Addressing the Psychological Impact of Dietary Changes in Trauma-Informed Nutrition Counseling
In this podcast, Lisa Jones, MA, RDN, LDN, FAND, interviews Julie Feldman, MPH, RDN, about the latest techniques in trauma-informed nutrition counseling, including ensuring client safety, collaboration, choice, trustworthiness, and empowerment and the harm of assumptions in nutrition counseling. This is episode one of a four-part series on trauma-informed nutrition counseling.
Additional Resources:
Van Der Kolk B. The Body Keeps the Score. Penguin Publishing Group; 2014.
Jones L, Feldman J. Trauma-informed nutrition counseling. Consultant360. December 2022. Accessed March 27, 2024. https://www.consultant360.com/podcasts/trauma-informed-nutrition-counseling
Listen to episode two of the four-part series here.
TRANSCRIPTION:
Host: Hello and welcome to Nutrition411: The Podcast, a special podcast series led by registered dietitian and nutritionist, Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant360.
Lisa Jones: Hello and welcome to Nutrition411: The Podcast where we communicate the information that you need to know now about the science, psychology, and strategies behind the practice of dietetics.
Today's podcast is part of a series of short episodes featuring Q &A with Julie Feldman. Julie Feldman is a registered dietitian nutritionist, nationally recognized nutrition expert, consultant, counselor, speaker, spokesperson, author, and owner and founder of Thrive Nutrition and Wellness, LLC, specializing in trauma and nutrition counseling for teens and adults. Julie is from West Bloomfield, Michigan.
Hi, Julie, and welcome.
Julie Feldman: Hi, Lisa. Thanks for having me.
LJ: Yes, welcome back.
We had Julie on before in a previous episode, which we will link to this podcast as well. Great information. I'm so looking forward to today and our discussion.
And I want to start with our first topic talking about uncovering the trends in dietetics. Our whole topic today is talking about trauma-informed nutrition counseling. And my first question for you Julie is, can you discuss the importance of cultural sensitivity in the context of emerging dietetic trends, and more specifically, how can nutrition counselors ensure their advice is both trauma-informed and culturally appropriate?
JF: Such a complex question to start with. Okay.
I think there are so many, probably, ways that I could address or answer that question. And obviously, we all have our antenna up about approaching probably anything that we do with a higher level of cultural sensitivity. And certainly, when thinking about delivering nutrition information from a trauma-informed or through a trauma-informed lens, I think sensitivity almost just kind of goes hand in hand with the idea of providing trauma-informed care.
So, at its core, trauma-informed care addresses five key issues -- safety, collaboration, choice, trustworthiness, and empowerment, all of those words, I think, easily lend themselves to the idea of cultural sensitivity as well, right? So, I think in many ways, being trauma-informed, almost by definition, implies a certain level of cultural sensitivity. I do think that the environment in which we're living right now, it seems almost increasing by the day, there's just so much divisiveness. There's a lot of even I think maybe before people felt like oh we're on the same page and you know in the last six months there's been a shift and people who typically would be on the same side of things are feeling the same way about certain topics there's like really vast differences in thoughts and opinions, so I think I guess the number one thing that comes to my mind is that you really need to check yourself at the door when we're providing nutrition counseling and assume nothing, you know? And I think it's almost naive to say that I even know how to be culturally sensitive because I don't necessarily know what somebody needs from me. So, I hope that sort of makes sense.
I find that I do a lot of asking questions and asking permission. So, whether it's asking what somebody's preferred pronouns are, and I even lead by making sure that my pronouns are on my Zoom next to my name. So, that just automatically creates a bit of a safe space.
I do all telehealth. So, I have certain things in my background that are intended to create a sense of safety. I try to be as inclusive as possible with simple things like even decorations. So even if it's not something that specific to my culture, I know maybe it is meaningful to some of my clients and the culture within which they identify or practice. So, I think trauma-informed care incorporates this idea of being sensitive of assuming that I don't know who you are.
