@understandingnutrition
Posted: 3 days ago

Challenging authority is challenging. Here’s Part two of preparing parents for the weight loss conversation. If a doctor says your child is overweight AND has a medical problem, I expect they will refer you to a specialist or recommend a treatment. If the treatment they prescribe is once again weight loss, say this: Are there any thin children with this medical condition? What treatment do you recommend to them? Because I’m willing to consider that option for my child. Alternately, l’d like a referral to a specialist in that condition. If the doctor says, no your child doesn’t have a medical condition, but they will if things don’t change, say this: I have learned that Predicting future problems based on size or weight alone is the definition of fatphobia. We don’t participate in that in our home. If my child’s growth seems abnormal compared to their previous growth, I am open to meeting a dietitian for further investigation. Please make arrangements with my insurance to cover that. And if the doctor says yes, your child has a medical condition. It’s the medical condition obesity. Simply say: I believe you’re trying to help, but Diagnosing an obviously healthy child Because they’re bigger than their peers is totally passe, And beneath your dignity. I want a doctor who sees My child as more than a number. Can you be that doctor? Or do we need to go elsewhere.

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@understandingnutrition
Posted: 1 week ago

It’s HARD to speak up to a doctor. It’s intimidating. It’s important. Let’s prepare the parents we know for the moment their child’s doctor mentions weight. Let’s show our kids we’re willing to stand up for them so they can stand up for themselves if they need to. Let’s remind them it’s ok to speak their truth and not try to make their doctor comfortable. Other ideas for what to say? I’d love to hear what you recommend.

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@understandingnutrition
Posted: 2 weeks ago

Embarrassing. Hypocritical. Indefensible.

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@understandingnutrition
Posted: 2 weeks ago

Only the names have changed. www.jessicasetnick.com/same-ship-different-decade/ Also linked in bio

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@understandingnutrition
Posted: 3 weeks ago

Like everyone else on Facebook, I recently read Larry Lonero’s post, “What happened to Southwest Airlines?” It felt like déjà vu. This has been going on in the eating disorder field for at least as long as I've been in it. I bet some of that sounded familiar to you, too. There’s lots of good work still being done. But it’s inconsistent. You don’t know what you’ll get from different locations of the same company, from unit to unit or month to month. When administrators haven’t worked as a dietitian (and some haven’t even worked in the field at all), they can’t possibly know what it’s like if they don’t listen to their staff. Specifically that you can’t use the same dietitian staffing patterns of a general hospital, addiction treatment center, or state behavioral health unit. You can’t just say “our license requires one dietitian per 48 patients.” Eating disorder care is just different. The results are unsurprising: Places where dietitians are valued - not just paid well but also included in decision-making, program design and leadership - and programs started or run by dietitians thrive. Elsewhere, undervalued, underpaid, experienced dietitians leave. It hurts the people who need help, too - patients and families who hesitate because of what they or someone else went through at a not-good treatment program, or even a fine treatment program that was temporarily short-staffed. And for those institutions we’ve come to trust, they can’t just admit every caller. Facilities known for consistently good care and communication will continue to have wait lists, so outpatient dietitians will have less-well patients for longer. I’ve been thinking about all of this for a while. And what the rest of us can do to cope. Here are the ideas I’ve come up with so far while we wait for things to settle: (Continued in comments)

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@understandingnutrition
Posted: 1 month ago

The notes say it all.

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@understandingnutrition
Posted: 1 month ago

Do you need a whole bunch of CEUs by the end of the year? Do you have education money left in your budget on a use-it-or-lose-it basis? Have you noticed more of your patients have disordered eating problems than you ever thought possible? Do you want more confidence in your nutrition counseling toolbox? Do you love a great deal? The Eating Disorders Boot Camp Ultimate Training Bundle is for you. Including recordings of three workshops, multiple books, client education handouts, a video demo of counseling challenges, a consultation call to ask me anything (and no test!) and 34 pre-approved CEUs for RDNs, all self-paced. An OUTSTANDING value at $480*. Tell a friend and you can each get $20 off with discount code BFF. Or sign up your whole practice (up to 6 RDNs) for only $2200. Visit EatingDisordersBootCamp.com to order and get immediate access. If you’ve done Boot Camp already, please feel free to comment with any thoughts for someone thinking about it. And of course feel free to ask me anything or message me with questions. *Payment plans always available by request.

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@understandingnutrition
Posted: 3 months ago

At FNCE Member Marketplace between these two legends!!!

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@understandingnutrition
Posted: 5 months ago

I realize I’ve been so excited about the new workshop next month that I haven’t sent a reminder about the end of intro pricing for the group version of the Eating Disorders Boot Camp Ultimate Training Package. The group package (up to 6 dietitians plus unlimited students, interns & other professionals) price goes up on Thursday from the intro price of $1100 to the regular price of $2100. It will still be an incredible deal (the total value for 6 dietitians is a staggering $8,800 back when these Boot Camps were sold separately), but I wanted to mention it for anyone who’s had it on their mind and wants to get in on the intro price. You don’t all have to be in the same facility or practice - if you gather three friends you each get it all for $300 instead of $480 (and even more savings if you get 4 or 5 to join you) and Celena will happily run multiple credit cards - just don’t purchase online, email her instead. The individual price will be staying the same, and Celena is always happy to work out payment plans for anyone who asks. Detailed scoop at EatingDisordersBootCamp.com and of course I’ll happily answer questions here.

