese children and teens that I began experimenting with these products. In client cases in which I had an overweight teen that generally skipped breakfast, I began using these products as a breakfast alternative. The teens were often happy to ‘drink’ their high protein breakfast and almost to my disbelief we started to get positive weight loss results with these teens, even better than we got when we used standard breakfast options of cereal or eggs on toast.

It is was this observation that lead me to approach a supplier of meal replacement products in Australia to look at supplying product for a research trial and ultimately an endorsement of these products as I do get positive results using them in clinical practice for weight loss.

This is not to say that I recommend meal replacements for all of my clients but I do find that for breakfast skippers, busy executives who often miss meals and for those who need a weight loss kick-start after finding themselves on a tough weight loss plateau that meal replacement products can support weight loss.

To this day I still do not really know why these products work so well, but I do know that if I nutritionally model breakfast with a similar macronutrient ratio to than of a meal replacement that I do not get the same weight loss results and all I can put this down to is the calorie restriction even if it is only a 100 calorie difference between the standard breakfast option and a meal replacement product.

Then of course there is the ongoing aggression that arises whenever sugar is spied on a nutrition label. Meal replacements tend to be relatively high in sugars as a high protein drink will taste pretty ordinary without some sort of sweetener or sugar base to sweeten it up. This appears to have no negative outcome on insulin release or weight loss in these products simply as the high protein load of these products is likely to be buffering the sugar load, particularly as part of a tight calorie control.

Of course it would be amazing to have a randomized controlled trial that really investigates why and if these products really do work but I unfortunately do not have the 3 to 5 years an RCT takes to justify using these products, I need to get results with my weight loss clients now.

As is the case with every option in nutrition and life in general people can ultimately make their own decisions when it comes to the way they choose to go about weight control. It is not my job to tell everyone what they should do for weight loss. Nor is it to constantly defend why I choose different options working with clients towards sustainable weight loss – this is the art of my own clinical practice but if asked I can give my best scientifically informed opinion on what I find works well in practice and that is what I have done in the case of meal replacements. Whether or not you agree is up to you but there really is no need to get so nasty about it.

Butter or margarine?

The growing number of reality television shows that highlight home cooked meals as well as the use of copious amounts of butter and oil again bring up the question, “should we be using butter or margarine?” Indeed it is one of the most commonly asked questions when it comes to nutrition and as is the case with all areas of nutrition, the answer is not so simple.

If we take a step back and consider the role of any type of added fat in the diet, it is important to remember that the average adult will require just 40-60g of fat in total each day. If we then consider that a serve of nuts, some oil in cooking as well as some oily fish will provide at least 2/3 of this amount we are really just considering where we need to get just 10-15g of total fat, or 2-3 teaspoons each day. For those of you who are now considering how much butter or margarine you smear on your toast, or how much is added to the average recipe featured on television cooking shows, yes, you probably do need to cut back as we really do not need a lot of added fat in general.

So, of these 2-3 teaspoons which is best? Butter, while the spread of choice because of its more “natural” image is largely a saturated fat. A teaspoon of butter will give you almost 3g of saturated fat, the type of fat which we need to keep as low as possible in our diet as it is the type of fat most likely to store and clog our arteries. A teaspoon of margarine on the other hand; a formulated blend of different types of oils depending on the one you choose , will give <1g of saturated fat per serve.

The story then becomes a little more complicated when you then consider that many of the varieties of both butter and margarine are now blends of different oils, as food companies attempt to get rid of as much bad fat from both the butter and margarines they sell, while bumping up the good fats from monounsaturated and polyunsaturated sources. Light and extra light varieties of both butter and margarine mean that the total amounts of fat received from these sources can be as low as 2g of total fat per serve, which means that either used in moderation of just 1-2 serves each day can be incorporated into any nutritionally balanced eating plan.

Cholesterol lowering margarines offer another selling point to consumers, especially given there are also light varieties of such margarines which contain concentrated amounts of plant sterols which, when consumed in high enough volumes can significantly reduce blood cholesterol. What also needs to be considered though is that these spreads are very expensive, need to be used in the right amounts (3-4 serves a day) and the cholesterol lowering benefits are perhaps not as powerful as weight loss itself. Such formulated foods then suit individuals who do not need to lose weight, who eat a low fat diet in general and who still have elevated cholesterol levels.

So, have I answered the question about which is preferable? As a nutritionist, my focus is developing entire diet plans that tick a number of nutritional boxes. Dietary modeling will indicate that of all the types of fat in the average person’s diet, it is the long chain polyunsaturated fats that tend to be lacking in the diet. For this reason, when choosing spreads I generally suggest an extra light variety that offers a decent serve of polyunsaturated fat. As is the case with any added fat though, I would much prefer my clients get the fat in their diets from nuts, seeds, oily fish and good quality oil which means that there is really very little place for spreads in the diet in general.

