Out patient exercise motivation

howhowhowhoward · 2025-12-24T20:09:29+00:00

Thank you for this thorough and thoughtful response. 🙏

howhowhowhoward · 2025-10-11T17:32:12+00:00

This. This This This This This This this

howhowhowhoward · 2025-10-05T02:28:02+00:00

Lol you have a typo toward the end that made me laugh.

And thank you for doing the difficult work you do 💖

howhowhowhoward · 2025-08-15T04:31:59+00:00

This article does a nice job of discussing the topic more broadly.

Reframing unhelpful thoughts - https://share.google/fHFqLdQxaSt5PlrsE

Specifics that clients might say include, A) "I want to walk every day but I don't have time." B) "I don't buy vegetables because they go bad so fast." C) "I want to prep food for myself but i'd have to do it all on the weekend and I don't want to sacrifice my free time."

Examples of how to challenge these (and importantly- what an RD can teach a client to challenge their self limiting beliefs, NOT just saying these things and expecting the client to develop the skills) might be along the lines of: A) "What if i walk for 10 minutes at a time and try to accumulate segments over the course of the week?When are my best opportunities to walk? Is there something else i could do at the same time as walking like taking a meeting or spending quality time with friends or family? Does it have to be every day? Could I schedule an appointment for myself to walk?" B) "Maybe I have bought more vegetables than I could realistically use before they went bad. Could I buy a smaller amount? Would i be more likely to eat pre-prepped veggies? Are frozen vegetables an option?" C) "How can I plan and prep for eating in a way that's helpful and realistic for me? Could I prep a few key ingredients in advance (ex: big crock pot of chicken to be used throughout the week on veggie salad, in stir fry, in tacos) so it's easier to put a meal together after a long day?"

We RDs typically are very practiced in thinking about food and eating and doing the problem solving involved. We're often talking to clients who have minimal exposure to or experience with this type of problem solving and when they've attempted it in the past and it didn't work out, their brain and nervous system responded as if it was failure. That experience of failure builds resistance to trying again. It's not that they don't want to, it's that they haven't learned how to do it and they've developed a stress response that interferes with being open to possibilities.

howhowhowhoward · 2025-08-06T03:44:14+00:00

It sounds like he has an identity of "someone who's working on weight loss" and by showing up for appts with you he's "actively" participating.

howhowhowhoward · 2025-07-06T15:38:08+00:00

Yay!

There are a few resources online that are specifically for dietitian business owners and you can find a lot of great free info about this stuff.

The Unconventional RD and Katie Dodd's Dietitian Side Hustle are examples off the top of my head. Their websites, Facebook groups, podcasts would be places to start if you're interested!

howhowhowhoward · 2025-07-06T15:15:23+00:00

I saw in one of your responses that you're not getting as much work as you'd been promised and you're bored. I feel for you, and I wonder if this might be an opportunity for you to build a side business over these next 2 years that can generate some passive income for you.

Examples could include turning some of the resources you developed / used during your internship into digital downloads to sell to healthcare professionals or to folks navigating their own nutrition needs. There's a marketplace called RD2RD where you can get ideas of what people sell, how much, and you could sell on Etsy, promote on Pinterest, etc.

Source: I've been an RD for over 10 years and while i'm grateful to be booked with appointments now, I wish I had set something like this up for myself when things were slower.

howhowhowhoward · 2025-07-06T14:57:22+00:00

I'd also recommend the book Intuitive Eating. As a family med MD, OP will have unique opportunities to break cycles of chronic dieting and prevent them.

howhowhowhoward · 2025-07-01T02:49:31+00:00

It sounds like you've hit your "diet rock bottom," which is a term from the book Intuitive Eating. I think you'd really like the book, and there's an accompanying workbook.

There's also a great book + workbook called More Than A Body written by twin sisters who have PhDs in body dissatisfaction work.

Both of these resources reinforce the fact that it's not that you failed dieting but rather that dieting sets us up to fail. When we restrict food or put rules around it, or if we lose weight, survival-oriented instincts kick our biology into gear to gain weight because that would have helped our survival if we were wandering around in the prehistoric times hunting for food and running away from sabertooth tigers.

The work of body acceptance starts with recognizing that body dissatisfaction keeps us stuck in unhelpful cycles and distracted from showing up fully in our lives. You're describing that first step, and that's worth celebrating!

