I've been told that perhaps I'm giving too much credit to my dietitian and not enough to myself for managing my weight loss. I have to stress that I don't think I could have lost that much weight without her help. A dietitian is someone who helps me create a balanced meal plan that is suitable for my body. She also helps me maintain my weight loss by motivating and encouraging me when I don't believe I can do it, or also keeping me from jumping off a cliff on those days when I'm adamant that it was the cupcake I had for my daughter's birthday that prevented me from losing an extra pound this week. Frequent weigh-ins with my dietitian keep me accountable to myself; to know that the weight loss is attributed to an effort I put in as opposed to sheer luck, and the weeks I gain weight are not necessarily a result of something I did. The visits help me stay focused on the positives. As a fat person I already give myself grief about my weight; I don't need a dietitian to do that for me. Similarly, I don't need someone to remind me that if I don't lose weight I could die from heart disease. That's the doctor's job (which he does very well).
I believe a good dietitian is a food therapist if you will. They're not interested in judging you or the choices you make, rather in helping you make better choices that will ultimately bring you closer to your desired goal. That includes, but is not limited to, giving you the freedom to eliminate foods you don't like, and eating the foods you do like, within reason, if those foods are not part of a healthy meal plan. Typical by-the-book dietitians are a lot like banks in that they put everyone in a series of buckets. You fit in bucket A, B or C; high risk, medium risk, or low risk investment. If you want something more tailored to suit your needs, then you may want to invest with an actual funds company that specializes in nothing but investments as opposed to a bank who offers homogenized investment opportunities. A by-the-book dietitian labels and puts you in one of those buckets because it's easier for them to do that than to customize a bucket just for you. A good dietitian is one who puts the effort into knowing you and your life style, and customizes an individual plan that will work for you. The difference between the two is subtle, but it's apparent in the little things they do and speaks volumes about their perception of fat people.
I have yet to see a fat dietitian. Most of the ones I know are skinny or average at most. So naturally, they lack the "fat perspective". Don't get me wrong, they know all about fat and what it does, but they have no clue of what it's like to go through life being fat. Fat people know they are fat; they are not in denial about it. There's a portion of the population who think fat people deliberately overeat, and don't care how they look. That may be true for some but not all of us. I have yet to meet a fat person that has not tried to lose weight in some way. Why do you think weight loss scams are so successful? It's because fat people know they are not accepted. They want to fit in and in doing so they try methods that may or may not be successful. Some of us like to eat just as there are some people who like to drink, gamble, or what have you. The difference is that as a society we have been trained to see beauty in skinny people, whereas a fat person resembles whatever we find repulsive.
Typical dietitians (or skinny ones) have not gone through life with the nickname porky, pudgy, or fatso. They were not teased about their weight on the playground and were not ridiculed by classmates in gym class - not for their weight. As adults they don't get the brush off at high end clothing stores, and unfriendly smirks in sporting goods stores. Indeed, I have lost over 115 pounds in the last year; I've gone down from a size 4X to a size Small, but I'm still fat on the inside. I identify very much with fat people and I still see skinny people as outsiders. I think like a fat person. I still go into stores and subconsciously end up at the plus size section even though nothing fits me there any more. I still like the styles targeted towards fat people. It's nauseating when I walk into the high end clothing stores nowadays, to see the very same clerks who brushed me off 6 months ago swarming all around me to sell me something that not's even full price but rather a clearance item, so it's not a commission related thing. That is what I find repulsive. The fact that I couldn't get a clerk to even notice me when I walked into the store 6 months ago, or the ones that look me up and down and then say they'll be right there, and the striking difference in their treatment when I walked into the same store last week and saw the same clerk who greeted me with a big smile and even complimented me on my choice of outfit; it's astounding. That's the treatment I was accustomed to for the last 20 years of my life. As a result, I tend to pick up on those little involuntary yet derogatory gestures. I get it at most places, and sometimes I even expect it, but not at the dietitian's office. It's my safe haven; it's the place where I can safely admit that I am fat, that I don't like being fat, and that I want to change it. It's the last place I would expect to feel judged. If you feel judged at the dietitian's office, then someone let you down. If your dietitian judges you then they have failed you and themselves.
My relationship with dietitians and nutritionists in the past has been rocky. I've been told what foods I should eat and which ones I should not eat - should being the keyword. A good dietitian does not should all over you, rather suggests that you avoid certain foods, not all the time, but most of the time. I've seen moderate dietitians, and some really horrible ones. I can't recall the number of times, for example, that I've been told I have to eat cottage cheese for breakfast, despite alerting the dietitian to the fact that I would rather eat a bullet then put cottage cheese in my mouth. When a dietitian lumps you into one of the usual categories for fat people, they are inadvertently telling you that they don't really care about your health or the effort you are making to maintain a healthy lifestyle, because by limiting your options they ensure that you will not be able to maintain healthy eating habits. It's unrealistic to expect someone to eat a food they hate everyday. A good dietitian knows that. By the same token, it's unrealistic to expect someone to give up a favourite food forever. Telling some one who eats a cupcake everyday that they cannot have them any more is ridiculous, and guarantees that this person will never be able to maintain a healthy lifestyle. A black and white approach to food is not conducive to any kind of change let alone a positive one. A good dietitian is flexible and understands the value of compromise. Instead of having a cupcake once everyday, we can start by limiting cupcakes to 2 times a week and take it from there. The goal of both you and your dietitian is to create and maintain a healthy lifestyle without adding stress. It's those little things that to anyone else come across as insignificant but what it tells you is that the dietitian actually cares about helping you achieve your goal and is not simply labelling you to fit into some pre-set notion of what others think you should be.
I guess in a nutshell I would say that the difference between a dietitian and a good dietitian, is that the former treats you like a patient, whereas the latter treats you like a customer.