I don't know what your story is. I don't know what things are important to you. And if we're going to actually do really good work together and make a ton of progress, it makes sense for me to start to understand those deeper pieces of you.
I know that I can't just tell you this is how much you should be eating, for example, without understanding what your culture is. I would need to know if you're fasting, if you avoid certain food groups because of your cultural identity.
I mean, all those pieces are important. If I don't open the door and make space for the client to share that type of information with me, then we don't do as good of work as we could.
LJ: I was listening to you answer that question and there are so many great notes in there, and I think a lot of the things that you're saying we can use every day in how we go through life in general, because a lot of times, you're saying assume nothing, but people make assumptions all the time.
We also need to practice these five steps: the safety, the collaboration. You want to make people feel all these things that you're doing; building trust, asking questions, asking permission, this is how we should practice.
So, for those that are listening, we can take away so many great things, not just fortrauma-informed nutrition counseling, but just how we practice our lives in general. So, thank you and bravo to you for doing all that stuff. It does sound like in the beginning, it's probably a lot of things to consider… you're looking in your Zoom background.
How many of us have all these things in our Zoom background and you don't even think about it, right? But you're thinking about it. Your business is primarily virtual, but that's fantastic. Kudos to you.
JF: Thanks.
LJ: Yes and thank you for answering that question. I know there was a lot there.
I really want to link to the first time that we talked to you because you break down more what trauma-informed nutrition counseling is, because I'm sure there's still a subset of practitioners that may not know or be as familiar with it. So, thank you for explaining what it is.
JF: Of course.
LJ: And then my next question to you is more specifically, what role do dietitians play in recognizing and addressing the psychological impact of dietary changes, especially in clients with trauma histories?
JF: So, I cannot stress this enough, and it's probably my favorite thing to talk about is the role that the dietitian gets to play in all of this. I think we weren't necessarily trained to do this. I know it's been 25 years since I was in grad school.
I literally shudder to think about how I provided counseling in the first couple years of practice because I didn't know what I was doing. Even though I went to a phenomenal school and had really good training, I just think I know, as a clinician, I have evolved a lot. I think first and foremost, it is our responsibility as registered dietician nutritionists to take into account the psychological pieces of what we're expecting our clients to do. Food is a big deal. That is the title of a talk that I give often.
Food is a big deal. Food is so involved in every aspect of our lives. And I know if you're listening to this podcast, you recognize that and you realize that.
Food is probably our number one coping mechanism. It's something that's taught to us super early on in our lives, how to use food to calm us, to soothe us, to help us through tough times and situations.
If we don't understand that asking a client or helping a client to change how they eat is going to have some sort of emotional impact on them, there is, in my mind, zero hope of creating meaningful and permanent change.
I think when you look at the reasons why somebody would come to see a dietitian, obviously probably the top two reasons someone's coming to see a dietitian is either to lose weight, right? And I'm not saying that I know the statistics around it, but I've been practicing for a long time, so I feel like I kind of have a good sense.
People are coming for weight loss, or people are coming with an eating disorder or a disordered eating pattern that perhaps require them to gain weight. So, I mean, those are for sure the top two. I'm seeing so much more by way of gut health and focusing on autoimmune type things. But really, when we think about those things, weight loss, weight gain, and you think about what somebody has gone through to get to the point that they're reaching out for help in one of those areas, I think it's really safe to assume that they've experienced some trauma around this, like there is something really traumatic in their storyline about their relationship with their bodies or their relationship with food.
And we know from research that trauma changes how we make decisions. Trauma changes how we are able to process information.
It isn't so simple as “Oh, your cholesterol is high. Let me hand you this sheet of paper that shows you all these foods that are low in cholesterol.” Or “Here are some things that we think you should limit or eliminate from your diet."
I need to understand that if somebody has tried and failed at this before, I would say many of my clients, when they come to me, I'm like the 10th thing that they've tried or the 100th thing that they've tried. I have many clients who come to me, let's say over the age of 40 who tell me, “I've been dieting since I was 8-years-old.”