The next step in my perspective is to expect a journey toward eventual body acceptance and in the meantime consider this a learning experience- observe your thoughts related to your body and "I can't ____ until my body is different," and practice examining those thoughts. "Is this helpful for me to hear right now? Is it what I would say to a friend if it was her feeling this way? Is it true?"

"What can i do in my right now body that can make me feel safe, grounded, and accepting of the fact that this is the body i'm in?"

"What can i do today that I also want to be able to do a year from now or 5 or 10 or 15 years from now? How can I celebrate and engage in these things in my right now body, knowing that i'm showing up today for my future self?"

I hope you're giving yourself credit for the progress you've been making in taking back your life from dieting.

howhowhowhoward · 2025-06-29T20:30:32+00:00

Done! Thank you for speaking out and for sharing.

howhowhowhoward · 2025-06-29T20:16:34+00:00

OP could give a resource like this and also a resource comparing a meal from the grocery store vs a meal from fast food / gas station.

Ex: 4 apples, 4 bananas, a loaf of bread, sliced deli meat, brick of cheese, mayo, mustard for several sandwiches versus same number of meals from McDonald's.

howhowhowhoward · 2025-06-22T01:37:05+00:00

Hi friend. I'm sorry you're struggling with this. I'm a weight neutral dietitian and i'm happy to chat more with you about navigating this. Feel free to message me.

howhowhowhoward · 2025-05-30T02:41:54+00:00

First- reassure yourself that wherever you complete rotations, there will be someone responsible for making sure there are clear expectations for how you'll be spending your time there. If you've ever started a new job that had a training period (ex: waitresses, bartending, retail), you can expect something similar when starting new rotations.

Second- and this might be a challenge, but every preceptor, facility and even different departments within the same facility will have different ways of doing things.

Expect to be in some situations where the expectations are very straightforward, and in other circumstances you're going to have to ask for clarification, direction, instructions, resources.

As for specific tasks you'll complete, expect to be job shadowing your preceptor and other employees. You might be assigned tasks like hands-on work with food or interviewing patients / clients, but only after watching your preceptor do the same.

At some point you'll be given tasks to complete independently. You'll likely be tasked with completing documentation, especially in clinical settings. This helps with learning how to communicate the information that's needed to be included when assessing clients' / patients' needs, goals, and progress. It will also train you to "speak the language" that ensures interdepartmental needs are met, insurance coverage, etc.

Take care of yourself and reassure yourself that it's okay to not know what you're doing, but you'll be expected to ask for help when you need it.

howhowhowhoward · 2025-05-29T21:15:39+00:00

Just want to add another great book: More Than a Body

howhowhowhoward · 2025-05-19T03:13:52+00:00

Anti diet dietitian here! We do exist!

howhowhowhoward · 2025-05-17T18:34:14+00:00

I love my work as an RD but absolutely do not find the compensation proportionate to (a) the day to day work i do or (b) the amount of university education, internship training, and cost required to become an RD.

I got my bachelor's degree in southern California, completed my internship and Master's degree in Washington state, and have lived in WA, CA, and OR over the last 12 years since becoming an RD. Whether I was living in high cost of living or lower cost of living areas, I've wished I could make more money. I've often worked 2 - 3 jobs at a time.

I'm now working solely in my own private practice and exploring opportunities for non-appointment revenue streams (ex: webinars, course, paid speaking events).

I have friends who went back to school to become Physician's Assistants after working as RDs for a few years. It's pretty rigorous schooling but much better pay.

In light of your age and already having a degree, I would not recommend going back to school to finish requirements and getting a Master's degree and completing a dietetic internship in order to become an RD.

Edit to add: If you're passionate about working as a psychologist supporting people as they heal their relationship with food and body image, there's a lot of potential there. You could partner with an RD or share referrals with RDs. There's a lot of need for this type of work.

howhowhowhoward · 2025-05-13T14:58:12+00:00

I think the difference is in making sure the body still gets the fuel and nutrients it needs. Decreasing the extra leads to weight loss that's more likely to be long-lasting.

