There’s no “right” or “wrong” way to handle a client who wants to lose weight, and certainly a lot of it depends on what context you’re seeing the client. Are you seeing them clinical or inpatient? Is it a referral from a physician for weight loss, or did the client find you on the internet? Having solid counseling skills is essential, and so is just being willing to show up to your sessions as a human being and have conversations, rather than selling your client on a “right” way to do things, in this case, intuitive eating.
While there’s (unfortunately!) not a guidebook for how to handle these conversations, there are a few things that are helpful to keep in mind. The first is being able to distinguish wanting to lose weight from the active pursuit of weight loss. The latter is not compatible with intuitive eating. That doesn’t mean you can’t work with a client who is actively trying to lose weight (hello that’s like 99% of eating disorders!), but it does mean being really clear on both your role as a non-diet provider and identifying non-weight goals you’re working on together. Sometimes these clients are some of the most rewarding, as you get to process with them in real time how dieting fuels their unwanted eating behaviors and stress around food. Other times, it’s just not a good fit and they aren’t ready to put dieting on the back burner. That’s OK! You’re allowed to wish them well, and remind them they are welcome back if things change. Providing a client with information and some space to process it is powerful work.
It’s also helpful to remember that if you are an intuitive eating dietitian who understands the current research on weight science, the physical and psychological harms of dieting, and benefits of a weight inclusive approach, not providing weight loss counseling is simply a matter of practicing ethically. If you understand this research, then you should understand that it’s not ethical to provide weight loss counseling if a client is asking for it the same way that it wouldn’t be ethical for a doctor to give an unhelpful or harmful medication to a patient who was asking for it. Dietitians often fear that it’s not providing client-centered care to provide weight loss counseling if someone requests it, but it’s not client-centered to provide a risky medical treatment that isn’t supported by research. If you do agree to weight loss counseling, provide informed consent and discuss the risks involved with the approach, as well as the research on long term success rates. Here is an informed consent form you can use.
Perhaps your stuck point is that you’re in an environment that makes it hard to have these conversations, like inpatient clinical. It’s helpful to remember that intuitive eating is simply one tool you can utilize in your practice. You can learn and grow in your knowledge and skills around intuitive eating, and it can inform your practice, but that doesn’t mean it has to be the main tool you use for each client. For example, if you’re an inpatient dietitian and are seeing a patient who was just diagnosed with diabetes and wants to lose weight, it would be weird AF to go into their room and launch into a diatribe on the 10 principles of intuitive eating.
However, your knowledge of intuitive eating could influence the work you do with them. For example, you might provide them with education on the importance of not eliminating carbs and talk about how doing such often leads to restrict-binge patterns that are harmful for glucose control. Or, you might help them identify pleasurable forms of movement, or teach nutrition advice for diabetes management in a gentle way. You can even drop some kernels of knowledge that engaging in health promoting behaviors is more helpful than weight loss – all without saying the word intuitive eating!
Yikes, I Just Realized I’ve Been Using Intuitive Eating For Weight Loss
Deep breaths. It can feel really icky to realize when you’re doing something unintentionally harmful. Please know that pretty much every intuitive eating practitioner can look back with a feeling of regret and shame at their earlier work, myself included. We were all trained in a weight centric paradigm, and given completely inadequate resources for counseling from a non-diet perspective – or just counseling skills in general!
Fiona Southerland, a fantastic dietitian and supervisor (check out her trainings and podcasts, as well as the other Fiona from Australia, Fiona Willer) calls this fence straddling, which happens when you’ve got a foot in two different paradigms. It’s a natural phase when you’re crossing from one paradigm to another, but it’s a problem when you get stuck in that place.
It’s easy to get defensive. To be honest, that’s often my natural reaction to criticism, and I often have to pause myself to take it in for a second. I hope you’ll use this opportunity for learning and growing. Speaking personally, I know that I’ve learned the most through mistakes I’ve made in the past. It feels really icky – even years later I still catch myself cringing at some things – but it’s important to lean into that discomfort, learn and grow.
If you’ve read all this and still don’t want to give up practicing weight loss counseling, that’s totally cool! Honestly. While personally, I don’t agree with it, you don’t have to base your clinical practice based on what other people might think. I think I can speak for other intuitive eating providers in simply asking that you are honest about what services you’re providing, and not using intuitive eating as a marketing tool.