the HAES® files: A Nutritionist by Any Other Name

by Health At Every Size® Blog

by Jon Robison, PhD, MS

This is a bit of a different kind of entry for me for this blog, but I had an experience recently that reminded me about something I had wanted to write about but had not gotten around to. I was facilitating a HAES® training recently with the coaches of a health promotion company who, among other things, provide nutritional counseling. There was a smattering of the usual “OMG where has this been all my life?” and also the occasional “OMG what planet are you from?!” One individual in particular had some real issues with the nutrition portion of the workshop.

We started the day by playing “the food game.” I ask for two volunteers and give each a marker and a place to write on a white or chalk board. I have them set up two columns, one on either end of the board. One column is titled “Good Foods (Healthy)” and the other “Bad Foods (Unhealthy).” Someone calls out a food and then says under which column it should be placed. The person in charge of that column writes it down. People can then agree or disagree. If they disagree with the placement and think it belongs under the other column, the other volunteer writes it down there as well. So, someone might say chicken/ healthy. But someone else might say but fried chicken is unhealthy and so we might put fried under unhealthy and baked under healthy. Someone might then say that white meat is healthy but dark not and so on. Then we move on to the next food. After about 30 minutes of what sometimes deteriorates into rather heated arguments of the virtues and evils of various foods, people get quite anxious and are more than ready to quit. I finish by acknowledging their confusion and anxiety and asking them to think about how the people they are counseling might be feeling.

At one point during the game, the woman I mentioned above calls out “fast food/bad.” I ask the group if all fast food is bad, and most, but not all agree that it is. The woman continues saying fast food is all bad because, for instance, a Big Mac has no nutritional value. I pause for a second and explain that there is, in fact, a significant amount of nutritional value in a Big Mac to which she replies “well, I don’t believe that is so.” So, here is a person who has only an extremely limited understanding of basic nutrition doing nutritional counseling for employees following blood screenings and HRAs. I suggest to her that regardless of whether she thinks the Big Mac contains too much of this or that to be healthy; because it provides fat, carbohydrate and protein – the three major nutrients – it is simply incorrect to make the claim she has made. She continues to disagree and I see that any more discussion is pointless. It reminds me of a colleague who says that math is not a popularity contest and therefore 2+2 equals 4 regardless of how you feel about it!

Unfortunately, it seems that many people, regardless of training or actual knowledge base, view themselves as qualified to give others nutrition counsel. This is a phenomenon that has surprised me many times over the last few decades. Doctors, most of whom have little or no nutrition training do it all the time. Recently, one of the kids on my son’s college soccer team told my son and the other boys that they shouldn’t drink Gatorade because it has too much sugar and salt and is bad for them and they can get everything they need from water. Of course, this is completely false and potentially dangerous for the boys, especially if they are exercising in the heat. Water can help with hydration but it does not replenish the electrolytes and calories from sugar which are so critical to endurance activities like soccer. By limiting their intake of these substances, they are opening themselves up to premature fatigue, slower recovery time and potential increased injuries. I am guessing the advice was handed down from a parent who was restricting calories and carbs for weight loss.

It is unlikely that people would hire someone with no training to fix their car or their television or their air conditioner and yet they listen to health professionals and others who have little or no training when it comes to nourishing the most important “machine” of all – their bodies. Of course, as in any profession, there are likely to be really good nutritionists and really bad ones and everything in-between. However, the next time you seek nutrition advice from someone, doesn’t it make sense to consider asking about their training, education and experience? It is at least as much as you would do for your car, television or air conditioner.

I am not sure of the best way to remedy this problem. I know there have been many people asking the same questions and I look forward to hearing people’s suggestions.

19 Comments to “the HAES® files: A Nutritionist by Any Other Name”

  1. I believe that a signficant impact here is ‘media’ – the 15 second sound bite reporting on some nutritional factoid that comes from a study of unknown parameters, but that the media picks up because it will garner interest in their advertising and other programming. I have a bit of a background in nutrition, and I feel like I’m swimming in the controversies, the diet issues, the foods to eat or not….while science should and does evolve with new findings all the time, I think the average citizen just throws up her/his hands, and tries wade through the information and what they hear from friends and colleagues, and makes choices that suit their circumstances. The other thing I find interesting is all the ‘special diets’ and the foods that are recommended – chia seeds is one example. Really? is the average person on the street going to forage in their stores for such nontraditional fare? It’s a giant lake of conflicting and overwhelming conversation about ‘what not to eat’ and many of us just can’t sort through what’s a good thing. Felicia M. Elias, CEBS

    • Felicia, I totally agree and sympathize with the problem – Some of us do our best to talk common sense about nutrition to people – explain that the rules and guidelines may or may not apply to them and that they should use themselves as an N of 1 in terms of their dietary practices – but you are correct that it is a difficult undertaking in a sea of such confusion – thanks – Jon

  2. A question for Jon: Did the participants ever come to an understanding of the damage caused by labeling foods good and bad?