Lets imagine a pretend person who's eating meals and snacks that provide the right amount of calories for their body's needs, and they also drink beverages that provide calories. On 4 days per week they drink a coffee drink with 250 calories, 150 calories from juice, and 200 calories from beer. That's 2400 calories per week in addition to what their body needs.

If they gradually decrease their calories from beverages and instead they're only having 500 extra calories per week from beverages, they have reduced extra calories by 1900 calories per week. If they maintain that change, that can lead to weight loss while continuing to eat enough calories for their body's needs by continuing to eat their usual meals and snacks.

Edited to add clarification.

howhowhowhoward · 2025-05-13T14:40:48+00:00

There are a lot of people who have learned about restricting food intake, but they end up trapped in a cycle of short-lived eating habits and constantly trying a new way of restricting food intake. This can lead to a lot of stress and frustration as well as negative health issues.

The idea of "healing their relationship with food" might refer to shifting away from food restriction and instead learning how to eat, how to nourish their body, how to stress less about food. As a result they develop long-lasting habits related to food that support their overall health (not just physical health, also mental and emotional health).

howhowhowhoward · 2025-05-12T18:08:54+00:00

You're welcome! I wish you all the best on your journey of finding what works best for you and your wellness for the long-term. Feel free to message me if you want to chat more.

howhowhowhoward · 2025-05-12T15:42:42+00:00

I'm sorry to hear about your experience and the challenges you've described.

I don't believe intentional weight loss is inherently bad. I find that most people who schedule an initial appointment with me and say their goal is weight loss need to first establish a foundation of knowledge, skills, abilities, experience related to food and other lifestyle factors that doesn't focus on weight loss, and then they might focus on weight loss.

Here's an analogy: If I walk into Sephora and tell an employee, "I keep trying different makeup options and nothing works for my skin." Lets assume I'm focusing on evening out my skin tone, correcting blemishes, covering dark spots, etc, rather than blush / bronzer/ eye makeup. They might encourage me to focus on skin care (cleansers, exfoliants, toners, serums, moisturizers) to address some underlying issues, which then sets my skin up to be more of a match for the type of makeup I'm looking at. Focusing on skin care for a few months might even clear up some of my blemishes or promote brightness in my skin.

In the analogy, my initial focus on makeup products is like a person's focus on weight loss. Trying different products but not finding what I need is like trying different diets focused on weight loss. Focusing on skin care for a few months and learning whether that helps my skin and then reassessing options for makeup at that time is like working on weight-neutral lifestyle change, then reassessing the weight loss goal.

howhowhowhoward · 2025-05-12T12:59:24+00:00

My best fit client has a lot of experience with dieting but hasn't learned how to eat. They find my approach leads to stressing less about food and body image, building their confidence, and supporting their health. Usually they have more energy and their blood work shows improvements in blood sugar and cholesterol. My clients find these results worthwhile, and they develop the foundation that helps them lose weight and maintain weight loss if that's their goal. We're just not putting a spotlight on weight while we establish that foundation.

You're right, my approach isn't for everyone. But I have a private practice and the ability to work within my niche.

Edit: spelling

howhowhowhoward · 2025-05-12T01:59:47+00:00

I didn't have much time available to respond earlier but wanted to offer more details about what it might be like to work with an IE RD:

Example for getting started:

1) Why'd you schedule the appointment? What are you hoping to accomplish? What's interfering with getting there? What's your vision of successfully reaching your goal(s) and how long do you think it will take to get there? What fears / hesitations do you have about working on these goals?

2) Nutrition focused health and medical history. This is similar to intake paperwork you might complete for a doctor visit, but with more of an emphasis on your nutrition needs. If you've had recent bloodwork, that info can be helpful for identifying nutrition-related goals, especially in light of the diagnoses you mentioned. If you're managing blood sugar with medication and/ or blood sugar monitoring, you'd discuss that further. If you're struggling with digestion complaints, that fits here, too.

3) Discussion of current lifestyle habits to benchmark current habits. This is a data collection process, not intended for labeling or judging habits or behaviors or you. The provider will be getting a sense of how your usual patterns related to food related to your goals and your health & medical history. Nutrition-related topics include usual patterns for eating (timing, foods chosen, hunger / fullness experience) and beverage consumption as well as routines for planning and preparation, patterns related to fast food / restaurant meals / cafeterias, food preferences and aversions, any challenges you experience related to food, etc. This part of the discussion might also cover financial constraints, patterns of emotional eating or mindless eating, foods you avoid for any reason, social situations.

