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Thursday, July 10, 2008

Nosce Te Ipsum, Gnothi Seauton, Know Thyself: Do Dietitians Help?

Teale had a post venting her frustration with a medical system that seems to ignore the needs of the obese (and brother, do I know it). It's like you don't count until an acute or chronic illness (that may very well be caused by the obesity) crops up. Prevention doesn't cut it for many.

(Not my HMO that I used to have. They were big on prevention, and I liked them, but hubby changed jobs and we don't have them anymore. They offered discounts for WW meetings and refunds if goal weight was reached, and they paid for dietitian visits.)

However, I gotta be as honest here as I was with Teale: It may not help anywhere near as much as we may dream/hope/wish/want/need.

In 1989, I had my first experience with a registered dietitian in private counseling practice. A very nice lady in the southern part of Miami-Dade county.That was back when very high carb, very low fat was the craze. I was put on one of those plans. She was surprised at how adept I was at guessing calories (she quizzed me on various foods and I knew them all dead on.) My problem wasn't knowing nutrition (I had taken a college course on it and other medical sciences, and I'd been reading diet books since I turned chubbo as a kid). My problem was ACTION, was DISCIPLINE, was APPETITE vs HUNGER, was EMOTIONAL, was STRESS. I also was on a lot of medications, and some of them made me hungry. Steroids.

Those issues still exist, plus I have age and a dead thyroid to throw in there.

I lost 29 pounds with that eating plan taped to my fridge.

I regained them all when my health collapsed and I had to quit working (immune issues). I then gained roughly 10-15 pounds per year for the next decades, losing occasionally on WW or with another dietitian, gaining all plus back.

My second dietitian came after my immune slapdown began to be controlled somewhat and I was functional again. Late nineties. She had/has a thriving practice in an affluent area of NE Miami-Dade country. I lost about 11 pounds. Regained that plus.

My third dietitian was a nice Hispanic gal in a not-at-all affluent area of North Miami. I went to her cause my blood sugar was rising and I was clearly heading into diabetes. I lost 8 pounds. Not much. But she told me about some supplements that helped with my cholesterol (I can't take statins due to reactions to it.)

I regained those, too.

On my own, I've lost 25, I've managed to not regain completely (my usual pattern). I do believe this blog is helping, but it's a daily struggle. Some days, I just wanna have surgery and be done with it--though I know that's a simplistic view. Surgery can be a great tool, but it's still an adjustment and a lot of work for people. Look at the celebrities who regain a lot of weight after gastric bypass, or the folks with lap-bands who still have to focus on healthy eating and exercise. One way or another, you still have to change.

This blog is my journal for change. And I thank you all who give me support.

Back to the subject: Dietitians give food and nutritional advice. Most of us who have been overweight a LONG time and have brain cells that are active are pretty well-educated about food. We know the different diets (low-fat, low-carb, vegan, ovo-lacto vegetarian, low-fiber, high-fiber, no gluten, combination, "clean eating") and we may well have tried some to all of them. Some of us read diet news religiously online or in magazines and journals. We keep searching for that key to unlock us.

We need to know what we lack so we know what we need and know what we don't.

I don't usually need information on food or an eating plan. I can get that online or in magazines or in books. As I peruse dieting blogs, I see some folks who need some good basic nutritional catching-up and others who are very savvy and learning FAST.

We who know our nutrition don't really need a dietitian, I believe.

Dietitians mostly examine and talk about how we eat, what we eat, when we eat, and what our medical issues need for us to eat and not eat or how often we need to eat. What supplements may help with this or that. How to cook, what oils are best, what snacks are good. A dietitian serves a purpose, and as long as you know what it is, you won't be let down if nothing radical happens, weight-wise.

Dietitians don't solve emotional eating problems. They don't solve self-esteem issues. They don't fix your wounded heart. They don't address your sin issues (ie, hedonism, selfishness, gluttony, sloth). They can't be there when the urge to binge hits. They can only help you within their area of expertise--what is good to eat for what condition you have or to optimize satiation or fat loss or steady blood glucose levels.

If you have a new medical condition and want expert advice on the foods best for that or the eating plan that may ameliorate it, that's fine.

But usually, what we need a dietitian can't give.

We need coaching. We need to keep up our motivation, our eyes on the goal. We need strategies and tools and insight that dietitians (in my experience) can't really give. We need someone to instill that sense of "I can." We need exhortation. We need strength.

We need a cheerleader/motivator/coach/miracle-worker. :)

Actually, we may need a therapist or counselor.

Or we may need a rabbi or pastor or priest.

Or we may need a very good, very firm diet buddy.

Or we may need a group hug.

I don't know what you need, but I do know that a dietitian can help me (and has helped me) tweak an eating plan, but they can't get me to stick to it. They can't help me to avoid a binge. They can't maintain my motivation, day in and day out.

I have to find something else to help me do that, and a lot of it I have to find INSIDE.

Ultimately, I have to figure out how to become my own dietitian, coach, trainer, motivator, cheerleader, minister. Not in a crazy, isolationist, uber-self-sufficient way. In a sane, strong sufficient way.

Still, it's good to have all those outside support persons while we find our inside support team. The team of "me".

Insurance can help me with a dietitian, a bariatric surgeon, a psychologist, an endocrinologist, with medication, with lab work.

It can't come and stock my fridge. It can't make me cook. It can't stop me from putting that chocolate cupcake in my mouth. It can't stop me from ordering a big old pizza. It can't stop me from hating myself some days. It can't help me feel worthless some days.

It can't help me figure me out in my deepest place.

This blog is part of me figuring me out, but most of the work happens over HERE, where the internet can't reach. The Delphic aphorisms: "Know thyself" and "Nothing in excess" are still so relevant, and especially for fatfighters.

Gnothi seauton. Nosce Te Ipsum. Know thyself.

Nothing in excess, except, I'd say, faith and hope and love.

How are you doing figuring out YOURSELF today?

BTW, if you have had a great or terrible experience with a dietitian, diet counselor etc, do let me know or gimme a link in a comment. I wanna read about it.

And I love the idea of Lyn's to get a ring that reminds us of our need and goals. I had almost purchased some artwork with "believe" and "faith." But a ring is portable. Love it.

Begin to learn about food:

Be your own therapist/coach:

Don't just say or think--but DO:

Get spiritual help:

Self-control, that fruit of the Spirit:


Chubby Chick said...

Great post! And I love Lyn's ring idea, too.

Thanks for posting all those links to the rings and books. You're awesome! :)

Heather said...

great post! I actually had a nutritionist in college and I loved her. she really changed my life, in more ways that I realized at the time. now I realize she gave me such classic advice and really tried to help me understand and accept myself at any weight.

Duchess of Dork said...

Liking your blog, missy!

Anonymous said...

I went to a dietician before, but did not like it. She kept trying to find a huge childhood catastrophy in my past, but there isn't one. It was actually annoying. I basically wanted a do's and don'ts list of food or a written out diet. But that wasn't going to happen. I have been toying with the idea of trying another dietician... we'll see.

BTW- LOVE the rings!! Great post.

Lyn said...

Great post. Enjoyed this very much! Thanks for the mentions :)