I have many clients who've been to multiple eating disorder treatment centers before they're coming to me, which means they have this whole long trauma history around making nutrition changes, which means they don't think that they are good at it. They have not been successful yet.
That's why they're talking to me. And I believe our role is to understand this, to recognize it and to really validate it for them because otherwise it's so easy for them to just be really caught in a looping cycle of shame, guilt, stress, frustration, and trauma. Those things just loop.
And I call that psychology… it's called a stuck loop. A loop of feeling those feelings, just looping and looping and looping.
And it's really, really hard to get somebody to be able to step out of that loop and to start to make different types of choices. So, what is the role of the dietitian and understanding that? I think it's everything. I would rather build a relationship with the client for three months before we even actually make any nutrition changes because I know at that point, if they feel empowered and they feel safe and they feel like we're collaborating and really putting together a plan that's personal to them, that their outcomes are way more likely to be positive. I was thinking… what popped in my head is, and I'm dating myself because when I was in college, we didn't even talk about this. This was one thing that wasn't even present.
LJ: Sure. Like you never said, does a person have a history of trauma? If you're just like, "Okay." what did you eat?” You’re doing a 24-hour recall and going from there.
So, I'm just interested to know, and I don't know the answer to this, but if they're changing curriculums based off of this? Because this would be something that I think would be needed to be added to the curriculum as dietitians are learning through college. I think it goes back to what you were saying, this is vital before you can move on to teach anything else, and that's why they're failing.
It's kind of like setting somebody up for failure.
JF: It is not “kind of like it.” It literally is setting someone up for failure. That’s exactly what it is.
I mean, I think also, dieticians sometimes don't get the best reputation because when you look at dieting success, that's pretty much what it is. It's lousy, right? I mean, when you look at long-term data and weight loss, for example, it's not pretty. And I actually think the current landscape with all of the weight-loss medications is making this topic even more nuanced and really bringing up even more feelings of trauma.
I have a lot of clients who were super excited about these new meds and tried them. They had miserable side effects on them, but all of their friends are losing weight on these medications. So now, not only are they continuing to struggle weight-wise, but now there's this trauma of I'm the only one that isn't being successful.
So, I think it's honestly, the current landscape has just more stigma and more negative psychological pieces to it for many.
LJ: I do want to take a step back and find out, for those listening to this and that are interested in exploring this, what's the easiest pathway to learn about how to do what you're doing? If they want to practice trauma and for nutrition counseling what would be their first step?
JF: Sure, it's a great question. Well, I do mentor other dieticians, so anyone's always welcome to reach out to me for that. I love that.
I would recommend doing some reading about trauma in general first, just so you have a solid understanding. In my mind, the Bible on that is the book “The Body Keeps the Score” by Bessel Van Der Kolk. That, I feel like, is a must-read for any healthcare practitioner, honestly for any person. Any person would benefit from reading that book. So, start with that and see how it feels to you too. I don't necessarily, although I think everybody would benefit from doing this type of work, I don't know if everybody feels super comfortable doing this work.
And if this isn't in your wheelhouse, and you don't feel trained or this isn't where you want to spend your continuing education hours diving into stuff like this, I encourage you to just know about it so that you can refer, whether that's to refer to a different dietitian or to partner with a therapist on some level to say, “I know that there are a lot of pieces of your history that are playing a role in how we approach this nutrition shift for you. And I would love to be able to support you in that by collaborating with the therapist to help you walk through some of these pieces.”
So, I think also as a dietitian, if this is not what feels super comfortable to you, just holding space for the idea of it and creating this idea for the client that they're not bad because making these changes is hard. But rather that there's a reason why making these changes is so hard for them, and let's get you the support that you need to help understand that better.
LJ: Yeah, I love that. It's the collaboration of it all too. And again, your contact information is provided, so feel free to reach out to Julie. We can always refer to you, right? I know you're very busy, so you probably have others in your network as well.
JF: Yes, of course.
LJ: Thank you for that conversation. Thank you for sharing that information.
Host: For more nutrition content, visit consultant360.com.