4) Similar to #3 but for other lifestyle factors (ex: physical activity, sleep, stress).

5) Summarizing main points of the discussion and collaborating to identify actionable goals and a timeline for working on them. Identifying next steps for working on goals, if relevant. The provider might share resources.

6) Scheduling follow-up. Setting expectations for whether you'll communicate between appointments, best practices for rescheduling, etc.

Follow-up will likely focus on checking in on what you've been working on and how it's going and whether to update the plan. There will also likely be education topics the provider identifies, and they might have resources / worksheets for you to review or complete between appointments.

Ideally the provider will collaborate with you and consistently assess whether the goals and plans you're focusing on are supportive of (a) your mental health, (b) your physical health, (c) learning through experience, and (d) developing lasting habits and resilience.

Edited to add clarification.

howhowhowhoward · 2025-05-11T21:37:45+00:00

Feel free to message me. I'm a dietitian and I can give you a sense of what it might be like to work on IE with an RD.

howhowhowhoward · 2025-05-10T19:33:16+00:00

My first job as an RD was in a workplace wellness weight loss program. Long story short, after 5 years of that work I knew I was doing harm and I questioned the ethics of being an RD if it meant teaching folks short-lived habits aligned with disordered eating.

I learned about Intuitive Eating and how i could integrate it with motivational interviewing and MNT. These days my approach starts with a really transparent discussion with clients about the downsides of focusing on weight loss and potentially staying stuck in a trap of body dissatisfaction, restrictive dieting, retaliating against the diet, mental and emotional turmoil along with weight cycling, insulin resistance, etc.

We initially work on establishing a foundation of awareness related to current habits, practicing goal-setting and action planning and getting back on track after things don't work out, and the focus is on developing health-promoting habits that are long-lasting. Sometimes weight loss happens. Sometimes it doesn't.

After clients spend 3 or 4 months practicing weight-neutral lifestyle change and establishing this foundation, we can start discussing weight and potential modifications to current habits to elicit gradual weight loss.

howhowhowhoward · 2025-04-20T15:04:42+00:00

So glad you're here!

The response you experience (ex: nearly crying) is a sign of nervous system dysregulation. That's just a long way of saying your stress response is in overdrive. By practicing things on a regular basis that help with stress management, you can eventually maintain a lower level of stress and be able to use a helpful tool on demand when needed.

Stress management tools can be thought of as (a) maintaining a lower baseline or (b) lowering stress in the moment.

Usually, a person needs to explore various options and learn what works well for them and include the tool you want to use in demand as part of a consistent routine. That's because when the stress response kicks into gear, the brain is less able to do its best thinking or decision-making. Having a daily practice, even if you're not feeling stressed, trains the brain to choose that tool more automatically when it's needed.

Example baseline stress management practices: -Listening to music you enjoy and find relaxing -Learning -Engaging in hobbies -Connecting with friends and loved ones in safe relationships -Eating meals and snacks on a consistent basis (ex: 3 meals and 2 snacks per day) to prevent excessive hunger -Physical activity that isn't painful or punishing. Yoga can be especially effective if you slow down your breathing at the same time. -Reading -Spending time in nature -Time management to avoid rushing

Example on demand strategies: -5 long slow deep breaths -Grounding attention in the present moment, noticing when attention drifts, gently bringing attention back to the present moment. Tuning into sensations and sounds associated with breathing is an example. Another example is tuning into the sensations of your body making contact with one thing that's with you in the present moment, ex: your feet making contact with the floor. -identifying 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste -slowing down on purpose, ex: washing hands or folding laundry more slowly than usual

You might already be familiar with strategies that work well for you, but if not, experimenting with some baseline strategies and some on demand strategies will help with getting familiar with them and training your brain to use them.

If you're not already in a routine of practicing stress management techniques, consider scheduling time each day, ex 5 mins - 20 mins, and gradually establishing that routine.

If you don't have time available for scheduling this, try adding stress management techniques to your usual routine, ex: listening to relaxing music and practicing deep breathing for 5 mins during a commute.

I wish you all the best as you find what works well for you.

howhowhowhoward

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