    • Hi Elizabeth,
      A few did but many did not – interestingly, and please know I am not endorsing or not endorsing ADA or the Academy or any other organization but the dietician that was present certainty got it. The ones that did not tended to have less training and/or obviously have fairly serious at least disordered eating issues –

  3. Wow. Can I get an amen?? Great post. I wrote a post called “I chew therefore I’m an expert…” Just like physicians, therapists, trainers, etc…not all “nutritionists/dietitians” sing the same song.

  4. Thanks for the important reminder to the HAES(r) community about engaging in evidence-based practice. We have the evidence on our side – it’s important that we use it.

    Speaking for myself, I find that I am more persuaded by practitioners who advocate for an individualized nutritional approach (based on heredity, environment, health status, personal preference, and other factors) vs. “one size fits all.” As for non-practitioners, we have all encountered the hero status of those who have lost weight recently which often has the bizarre effect of making them nutritional “experts” authorized to dispense nutritional advice. Yeesh.

    • Absolutely Fall – an N of 1 approach!

    • Good point, Fall. I, too, have become very suspicious of people who have a One Size Fits All program of nutritional advice. Though we live in a world where many different ethnicities mix, I am overwhelmingly northern European with northern European health issues, in particular hypothyroidism. I would like to be vegetarian, but total vegetarianism, and certainly not veganism, does not agree with me. But for some people vegetarianism and veganism are just the ticket.

  5. Great Article and very good points! Many have been inundated with propaganda from the Corporate Ministry of News Networks (otherwise known as main stream Media) Thank goodness for places like HAES to hear the truth!

  6. I am lucky enough to have doctors who answer any questions I might throw at them, by telling me what some other doctors believe, what beliefs are controversial, and what studies exist, and which seem to be convincing and which do not. When they give me their personal opinions, they qualify them as such. I wish other “experts” were as honest about what is not really known or proven. Unfortunately, as has been pointed out by Jon and commenters, in the area of nutrition especially, everyone in the room often thinks they are an expert. You might as well argue a point in theology.

    I am certain that in most cases, it is issues of body weight that are muddying up the nutritional waters with such people.

  7. As a Registered and Licensed Dietitian specializing in eating disorders with a HAES approach, the first thing that caught my eye was “coaches that give nutritional advice”. That is the first problem. Also, even dietitians indoctrinated into a strict medical model can give horrible advice about ways to lose weight and which bad foods to avoid. As the Academy of Nutrition and Dietetics as well as State Licensing Laws guarantee educational requirements and can protect against nonprofessional “nutritionist” from giving “advice” reporting these unlicensed “experts” is a first choice. Secondly, please find a good RD specializing in ED’s and/or HAES philosophy and explain to referrals the major differences in philosophies and treatments. Great article addressing a huge problem!

  8. Hey Bill, These folks needs to have his own blog! I would definitely stick with them! Jon

  9. Excellent article about a very important subject!

    I get particularly peeved with doctors who have had NO nutritional training who attempt to offer nutritional advice.

    For example, one time at one appointment, although I’ve never in my life had an abnormal blood glucose reading under any circumstances, my lab test showed an a1c of 5.7

    Based on that, my NEW doctor (first, and only time I’ve ever seen him) plopped a diagnosis of “PRE-DIABETES” into my medical chart, and then proceeded to tell me I must now eat a “low carb” diet. Since I had never discussed my eating habits with him, I blurted out, “I’m a vegetarian; how can I possibly eat a low carb diet? All plant based foods are carbs.”

    He says to me, “Maybe you’ll have to start eating more meat,” with a big grin on his face that looked like he didn’t believe that I was really a vegetarian. I must’ve looked simply dumbfounded, so he followed this remark by saying, “Well the next time you feel like eating a potato, eat broccoli instead.” THAT WAS THE END OF THE APPOINTMENT and he walked out of the room.

    So I’m sitting there with a new “diagnosis” of PRE-DIABETES, no referral to a dietitian or a diabetes counselor or anyone else, and nothing more than the advice to completely restructure my life to start eating meat again (after 35 years as a vegetarian) and [never again?] eat a potato but [always?] eat broccoli instead(for the rest of my life?).

    Is that supposed to treat/cure my alleged “PRE-DIABETES?” (Please note the sarcasm. I, myself, am skeptical about dubious “pre-disease” diagnoses based on one single test on one single occasion which produced one single test result just barely above some arbitrary current cut-off point.)

    I am actually fairly well-read (for a lay person) on this topic because I have ALWAYS been extremely interested in health and nutrition, and have ALWAYS read a lot on this subject (including LONG before the existence of the Internet).

    I cannot imagine if this was the nutritional advice given to a random person off the street who hadn’t previously known anything about nutrition other than what friends and family and the popular media might have passed along.

