Dietician During Major Weightloss?

beabria
beabria Posts: 260 Member
edited June 13 in Food and Nutrition
I have a little over 100lbs to lose, and have a strongly renewed interest in getting to a healthy weight following a recent health scare. (Not actually caused by excess weight, but it was more that it was scary to imagine dealing with that while carrying the excess weight.) I considered weight-loss surgery, but decided to first try dietary changes with a therapist and a nutritionist on my side. I've learned a lot about what foods make me feel healthier vs not through previous attempts, and hoped a nutritionist would help me balance that experience with nutritional needs and the calorie deficit necessary to lose weight. I looked up lots of statistics, saw how abysmal the rates of success (especially of keeping weight off) are - and decided that it might even be a good idea to commit to continuing to see a nutritionist for the rest of my life. This felt like a good healthy decision.
After contacting a bunch of dietitians who weren't taking new patients, I finally got up with one who would talk to me. I got no further than saying how much I had to lose, that I had considered weight surgery, and that I wanted to try working with a professional before going that route - when she cut me off. She (a registered dietician) said that research doesn't support that people can lose more than 10% of their body weight and keep it off through dietary changes. She talked about her philosophy of focussing on healthy foods and not weight. (For the record, I think that's a great idea for general health - I've been working on this for several years and am much healthier - but no lighter.) She asked whether I thought this would be a good fit, with a tone that obviously said "no".
I'm feeling kinda devastated. I literally got rejected by a dietician because I want lose a substantial amount of weight but get advice on healthy choices along the way. So I'm wondering, is this just not something that dietitians can help with - am I unreasonable to ask? Are dietitians are just for thin people? Or do I need to look for something else? Have any of you sought assistance from a dietician when losing >10% of your bodyweight???

Replies

  • glassyo
    glassyo Posts: 6,534 Member
    edited June 13
    It's nice to know that dietician doesn't need the income. I don't see how she gets any at all with that attitude but whatever :)

    Although, maybe was going for the weight automatically coming off if you eat healthy. Which isn't quite how it works if you like to eat.

    Ok, I'm gonna say it. People around here are big on going through registered dieticians and your doctor if there are medical reasons for changing the way you eat but there are long time users here who have been there/done that. Randos or not. :)

    As for keeping the weight off, life and covid and tragedies and things happen so yeah, weight can be regained but it can also be lost again. Just not in yo yo dieting way.

    Have you set up your calorie goal on here? Have you been logging and weighing your food? Did you come straight from the dietician to this post? :) You know how to eat healthy. The missing pieces are eating in a deficit and doing it in a way that's not torturous to you.

    Btw, I lost 50% of my body weight and have kept it off for years (sometimes surprisingly..I've been going cray cray for a while :)) I admit, it wasn't all with "healthy" food. Lots of cookies were involved.
  • beabria
    beabria Posts: 260 Member
    edited June 13
    @glassyo and @AnnPT77 thank you - it is both helpful and encouraging to hear from people who have lost weight *and* kept it off! Sometimes it does feel like a near-unicorn, and hearing what amounted to "I don't think it's worth bothering with you" from a professional I'd hoped would help was making me feel it was truly impossible.
    I have set up my goals and am weighing everything out. So far I've lost 5% body weight, but I'm approaching the "great plateau weight" I've always hit in past efforts, when I'd stay at the same weight for 1-2 months while still supposedly eating a deficit. I guess I was hoping that a dietician would be able to offer me some pointers. But, this time I've decided to try a greater deficit am hoping it will get me past the plateau. (Oddly, I'm not actually finding the greater deficit is making me hungrier than the lower deficits. I'm assuming this is down to the *what* I'm eating rather than the how much.)
    In any case, I'm glad to hear from people who have not just lost weight, but who also kept it off. (Congrats, btw!) And thanks for the pointer to resources and the tip about scams!
  • AnnPT77
    AnnPT77 Posts: 25,202 Member
    beabria wrote: »
    @glassyo and @AnnPT77 thank you - it is both helpful and encouraging to hear from people who have lost weight *and* kept it off! Sometimes it does feel like a near-unicorn, and hearing what amounted to "I don't think it's worth bothering with you" from a professional I'd hoped would help was making me feel it was truly impossible.
    I have set up my goals and am weighing everything out. So far I've lost 5% body weight, but I'm approaching the "great plateau weight" I've always hit in past efforts, when I'd stay at the same weight for 1-2 months while still supposedly eating a deficit. I guess I was hoping that a dietician would be able to offer me some pointers. But, this time I've decided to try a greater am hoping it will get me past the plateau. (Oddly, I'm not actually finding the greater deficit is making me hungrier than the lower deficits. I'm assuming this is down to the *what* I'm eating rather than the how much.)
    In any case, I'm glad to hear from people who have not just lost weight, but who also kept it off. (Congrats, btw!) And thanks for the pointer to resources and the tip about scams!