Finding your motivation

“You can have anything if you want it desperately enough”

If I knew the secret to getting every single individual motivated I would be in a very powerful position indeed, but unfortunately, as is the case with many human attributes, motivation is a complex and changeable state. For many, motivation, particularly when it comes
to health and fitness routines in innate; we learnt to eat and behave in a certain way when were small and will continue to do so for the rest of our lives. For others, a health scare or realisation that you are 20kgs heavier than you should be gives us the kick we need to change our daily habits and turn our lives around. Then there are those individuals who just seem to never get it
and keep at it; they try one health and fitness craze after the other, never cementing a pattern of living that give their bodies and lives at better chance.

If you are reading this it is safe to say that on some level you are motivated. If you know that now you also need to cement your motivation it may be useful to clarify a few things. Some simple
questions that may help you to clarify the key reasons that you want to get your body fit and healthy and ultimately keep it that way include:

What are the benefits of keeping my body fit and healthy?
How would my life be better if I felt better about my body?
Am I the kind of healthy role model I would like to be for my children?
Can I physically do all the things I would like to with my body?
What am I really putting into my body each day?
If I was fit, healthy and happy what would I be eating and what training would I be doing each day?
If I knew I could keep my body disease free by eating well and moving, would I be more inclined to move more and eat less?
Who are the people in my life who would support me living like this?
What changes can I make to my lifestyle today that will help move me closer to my goal of living well and feeling healthy?

Having clear answers to some or all of these questions is not only useful in helping to remind you of the bigger picture reasons for wanting to get in shape and stay there but keeping the answers to such questions on hand can be very useful to refer back to when and if you do find yourself going off track.

The truth is that for behavioural change to be sustained, the desire for wanting it needs to come from within. It cannot be based on wanting to look good for a wedding, or to fit a certain dress, it
has to come from deep within to such an extent as it actually becomes part of you and you can no longer imagine life without it. As you embrace this new approach to weight loss and control, give yourself time to cement your new habits – you need 3 months. 3 months of regular training and eating well for these behaviours to become habits. And the longer the habit is with you, the harder it is to break.

Is your teen obsessed with being thin

A few years ago, I wrote a piece for Dolly magazine about an increasing common style of eating in which teenagers became somewhat obsessed with ‘healthy eating’. The girls typically presented with concerned parents who had noticed a change in eating habits and significant weight loss. These tall, lanky, lean girls did not satisfy the diagnostic criteria for a clinical eating disorder but refused to eat anything other than low calorie, low fat, unprocessed foods. Epitomizing all things natural’ and ‘healthy’, such a diet, solely consisting of fruits and vegetables, nuts, seeds and grains, while lacking in essential nutrients remained adequate (just) in calories so that followers become exceptionally thin, although not necessarily underweight.

Now whether it is becoming increasing common, or I just happen to see it in my clinic, again this week I have been referred two teenage girls with the same presentation - a presentation I am now treating as ‘orthorexia’. “Orthorexia’ was first described by an American doctor in the late 1990’s, who was seeing an increasing number of female patients who were exhibiting a number of eating
disorder related symptoms including eating only an extremely limited food variety, and maintaining an extremely low body weight without satisfying the criteria for a clinical eating disorder. These girls were obsessed with only consuming foods that were “pure” and “healthy”, and as a result tended to consume only extremely low calorie, unprocessed foods, which in turn kept their body weight extremely low.

Unlike sufferers of a clinical eating disorder, these girls were not malnourished, as their diets were packed full of nutritious food choices, but in many cases their mood state was low either a result of a low food intake or a result of other stressors in their lives such as school issues caused by a clinical depression.

All cases I have seen in practice have been teenagers between the ages of fourteen to sixteen, from middle class family backgrounds attending good schools. All girls have been classified as “very intelligent” but struggle socially with the pressures only teenage girls experience from peers - the lure of boys, the pressure to achieve at school and to look good. A trigger, either family distress or negative interaction at school appears to be a common link with all cases, leading to depressed mood and the desire to be in control of as many other variables in their life as they can, such as their food intake and the way they feel about their body.

From a clinician’s perspective, this is a challenging situation. The girls are underweight but not “unhealthy” and their eating patterns are disturbed, without being clinically disordered. Blood biochemistry can be checked for signs of physiological distress but in a number of cases, return within normal ranges as food or supplement intake, although minimal keeps the girls within normal biochemical ranges.

For parents the scenario is exceptionally daunting. The rigid ‘all or nothing’ thinking that accompanies clinical eating disorders can be observed with this patient group, and we can be talking just a few kg shy of becoming clinically underweight. For this reason parents can be assured that the best thing they can do is to take control of the home food environment. Be strict with meal times, ensure family meals are enjoyed together and insist that your teen consumes the protein rich foods that they require for optimal growth and development in some form, whether it is in vegetarian protein rich options or via supplementary foods. Failure to comply with these basic eating rules needs to result in clear consequences such as removal of privileges or social media in the same way you would parent a toddler or small child. Most importantly, any link to weight loss and monitoring needs to be removed from the home, which means that the scales may need to be quickly thrown away.