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@understandingnutrition
Posted: 5 months ago

Mic drop.

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@understandingnutrition
Posted: 5 months ago

Discrepancies in recommendations are a recurring theme in supervision. “How do I reconcile differences of opinion?” “Is it ever ok to openly disagree in front of the client?” “How do I disagree without undermining other professionals?” “What if I know for a fact the other person is giving bad advice?” I’ve got answers to these challenges plus other things no one ever talks about at conferences and I’ll show you what to do and exactly what to say in each of these sticky situations at Supervision Boot Camp next month. Join me live in Atlanta or live online. Link in bio, and I’m still taking questions.

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@understandingnutrition
Posted: 5 months ago

Not everyone who crosses your path is going to be a good fit for your practice. It’s obvious, but so often we’re too optimistic, or don’t like to say no to people, or disappoint our referral source, or a hundred other reasons why we try to make it work. Start thinking - and describing to clients - that your first meeting is an interview (which goes both ways) to evaluate whether or not you’re a good fit together. And every session after that will continue the assessment. Both parties have the option to renew, revisit, or rescind the relationship at any time. You don’t have to know for a fact on the first day that you can solve someone’s problems… a willingness to try can often be enough. But if you know up front that a client’s not a match, have the courage to let them go. Have you ever seen a client for waaaay too long because you weren’t sure how to say goodbye? More at SupervisionBootCamp.com September 23rd, live in Atlanta, live-streamed and recorded. Even more in The Sleepless Dietitian’s Book of Answers, SleeplessDietitian.com. See link in bio for the scoop.

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@understandingnutrition
Posted: 5 months ago

I was honored to be invited back to The SeasonED RD podcast with Beth and Abbi — two fun gals to spend time with for any reason — but since we got our polite chit chat out o’ the way on my first visit, this time we just let it rip! I mean my first episode wasn’t tea with the queen or anything, but this one was downright uncensored. You’ll find out for yourself when you listen (link in bio, obv) so I’ll just sum it up by paraphrasing a classic… “When I look back on all the crap I learned in RD school, it’s a wonder I can even think at all…”

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@understandingnutrition
Posted: 6 months ago

@gaudianiclinic Jennifer Gaudiani has written an amazingly clear explanation of Mast Cell Activation Syndrome (MCAS) that everyone who works in the eating disorder treatment field should read. There are so many causes of what we mistakenly call “eating disorders” and the biological contributors - concussion, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), sleep disorders, MCAS, Chronic Anovulation (PCOS), Postural Orthostatic Tachycardia Syndrome (POTS), MTHFR & other DNA mutations just as a few examples - are the least studied and the most pooh-poohed by people who only believe in their one-modality training. Please, PLEASE believe your patients’ report of their experiences and don’t be the person who says it’s all in their head, or worse - that they’ve caused their own problems with their eating or their weight, and everything will be better if they eat better or lose weight. MANY of these symptoms predate the eating disturbances and often dysfunctional eating behaviors are the tool the individual is using to try to relieve their own discomfort. It’s not hard or time-consuming to try to get a history of symptoms. Remember that half of the women with bulimia in one study reported irregular menstrual cycles BEFORE their eating symptoms ever developed. Think of the individuals with insulin resistance or hypothyroidism who starved to lose weight and were still chastised by their providers for not trying hard enough. I have had patients who were told that their acanthosis around their neck was a normal sign of their ethnic heritage. Multiple dietitians have told me they thought they had night-eating syndrome until they were correctly diagnosed with sleep disorders. I was told at different times it was impossible that my new glasses were causing migraines and that if I was dreaming I was getting rested - both completely incorrect. You probably have your own story of being told your symptoms aren’t real….(continued in comments)

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@understandingnutrition
Posted: 6 months ago

Dietitians are sensitive and smart - good qualities but a tough combination. We’re sensitive to how eating disorders are hurting our clients but smart enough to know we can’t solve it all. It’s hard to accept that we don’t have all the answers about eating disorders or eating disorder treatment. How do we maintain integrity amidst uncertainty? How do we balance optimism for recovery with fears of the unknown? How do we guide our clients to face this same uncertainty with courage? How do we withstand criticism or tolerate the zealots who claim to have all the answers? How do we sleep at night knowing diet culture is making more eating disorders every day? How do we go to work every morning unsure of what the day will bring? Our work can be unspeakably hard, and it’s not something you can talk about at book club where no one will understand. It’s time to open up these topics and time to get some answers. September 23rd in Atlanta, live-streamed and recorded. More info at SupervisionBootCamp.com.

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