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3 How to get the most out of your visit to the registered dietitian

Visiting a registered dietitian (RD) seems to be as popular as going to the dentist to have a cavity filled. Maybe less so. Perhaps people cringe at the thought of exposing their personal food choices and body weight to a RD. Perhaps they expect to be scolded or judged. Unfortunately, many physicians have not exactly helped put these perceptions to rest. In some cases, the physician may even use the threat of an appointment with a RD as some strange motivational tactic to encourage patients to change behaviors. Not surprisingly, this tactic doesn’t work, but it does turn the RD into the boogeyman. In other cases, health care professionals will make offhand, negative comments such as, “You won’t be able to eat THAT anymore,” and then set up an appointment without a patient’s consent, creating a scenario where the individual anticipates having things taken away from them before they even step through the door.

Here’s the good news about a referral to a RD—it is not punishment, it is valuable. The RD is a vital member of your diabetes health care team and a terrific source of nutrition information. In fact, most people find that a RD expands their food choices as opposed to limiting them. Considering the other options for nutrition education—food advice from a copied menu or an article from a popular magazine—it’s not surprising that most enjoy the special attention and conversation

WHAT’S A RD?

Once you realize a RD is not a dietary dictator or the food police, you might wonder what a RD actually is. Following are some characteristics all RDs share.

RDs are food and nutrition experts.

RDs have attained at least a Bachelor’s Degree.

RDs have completed coursework and supervised practice accredited by the Commission on Accreditation for Dietetic Education (CADE).

RDs have had to pass a national exam by the Commission on Dietetic Registration (CDR).

RDs must continue their training by achieving a certain number of educational requirements each year (in other words, they must stay up to date).

RDs work in hospitals, clinics, health care facilities, wellness programs, food industries, private practices, public health services, universities, research facilities, culinary institutions, schools, cooperative extension services, and government agencies.

RDs in diabetes care follow precise practice guidelines, to assure quality.

RDs come in all shapes, ages, and sizes, and either gender; they are human, after all.

RDs want to help you, not punish you.

DOES A RD VISIT COST MONEY?

A visit to the RD will likely mean an out-of-pocket cost. Find out from your insurance company in advance what will be covered and what will not be covered. Medicare does provide coverage for meeting with RDs under certain conditions, and many private insurance policies will cover appointments if the RD is associated with an American Diabetes Association Recognized Diabetes Education Program or American Association of Diabetes Educator’s Accredited Program (see the box How to Find a Professional). With so much “free” nutrition information out on the web, on newsstands, and in magazine racks (some of it valid, most of it utter nonsense), many people wonder why they should pay a RD. It helps to remember they are medically and professionally trained and they are working with you. There is a lot of free general medical advice available as well, but we still understand the importance of visiting our doctor for a checkup. The same is true of a RD.

WHAT WILL YOU GET FROM YOUR VISIT?

Meeting a RD is much more personal and useful than being given a free “diet sheet” from a tear pad at the doctor’s office. Why? Because you are an individual. From the minute you started putting food in your mouth, your reaction to food was unique. At about 12–18 months old, when you became independent with your spoon, you gained control of what you did and did not put in your mouth. From that time on, you learned to make your own choices.

An individualized plan designed for people with diabetes allows choices as well. How could a copy of a preprinted 1800-calorie diet with a one-day menu possibly work for everyone? People with diabetes come in different ages, sizes, and shapes and each has different medical needs. One plan does not fit all. To make sure you get the most of your appointment, ideally ask for a consultation with an established American Diabetes Association Recognized Program or American Association of Diabetes Educator’s Accredited Program. Look for someone who is a Certified Diabetes Educator (CDE). A CDE is a professional who has met standards and passed a qualified exam to be designated as someone knowledgeable and experienced in diabetes care. See the box How to Find a Professional for more information on how to find these professionals.

GET THE MOST OUT OF YOUR VISIT TO THE RD

ASK YOURSELF WHAT YOU WANT OUT OF THE VISIT

Do some soul-searching before your appointment and determine what you want to learn from your visit. You will also likely be asked to make some changes; what are you willing to do? You should be in a state of mind to receive suggestions and act on them. If you feel your first RD doesn’t meet your needs, don’t give up; ask for another RD.