    Here's some maybe-unexpected advice: If you lose at a reasonable rate right up to the perceived plateau, then stall, consider waiting it out, rather than cutting more steeply. Especially if you're losing fast, it's common to get some water retention rebalancing for a while, masking ongoing gradual fat loss on the scale. If that's so, hanging in there patiently will eventually let you see a scale drop when the water weight stops playing peek-a-boo on the scale with the fat loss.

    Steeper deficit increases stress on the body. Stress can contribute to water retention increases. While a steeper deficit can be non-hunger-provoking initially, there can be snap back later (either hunger or fatigue/weakness) that's counter-productive.

    If you've actually stopped losing because you're eating maintenance calories, that's likely to look like a gradually tapering-off weight loss rate, not an abrupt stall.

    Just a thought.

    More background on that stuff here:

    http://community.myfitnesspal.com/en/discussion/10604863/of-refeeds-and-diet-breaks/p1
    https://community.myfitnesspal.com/en/discussion/10683010/the-weird-and-highly-annoying-world-of-scale-fluctuations/p1

    (That first one has relevant info on stress, water weight, etc., even though the thread title may not seem on-point.)
  • lessjess22
    lessjess22 Posts: 21 Member
    You sound like you might be wanting to see a nutritionist long term primarily for accountability and motivation. They may not be your best resource. A nutritionist is typically only seen for a few visits to teach you about nutrition. A therapist is great for the emotional and motivational aspects, and I think your plan to see a therapist is solid. However, rather than pay to see a nutritionist long term, it may be more beneficial (and much less expensive) to educate yourself on the basics of nutrition and then engage with a peer group of people with the same goals. For example, posting here, joining a weight loss group (TOPs, Overeaters Anonymous, Weight Watchers meetings), or finding support among family and friends. Most people already know enough ionabout the science of nutrition to be successful, they just have trouble putting the knowledge into practice. A good nutritionist is just going to teach you to eat less processed food, eat plenty of lean protein to keep you full and encourage you to eat fruits, vegetables, and healthy whole grains, drink a lot of water and exercise. That's really all there is to nutrition unless you're an athlete or have a medical condition that causes you to have unusual nutrition needs. To lose weight, you just need to be a calorie deficit. Too many people overcomplicate weight loss. You can lose weight eating nothing but Twinkies if you're in a calorie deficit, but obviously you're going to feel much better and be much healthier if you eat healthfully.

    No matter what you decide to do, don't let your bad experience with that nutritionist get you down. They aren't a good fit for you and frankly, they were rude and dismissive to you. It is completely possible to lose all your excess weight without bariatric surgery, and keep it off. That nutritionist does not get to decide what you're capable of. YOU do.

    Good luck on your journey and I wish you the best.
  • Xellercin
    Xellercin Posts: 878 Member
    I lost nearly 40% of my weight and have easily kept it off. I regained a bit, but that was due to meds like prednisone, but I've lost it again. I've done all of this with very minimal exercise because I'm disabled.

    I think the stats for weight loss and maintenance are abysmal because of the way weight loss is generally approached. I don't think losing weight is hard at all if you understand the basics of behaviour modification.

    Typical diet culture involves radial behavioural change with no real strategy for supporting that change. It usually produces rapid initial loss and then diet failure, and the person believes that *they* failed because the diet "worked" at the beginning. Same with exercise, people go from sedentary to intense programs and get incredible results and first and then can't sustain it and stop going altogether.

    That's what doesn't work. Excessive behavioural change all at once with no plan for onboarding the new habits into habits. Routines that require immense discipline to implement, in usually already busy, over stressed, over burdened lives.

    It takes time and incremental steps to overhaul a lifestyle, deconstruct and reconstruct behavioural patterns. But if you take that time, then it's actually really, really easy.

    I've helped many people lose and keep off weight over the years by helping them figure out their own habit behaviours.

    I think it's great that you are seeing a therapist as I've always said that the best diet is really good therapy.

    They key is to understand why you gained the weight in the first place, and to address the behaviours that keep the weight on.

    Is it a lack of nutritional knowledge? That's easily solvable with learning how to eat well.

    Is it a pattern of stress or comfort eating? Then those patterns need to be replaced with healthier coping skills. Or you may need to modify your life to be less stressful.

    Is it problems with body image and self esteem problems, where you don't feel you deserve to have a healthy body?

    Is it the product of trauma, where excess weight feels like a barrier against the world? If so, then the trauma needs to be addressed, for a lot of reasons.

    Is it a combo of some or all of the above?

    You have to remove the barriers and figure out ways to make healthier behaviours the easier option.

    That takes time and incremental, strategic changes.

    For me, I started with therapy to help with the overwhelming stress and I started with breakfast. I didn't change anything else about my lifestyle. I didn't count calories, didn't join a gym, I didn't have the bandwidth for any of that.

    I just started with mental health support, and figuring out how to easily feed myself nutritious food every morning. I didn't take on ANY lifestyle changes beyond that until healthy breakfast was an easy, and automatic part of my day.

    I also didn't have a weight loss goal. I knew that a healthy lifestyle could not sustain my obesity, so my goal was just to build a much, much healthier life, one step at a time, and accept whatever weight my body ended up at through living REALLY well.

