The Non-Diet Approach Guidebook for Dietitians (2013): A how-to guide for applying the Non-Diet Approach to Individualised Dietetic Counselling

By Fiona Willer

It is hoped that this guidebook will be useful both as a text and as a workbook for dietitians working in private practice and outpatient settings, and also perhaps by other health professionals involved in counselling individuals with weight concern.
This guidebook has the following features:
- A clear explanation of the non-diet paradigm with supporting evidence
- A framework for dietetic practice using the non-diet approach
- Each section for the five core components of the non-diet approach includes a description of the core component, discussion points to inform your counselling, and worksheets which can be used in sessions to support client education or given as ‘homework’
- How to integrate the non-diet approach into the Nutrition Care Process
- Assessment tools
- Forms to use for the client record
- Recommendations for further reading and an extensive reference list

Please see www.healthnotdiets.com for more details.

• Language: English
• Publisher: Lulu.com
• Release date: Apr 3, 2022
• ISBN: 9781471740220

Book preview

THE NON-DIET APPROACH GUIDEBOOK FOR DIETITIANS

A how-to guide for applying the non-diet approach to individualised dietetic counselling

Fiona Willer, APD, AN

Dietitians are very good at assessing the ‘who’, ‘what’ and ‘when’ parts of individual health improvement through nutrition.  We use empirical research to understand what elements are effective in reaching this goal. The non-diet approach is an alternative answer to the question of ‘how’ this knowledge is best passed on to our patients and clients

Disclaimer

In view of the complex, individual nature of health and fitness issues, this book and the ideas, programs, procedures and suggestions are not intended to replace the advice of trained health professionals.  All matters regarding one’s health require medical supervision.

The author’s role is strictly educational in the context of these materials.  The author is not providing any medical assessment, individualised therapeutic interventions, or personal medical advice.  The information presented offers a perspective to inform decisions related to food and health.  Seek medical advice from your personal health care provider regarding your personal risks and benefits insofar as adopting the recommendations of this program.

The author disclaims any liability arising directly or indirectly from the use of this book or program.

Self-published via Lulu Publishing Ltd, Lulu Enterprises, 3101 Hillsborough St, Raleigh, NC 27607, United States.  www.lulu.com

Hard copies can be ordered via www.lulu.com or for special discounts for bulk purchases, please contact Fiona Willer at PO Box 420, Kenmore, 4069, Australia or [e-mail].

For more Non-Diet Approach training and workshops, see www.healthnotdiets.com

Copyright

THE NON-DIET APPROACH GUIDEBOOK FOR DIETITIANS: A HOW-TO GUIDE FOR APPLYING THE NON-DIET APPROACH TO INDIVIDUALISED DIETETIC COUNSELLING

First Edition

Copyright © 2013 Fiona Willer. All rights reserved.

ISBN: 9 781471 740220

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any other means, electronic, mechanical, photocopying, recording, or otherwise without written permission from the author.  Exceptions for selected pages are marked clearly and must be copied with the permission statement included.

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For my babies, Alexander and Elliott, and the inner child in all of us.

Introduction

These days weight, and what to do about it, is highly controversial.  Fatness is now assumed by many to be an unequivocal marker of health status.  There is also the pervasive assumption not only that weight itself is the problem, but also that dieting is the answer.  Dieting for weight loss and preoccupation with body shape and size is a highly culturalised phenomenon which is so widespread that it has become normative in western society ²². It is so deeply entrenched that alternatives to weight loss dieting and studies which show a protective effect of fatness are often met with undue scepticism and sometimes outright outrage.  Not only has the damaging effect of excess weight often been (sometimes hysterically) overstated, but there is scant long term evidence that traditional weight loss interventions achieve what they set out to achieve.  As an added blow, these interventions have been shown, where investigated, to lead to exacerbated problems with body image, depression, disordered eating and weight regain for many23 24.