Secondly, but most importantly exploring the underlying emotional triggers such as stressors at home or at school that may be directly or indirectly related to the depressed mood and rigid eating patterns of these girls is an important part of the process to help empower them to be able to manage the various scenarios that arise in their day to day lives. There are a number of simple
techniques including diarising all personal interactions with both friends and family that may be causing distress or anxiety is one way to help the girls learn to identify and manage their emotions, rather than using food and exercise as an escape from them. For teens that are exceptionally bright, keeping them busy and their minds active with scheduled exercise and/or sport, controlled social media usage and regular relaxation via pilates, yoga or meditation are other possible ways to shift their focus from food to life.

While adolescents’ can be an extremely challenging group to work with, they can also be an enormously rewarding client group. I have now seen a number of what I would describe as ‘orthorexic’ teens gradually work through their eating distress and are now well on their way into their final years of school, significantly happier and healthier than when I first saw them.

Unfortunately, the powerful media images of health and beauty are unlikely to disappear entirely and hence the incidence of conditions such as orthorexia is likely to increase. The key for health professionals and families affected is to know how to identify and manage this healthy food habit before it is too late.

Are you tired all the time?

If there was a commonality of all the women I see in my clinic, it would be that they are all tired. Tired from not getting enough sleep, tired from the demands of the kids, tired from working too hard, tired of dealing with their weight and tired of not having enough energy to do all the things that they need and want to do with their day.

This is not surprising. So many of us live frantic lives with long working days and even longer commutes, ever increasing family and relationship commitments and bumper social lives that it is a constant juggle to get through the day, let alone with a reasonable amount of rest and time to get your thoughts together to power on all over again. While the demands of modern life are unlikely to change anytime soon, there are a few key lifestyle changes you can commit to that will at least help maintain your energy levels on a daily basis so you cruise to the end of your day, rather than collapse into it.

Iron Up
If you are a meat eater you need to eat red meat 3-4 times each week. Why? Simply because your body is programmed to absorb the iron it needs to transport oxygen around the body from animal sources of iron, namely red meat and if you do not give your body regular access to it, your stores will gradually be depleted and you will be tired. Vegetarians are different, as they are programmed to absorb their iron from non-meat sources but meat eaters; you need that steak, lamb or pork 3-4 times every single week.

Get into the sun
I know you are not keen to bring on any more wrinkles but the truth is that many Australian’s are simply not getting enough sunlight when we can to ensure we are making enough Vitamin D. Vitamin D has numerous functions in the body and is also known to help prevent a number of diseases including some types of cancer. When it comes to energy levels, low Vitamin D also tends to result in lower mood states and muscle fatigue so if you are not feeling 100% and cannot remember the last time you went into the sun, it may be time to have your Vitamin D checked by your GP.

Fresh is always best
For busy women on the run, grabbing a one off coffee, protein bar or pre made sandwich in place of a home prepared, nutritious snack is not an issue but if your diet is based solely around processed foods and supplements, you will not be doing your energy or immune system any favours. Fresh foods include fruits, grains, vegetables and seeds offer numerous nutritional benefits over any processed foods, which means you need these foods every single day to keep your training body at its best. As a general rule of thumb, the brighter the fresh food, the better it will be for you and we need at least 2-3 cups of brightly coloured vegetables and a couple of pieces of fruit every single day. Easy yet convenient ways to get your vitamin hit each day include grabbing a fresh juice rather than a coffee, keeping quick cook vegetable packs at work and for quick dinners and try snacking on fresh carrots and other cut up vegetables on a daily basis.

Watch the stimulation
The ironic thing about consuming caffeine and other “energy” type drinks to help increase energy is that they are just as likely to leave you feeling even worse than before you consumed them. The reason for this is that even though stimulants, whether they are in the form of caffeine or sugar will give you an initial “hit”, they will also see a subsequent “drop” once the stimulant has been metabolized. For this reason, using caffeine in small amounts regularly and avoiding all sugar based drinks is a much better option than relying on them for an energy hit in times of trouble. Ideally large volumes of water, some herbal tea and a couple of cups of tea or coffee each day are the best types of fluid for you to ingest to keep you optimally hydrated and your energy systems at their best.

Add in your energy superfoods
When energy demands are high, it makes sense to include as many nutrient and energy rich foods into your diet as you can. Often as women try and keep their weight down, they consciously drop carbohydrates from their diet but it should be remembered that wholegrain carbs are a rich source of both essential nutrients required for energy production, including the B group vitamins. If you have been feeling tired, make sure that you are including at least one serve of wholegrain carbs in each of your meals and snacks.

Just as important is to ensure that you are getting plenty of powerful antioxidants from brightly colours fresh fruits and vegetables on a daily basis. Add in a fresh vegetable juice and aim for serves of salad or vegetables at both lunch and dinner to give your body every chance of being at its best, day in, day out and fend off fatigue with as much good nutrition as you can.

Go to bed
Perhaps the most obvious and simplest way of improving your energy levels, preventing
fatigue and feeling better in general is to simply get more sleep. While the average adult averages just 5-6 hours of sleep a night, we need as much as 7-9 hours’ sleep a night to be at our best. So even if you can only get to need early a few nights each week, make this commitment. Remove all electronic equipment from the bedroom including mobile phones near the bed and practice getting into bed by 10 or 11pm and reading before you sleep – just the way nature intended it.