  10. This resonates with me. I’ve been seeing a GP psychotherapist for the last 4-5 months who practices a rather unique form of therapy that seemed to work well for me. On my last visit to him, I asked if he might be able to coach me in his technique to work through my longstanding body image issues because I don’t want to feel anxious about it anymore and I have better things to do with my emotional energy and time than to be wrapped up in my body and how it looks. Instead of doing what he’s well-trained to do, he told me that I should consider the Atkins Diet.

    I looked at him a bit gobsmacked because I’d initially told him about my disordered eating past, and I reminded him that diets — all diets — are not good ideas for me; that they take me down a road I’ve already traveled and no longer want to be on. He responded by saying, “Well, carbs stimulate the brain’s amygdala in the same way that opioids do, so it’s well-known that they’re addictive. You should avoid them.” And I just stared at him and said, “So you’re suggesting that my history of body image anxiety can be resolved by not ever eating bread or potatoes or fruit or most vegetables?”

    And he said yes.

    I said, “With all due respect, I try to practice a Health At Every Size® approach to living, eating and moving and this advice isn’t helpful.”

    Besides the fact that I love all food and I am happiest when I don’t restrict any food, except the ones that cause me physical distress, I’m also an athlete who NEEDS carbs to fuel my activities. I was so peeved that this guy felt entitled to dole out diet advice when he was supposed to be facilitating my therapy session with a specific technique just because he’s an MD and he has an opinion about nutrition.

    Needless to say, that was my final session with him.

  11. Amy, I am enraged on your behalf! It is really frightening that an MD isn’t aware that advising ANY kind of diet to someone with an eating disorder history is very risky. I am so glad you are able to stand up for yourself, but I can’t help but think of all of the people struggling to recover who might actually take his advice!

    I’m an eating disorders clinician – although not an RD – and when I talk to people about their food choices and they’re doing the good/bad healthy/unhealthy talk I try and shift to acknowledging that some foods are, in fact, more “nutrient dense” than others but that doesn’t mean that a food that isn’t “nutrient dense” isn’t “healthy”. It’s normal and health enhancing to eat a variety of foods including foods that we eat primarily because they give us a lot of pleasure in the eating of them, rather than their nutritional value.

    When you open up what makes us healthy to include emotional satisfaction and pleasure it’s amazing just how many foods qualify as “healthy” 😉

    • Lisa, thank you so much for your wording. I am battling body image issues and disordered eating and want to focus on HAES. My therapist and I have been working diligently to avoid the concept of good/bad foods. This really helps!

  12. Sorry for coming late to the discussion, have been dealing with some family health issues.
    Like Terri Michael, I am an RD who specializes in disordered eating. And I share the concern she and others have mentioned about health coaches and “nutritionists” without proper education and credentialing providing nutrition counseling. And as she mentioned, we need to report this to our board of dietetic practice since this is illegal, at least in states that have licensing. Unfortunately, these folks can provide wellness counseling/education because this is not considered medical nutrition therapy.
    Several months ago I attended a talk by a “nutritionist” near where I practice. Apparently, she had graduated from Andrew Weil’s program. She held up a package of Quaker oats and told the audience it was “nothing” and the body could not digest it. Later, someone from the audience asked what would be a good snack at work in the afternoon when she was hungry and tired. This “nutritionist” told her “anything fresh, like a green salad”… if this food, with almost no energy value, would help this woman at that point in time. Another “nutritionist” in my area, who had graduated from a different holistic program, spoke to a local eating disorders support group. One of my clients happened to attend this meeting. She had made great progress in resolving bingeing and had been able to incorporate desserts appropriately without bingeing. Utilizing mindful eating strategies, she was exploring which desserts she enjoyed and felt good in her body. The “nutritionist” told her she should only eat desserts that were sweetened with fruit juice. When I next saw the client, she was greatly distressed and had returned to frequent bingeing.
    It appears to me that the general public does not tend to question the education and credentials of people providing nutrition counseling/education. I am often advising people about the need for this. Of course, as Terri mentioned, often properly credentialed nutritionists (and other health professionals) promote the good/bad food paradigm. And of course the diet/fitness industry and the media are always promoting this. It seems to me that not only folks with eating disorders, but most of the population believes if a food contains fat or sugar or is processed, it is bad. In my view, as a HAES (R) RD, it is my role to challenge the above as well as the traditional thinking about weight and weight loss.

    • Hi Terri and Debbi,
      Thanks for the insightful comments – There is an additional problem however – and you may know more about this than I.There are now organizations that are providing certifications for “nutritionists.” For example, The American Nutrition Association has a variety of certifications – some look on the surface as fairly substantial – some not so much – They have, for example, what they title a Certified Nutritional Consultant – (I met one during a workshop I did last week – which is why I looked it up – requirements?: open book exam – only – yikes! – does not seem like that could possibly be ok – Jon

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