People who diet restrictively tend to have concrete beliefs about the value of different foods, eating behaviours and body shape that are more extreme than non-dieters²⁵.  Frequent weight loss dieting has been associated with increased morbidity and mortality risk²⁶, reduced bone mass (even in obese populations) and increased cortisol production²³, and is a strong predictor of weight gain over time23 24 27.  Further, chronic dieters are more likely to have lowered body appearance evaluation and body satisfaction²⁵, exaggerated responsiveness to nutritional or food-related cues²⁸, depression and anxiety²⁹.  People are considered to have Chronic Dieting Syndrome ³⁰ when the following are manifest: a) persistent over-concern with body weight and shape, b) restriction of food choices for two years or more, and c) continual dieting to achieve weight loss without success or with weight regain.  Chronic Dieting Syndrome occurs far more frequently in women than men³¹ and although the prevalence of Chronic Dieting Syndrome has not been quantified in the literature, it is encountered often in dietetic private practice.

It is apparent that the practice of dieting for the vast majority of people with weight concern is unhelpful.  The non-diet approach turns traditional dietary prescription on its head by shunning external eating drivers and panic-driven behaviours, and turning the focus inwards, towards internal body cues, self-acceptance and more multidimensional concepts of self-care.  This method is showing promising clinical and psychological results as one of the most helpful, least harmful ways to assist those with weight concern. We as dietitians are well-placed to counsel within this paradigm.  After all, our professional reason for being is to assist individuals to make helpful food and eating choices which allow them to live as full and healthy a life as possible. 

The more varied our diet, the more likely we are to be meeting our nutritional requirements.  The USA Academy of Nutrition and Dietetics in its latest Position Statement on the Total Diet Approach to Healthy Eating³² states that ‘the overall pattern of food eaten is the most important focus of healthy eating. All foods can fit within this pattern if consumed in moderation with appropriate portion size and combined with physical activity.’  This is strongly consistent with the outcomes of the non-diet approach: a wide variety of foods eaten to satisfaction with regular, enjoyable, physical movement.

It is hoped that this guidebook will be useful both as a text and as a workbook for dietitians working in private practice and outpatient settings, and also perhaps by other health professionals involved in counselling individuals with weight concern.  It brings together current research and practice in the fields of psychology, psychotherapy, dietetics and obesity management and contextualises the non-diet approach for those working in individualised dietary counselling.

What Is In This book?

This guidebook has the following features:

A clear explanation of the non-diet paradigm with supporting evidence

A framework for dietetic practice using the non-diet approach

Each section for the five core components of the non-diet approach includes

Description of the core component

Discussion points to inform your counselling

Worksheets which can be used in sessions to support client education or given as ‘homework’

How to integrate the non-diet approach into the Nutrition Care Process

Relevant domains for Nutrition Assessment, Nutrition Diagnosis, Nutrition Intervention and Nutrition Monitoring and Evaluation

Assessment tools

Forms to use for the client record

Recommendations for further reading and an extensive reference list

What is the Non-Diet Paradigm?

The non-diet approach to weight management is an emerging field of study, with promising results shown in the areas of quality of life, improved biochemical markers, improved psychological outcomes and reduction of weight cycling 15 24.  This approach is also referred to as innate eating²⁰, mindful eating ³³, and intuitive eating ⁹. It sits within the Health at Every Size (HAES) paradigm ³ and can be seen as part of the anti-dieting movement³⁴. At the core of the non-diet approach is the focus on responding to internal eating cues (physical hunger and fullness, the hedonistic pleasure aspects of the experience of eating,) self-care and a non-judgmental, nurturing and grateful attitude towards one’s self and food. In this way it is aligned with the psychologist-administered treatments of Mindfulness Based Stress Reduction³⁵ and Acceptance and Commitment Therapy (ACT)³⁶ which have been used by psychologists to help those with eating and weight issues37 38, and are constructed upon Self-Regulation Theory³⁹. 

In non-diet approaches, the typical dieting behaviours of weighing and measuring food and body, recording detailed food diaries, extensive forward planning and timing of meals, concrete energy intake, specific weight loss goals and the use of ‘diet’ foods are firmly discouraged. It is instead a much more gentle approach, allowing the client to build skills and confidence in their own innate ability to select appropriate foods for their body in appropriate amounts.

Research validating the non-diet approach has so far occurred largely in group education settings, and has been led by a variety of practitioners including nurses, dietitians, psychologists and exercise physiologists 8 15 21 40 41. The techniques most commonly used in non-diet approach multidisciplinary group studies are intuitive eating (hunger-fullness training and mindful eating), mindfulness meditation training, awareness of non-hungry eating cues, education about the adverse effects of restrictive dieting, self and body acceptance, basic