1. What is dietetics?
Dietetics is the practical application of the science of nutrition. Dietetics is a registered health profession in Canada; dietitians are registered with a provincial college, association, or order of dietitians. Dietitians practicing in Canada’s north are registered with a provincial regulatory body of their choice. All dietitians hold the minimum of a four-year university degree in human nutrition and will have completed either a post-graduate dietetic practicum or a Masters/practicum program, and will have passed the Canadian Dietetic Registration Exam.
Most dietitians work in hospitals, clinics, care facilities, and institutions where people live or take their meals (such as ships, prisons, schools, training centres, the military). Dietitians also work in public health or community nutrition; their focus is on optimizing the nutritional status and well-being of populations. Some dietitians have private practices and specialize in an area of interest to them including food allergies, celiac disease, swallowing disorders, intensive care, sport nutrition, feeding infants and children, pre- and postnatal nutrition, or men’s health. And some dietitians work in food – including agriculture, planetary food sustainability, food product development, food legislation and policy, and marketing.
2. What is nutrition care planning?
Nutrition care planning involves synthesizing all the information a person has provided along with an understanding of the natural history of any medical conditions a person lives with to develop a personalized plan. Everyone is different so every nutrition care plan will reflect an individual’s needs. All care plans are aimed at optimizing nutritional status and well-being. Nutritional well-being means that a plan and one’s eating has to align with one’s circumstances, and values and beliefs about food and eating.
3. What is medical nutrition therapy?
Medical nutrition therapy (MNT) is a newer term for therapeutic nutrition or nutrition care management. All of these terms relate to modifications in food composition or texture, amounts of specific nutrients or foods, or timing of food/fluid intake throughout the day aligned with medication use or personal tolerance. MNT is individualized so that every person nutrition care plan will reflect their needs.
4. What is nutrition counselling?
Nutrition counselling is a personal consultation with a registered dietitian. Typically, the process is that a dietitian witnesses the person’s narrative, conducts a nutrition assessment and makes a nutrition care plan based on the information provided, makes food, nutrition and eating recommendations toward optimizing a person’s nutritional status and well-being, and works with the person to find ways to implement the recommendations. Ideally, nutrition counselling involves more than one conversation. Sometimes during nutrition counselling, nutrition does not come up at all! In these situations, a person talks about their relationships with and through food. In nutrition counselling practice, the nature of the conversations depends on the person’s interests and/or concerns. There is not one prescribed diet for all.
5. I love my mom. Why do I feel anger and frustration related to trying to get her to eat?
There are several reasons for this emotional response to feeding someone you love who cannot eat as they once did. One reason is the connection between the person offering food and the person eating it is changed, and often permanently altered.
The unspoken messages in offering food and eating it are that food is offered that will be safe to eat and that will provide nourishment for the person to continue living; in eating the food, the corresponding message is trust in the offerer that the food is safe, and thanks. It’s about love. The rejection of love that is offered in the form of a bowl of soup, for example, hurts.
When a person who is sick is no longer able to or has a challenging time participating in the normal offering/receiving of food, this connection is lost so the person offering food often feels hurt and sadness. The longer this situation goes on, the more these feelings grow.
A second reason is that everyone has opinions about what, when, where, and how to feed the loved one who is sick. This is because everyone who knows the person shares in their love and hope for the person to get better. When I worked as a dietitian in cancer care, this was the most common reason for a nutrition consultation. How these situations unfold relate to the personalities involved and family dynamics.
There are two things that all situations have in common. The first is that ideas about feeding a loved one are largely based on values and beliefs about what is most important in the situation the loved one is experiencing; these will be different for each person and may differ within a person over time or sometimes, these rapidly change based on them learning about new information. The second is that, in wanting for someone to get better, family and friends can become forceful in expressing their beliefs about the ‘right way’ to feed the loved one. Not everyone will agree because everyone’s beliefs and values differ. These situations are tricky to navigate. We know that caregiving is exhausting and feeding a loved one who is sick becomes one more thing to try to have to sort out.
People have told me that a helpful phrase to navigate these situations is “Thank you for your ideas and for caring”. No promises to take action on the advice just received are needed.