STAY POSITIVE

Forget the negatives you’ve heard in the past and start from scratch. If you are anticipating the worst, this negativity will set the stage and will become the inevitable outcome of the visit. Unfortunately, friends, family members, and health care professionals may have said some unkind and hurtful things to you about your weight, food choices, or food behaviors. Start your new relationship by viewing the RD as someone who is there to support you, and remember that it may take a few visits to formulate the right plan.

BE TRUTHFUL

Hiding information about your eating habits or behaviors will make it impossible to develop a personalized meal plan that can work. For instance, if you have a weekly date out with friends at a local restaurant, tell the RD. He or she can help you make the best choices at this restaurant and not force you to give up important parts of your lifestyle. Tell the RD what your favorite foods are—any plan that cuts out these foods completely will be difficult to follow.

SET SHORT-TERM AND LONG-TERM GOALS

Goal planning is an essential part of changing habits. Food habits have taken years to establish and will take time to change. A proper goal should answer three questions:

1. What? What you want to achieve (the change)

2. When? When you plan to achieve it (the timeline)

3. How? How you will achieve it (the strategy)

EXAMPLE: “I will substitute a 15-gram carbohydrate food choice for my mid-morning snack at work instead of a candy bar (1). I will start doing this next Monday (2). I will go to the store on Saturday and select some new things that have about 15 grams of carbohydrate in them (3).”

Without these three elements, it is difficult to initiate change. During your appointment, write down your goal and include these elements to provide a clear concept of your plan. Your goals should be realistic—losing 20 pounds overnight is not a good short-term goal. In setting only a few realistic goals at a time, you will be better able to make changes that will last a lifetime, rather than just a few days.

REMEMBER, NO ONE’S PERFECT

No matter how great your meal plan, there are going to be times when you fall off the wagon. Ask your RD about relapse prevention and strategies on what to do if you get off track. One very important tip: Do not call your plan a “diet.” This word has a negative and short-term implication. Medical literature calls it a “medical nutrition plan,” but most RDs will simply call it a meal or nutrition plan. Another word to drop from your food vocabulary: “cheating.” Instead, you make “choices” with food. Learning how to incorporate your favorite foods into your plan will help you stick with your plan.

BRING IN A FOOD DIARY

A food diary can help you identify some previously unrecognized food behaviors, such as unconscious eating (nibbling while you cook, snacking while watching TV, grabbing a handful of something as you breeze through the kitchen) or nervous snacking (eating while you are stressed or nervous). See the food diary sample in Table 1 for an example.

TABLE 1. SAMPLE FOOD DIARY

TAKE THE SHOPPER AND CHEF WITH YOU

The person who prepares your food should, if possible, accompany you to the RD visit. No, this does not mean you should hunt down Ronald McDonald. But if your wife or husband does the cooking for you, they should learn what you learn. Knowing what to buy and how to prepare the food is an important part of putting together the pieces of a meal plan. Ultimately, though, the responsibility to follow the plan falls on the person who holds the fork.

TAKE MENUS AND EMPTY BOXES WITH YOU

If you visit a particular restaurant on a regular basis, ask for a menu and bring it with you to your RD visit. With this information, you and the RD can identify healthy choices and develop strategies for eating healthier while eating out. The same is true for some of your favorite boxed foods—take in the label. With your real-life tools (menus, labels, etc.), you will be able to individualize your plan and practice making choices.

COMPLETE A NUTRITIONAL ASSESSMENT

Ideally, your RD will have you to complete a nutritional assessment, which should ask for:

Food likes and dislikes

Food allergy history

Current weight

Past weight

Current health status and medications

Food intolerances

Swallowing abilities

Digestive problems

Food purchasing needs

Food preparation styles

Restaurant dining habits

Alcohol use

ASK FOR A FOLLOW-UP

Determine when the next visit will be, or how a follow-up will be handled after your visit. A follow-up will give you the opportunity to discuss real-life experiences you’ve encountered with your meal plan, what things work, and what may need some more planning. The RD can provide a source of support and encouragement for whatever your goals are, so use your resources and stay in touch. Once you’ve established a meal plan, it may help to touch base with your RD annually to discuss new food choices and any new information that may help you improve your plan.

MORE RESOURCES TO EXPLORE

WEBSITES

American Diabetes Association Website …. WWW.DIABETES.ORG

American Dietetic Association…… WWW.EATRIGHT.ORG

American Association of Diabetes Educators…… www.DIABETESEDUCATOR.ORG