    I thought I would probably end up low-overweight BMI range, or high-healthy BMI. I just intuited that I wouldn't get very lean without serious, intentional restriction.

    That made sense to me, but I was wrong. Over time, I just kept optimizing my lifestyle and ended up the leanest I've ever been, and the same weight I was at 18.

    The thing with incremental change is that it can just keep going. You can actually change your lifestyle far more radically through small, sustainable changes than you can through sudden, sweeping changes.

    Time is a VERY powerful force when you harness it. What makes most people fail in any major goal is impatience. But if you learn to embrace time as your greatest, most passive tool, you can do amazing things.

    I focused on healthy changes and time just made the weight disappear. I felt like I didn't need to do anything, because each change was done in a way to be easy. So I was just focused on doing easy things, little by little, and my new body just showed up.

    It's been several years, I very much enjoy my healthy lifestyle and it takes absolutely no discipline to live this way. My spouse has also lost substantial weight, down to the leanest they've ever been.

    We've been living and eating off-diet, eating all sorts of crap and not doing our regular exercises for 6 weeks because we were temporarily living in very different conditions.

    We're back to normal now and SO HAPPY to be back to our normal food and activity. Our healthy lifestyle is our normal, and deviating from it to eat crap feels awful, and doesn't feel right.

    So yes, the stats on weight loss are terrible, but that's because almost no one approaches weight loss in a way that's likely to work long term.
  • Xellercin
    Xellercin Posts: 878 Member
    edited June 14
    AnnPT77 wrote: »
    beabria wrote: »
    @glassyo and @AnnPT77 thank you - it is both helpful and encouraging to hear from people who have lost weight *and* kept it off! Sometimes it does feel like a near-unicorn, and hearing what amounted to "I don't think it's worth bothering with you" from a professional I'd hoped would help was making me feel it was truly impossible.
    I have set up my goals and am weighing everything out. So far I've lost 5% body weight, but I'm approaching the "great plateau weight" I've always hit in past efforts, when I'd stay at the same weight for 1-2 months while still supposedly eating a deficit. I guess I was hoping that a dietician would be able to offer me some pointers. But, this time I've decided to try a greater am hoping it will get me past the plateau. (Oddly, I'm not actually finding the greater deficit is making me hungrier than the lower deficits. I'm assuming this is down to the *what* I'm eating rather than the how much.)
    In any case, I'm glad to hear from people who have not just lost weight, but who also kept it off. (Congrats, btw!) And thanks for the pointer to resources and the tip about scams!

    Here's some maybe-unexpected advice: If you lose at a reasonable rate right up to the perceived plateau, then stall, consider waiting it out, rather than cutting more steeply. Especially if you're losing fast, it's common to get some water retention rebalancing for a while, masking ongoing gradual fat loss on the scale. If that's so, hanging in there patiently will eventually let you see a scale drop when the water weight stops playing peek-a-boo on the scale with the fat loss.

    Steeper deficit increases stress on the body. Stress can contribute to water retention increases. While a steeper deficit can be non-hunger-provoking initially, there can be snap back later (either hunger or fatigue/weakness) that's counter-productive.

    If you've actually stopped losing because you're eating maintenance calories, that's likely to look like a gradually tapering-off weight loss rate, not an abrupt stall.

    Just a thought.

    More background on that stuff here:

    http://community.myfitnesspal.com/en/discussion/10604863/of-refeeds-and-diet-breaks/p1
    https://community.myfitnesspal.com/en/discussion/10683010/the-weird-and-highly-annoying-world-of-scale-fluctuations/p1

    (That first one has relevant info on stress, water weight, etc., even though the thread title may not seem on-point.)

    I 100% agree.

    When I was losing, I never had a real plateau, I only had stalls on the scale, but those are usually not an actual plateau.

    I would lose weight for a bit, and then the scale would stall for upwards of 2 months, then it would drop again and then stall.

    The pace of loss was consistent *on average*. The numbers on the scale weren't.

    I only ever had a real plateau around holidays when I would eat and drink more on average for the month of December.

    Fat loss can be linear, but the number on the scale never will be because it doesn't actually indicate fat loss.

    There's too much going on in the body for the scale to tell you what's going on with your fat stores from week to week.

    Patience and time. Patience and time.
    I never EVER adjust my routine with less than 6-12 weeks of data.
  • cmriverside
    cmriverside Posts: 32,380 Member
    edited June 14
    I'll just jump in late and say, I lost 80ish pounds in 2007-08 and I've kept it off. (Female, 5'8", lost the weight in my mid-fifties.) No help from doctors or nutritionists. Just good old food logging and studying that food diary and making adjustments to my nutrition. Some exercise is part of most days, just a long walk usually.

    I would agree that eating less is not really the answer.

    For me, when I hit a plateau I also hit a wall physically, so I guess I was lucky. I had been eating at 1200 calories plus Exercise calories and then when I hit that plateau (at about 40 pounds lost) I actually INCREASED my calories to 1600 PLUS exercise calories. I lost the rest of my weight eating around 1900-2000 per day. I now eat a bit more than that to maintain.

    Less is not necessarily the answer when you hit that plateau.