“We should be as kind to ourselves as we are to others”

This week we chat to Tabitha Hume, a registered clinical dietitian in private practice, to find out why she became a dietitian, what she enjoys most about the work she does and what the challenges are:

Why did you become a Registered Dietitian?

I danced very seriously when I was at high school (ballet) and fell prey to the eating disorder monster. When I went to UCT, I started out studying BSc with an aim to genetic engineering, but then someone mentioned that dietetics was offered as a post-grad honours degree and my interest was piqued. I changed my BSc subjects to physiology and psychology and then was equipped for dietetics. I had a very strong interest in the physiological development of metabolic problems and so when I started my honours thesis on the hyper-metabolic response of paediatric burns patients, I was in heaven! Then after honours, my huge thirst for knowledge blessed me with a research and lecturing post at Wits Physiology Department, doing my thesis on carbohydrate and insulin metabolism, which was incredible. I knew I was in the right career when I started private practice and saw how rewarding it was, helping people with disordered eating and eating disorders completely lose their fear and anxiety of carbohydrates and remain skinny whilst eating a LOT.

So, it was really an evolution into dietetics, but a perfect fit!

What do you enjoy most about the work you do? What are the most satisfying moments?

I love interacting with people. I see myself as a bit of a teacher. Watching as the penny drops with people is very rewarding. Seeing previously restrictive people turning into satisfied eaters with a genuine passion for eating, and losing weight or stabilising muscle mass makes me feel like I’ve helped both body and mind, and made a positive difference. My most satisfying moments are probably seeing my past anorexic and bulimic patients enjoy food, socialising, eating with their families, and moving on to inspire other eating disorder sufferers with lecturing, blogging and mentoring. That’s paying it forward and I feel blessed that I am able to be part of that journey.

What has been your career highlight?

I think this answer has two parts: The first was the success of my first three books. Then, the second highlight has been slow: working my way back up from complete financial and emotional ruin after being accused of malpractice in 2001. However, the exoneration and my ongoing passion for helping people recover has put me back in the practice seat and made me stronger in the process. I’m proud of that.

What are the most challenging aspects of your career?

There are 3 main challenges, which hit me every day.

  • The fact that everyone and anyone dishes out conflicting and pseudoscientific dietetic advice and that the public is not protected against this. More disease and death is being caused by confusion, yo-yo dieting, eating disorders and orthorexia arising directly from ‘diet gurus’ who have little or no physiological or medical background. Because the public sees these ‘diet gurus’ and registered dietitians as equal authorities and equally qualified to dispense dietetic advice, I sometimes feel angered that I am forced to highlight the vast difference in qualifications there are. It’s crazy that we are forced to ‘convince’ patients that we are the experts. After all, someone with a rotator-cuff injury would not question a physiotherapist on what advice she received from her personal trainer!
  • Apropos the above: I also find it very challenging that medical aids still don’t see the massive value in dietetic therapy. This hinders the patient from obtaining the full scope of care that they actually need from a dietitian, and this incomplete process leaves the full lifestyle change open to failure, further exacerbating lost faith in dietetics.
  • With the plethora of rubbish advice available to people, much of the limited time in consultation is spent trying to teach complicated physiological concepts so that they can understand and thus ‘trust’ the advice we give, because it is often so contrasting to what is fashionable and the latest fear-mongering fad. Patients so often say, “I need to spend a whole day listening and understanding because only with understanding it ALL can my enormous fear of food be undone.” We, as dietitians, shouldn’t have to do this. We should be able to guide, direct and heal. Not have to spend patients’ valuable time convincing them that eating normal food is OK.

How do you cope after a day of nutrition disaster and bad eating choices?

I speak to myself kindly, as I would to a child who made mistakes. We all do things for a reason, and I show myself WHY I made those mistakes, and rapidly make small adjustments to address that problem for the future. As soon as I let guilt in, my tendencies to be mean to myself start, and this simply starts a complicated restrict/defiance pattern in my eating which is not healthy. We should be as kind to ourselves as we are to others.

What are the three things that you think people should stop saying when they meet a dietitian?

  • “Are you sure? Everyone else seems to be saying that blah blah blah (insert pseudoscientific rubbish)”.
  • “I know what I should be doing I just can’t seem to have the discipline”. …..Um, no! If you don’t have the discipline, it’s probably because you are doing it wrong!
  • I won’t need much time with you… just give me a diet sheet of what I can and can’t eat”.

What should clients look out for when deciding which dietitian to work with?

I think this is a very difficult one to answer, seeing as most dietitians have equal qualifications. I’d say that because patients usually require a lifestyle change (and that is a fairly personal process), finding a dietitian with whom the patient ‘clicks’ on a personality level is very important to motivation and trust.

What is your favourite dish and your favourite treat food?

Undoubtedly a hot lentil curry with chutney and tons of fresh coriander!

My favourite treat food would be warm apple pie! (Vegan of course!)


The Role of the Dietitian in Eating Disorder Treatment

Eating disorders are complex illnesses with both psychological and physical aspects that require treatment. For this reason, over the past few decades, it has become more common for the treatment of people with eating disorders to be managed by multi-disciplinary teams which can deliver the necessary medical, psychological and nutritional help. As society’s foremost expert on nutrition, the dietitian has an important role on the treatment team for a person suffering from an eating disorder, and more opportunities are opening up for dietitians to develop as experts in this role.

Julie Deane-Williams, a registered dietitian and ADSA (Association for Dietetics in South Africa) spokesperson who has a special interest in treating people with eating disorders, points out that in some cases, the dietitian may also be the first port of call for help.

“Even though there are high levels of denial associated with disorders such as anorexia nervosa or bulimia nervosa, the dietitian is often the health care professional on call, especially when it comes to a person struggling with emotional/comfort eating or binge eating disorder. Typically, in the first session, a sufferer, usually female, confides that she is desperate to lose weight; reveals disgust at her body, even if she is within a healthy BMI (Body Mass Index) and feels shame that she has been unable to stick to a diet. The dietitian soon discovers that the emotional eater has tried many different diets. Patients commonly are keenly aware of the energy content of different foods but that doesn’t mean that they know much about nutrition. Often the patient hopes that the dietitian can provide a ‘miracle’ diet that is finally going to help her lose weight and keep it off.”

In combination, these are the warning signs for the dietitian who can recognise the symptoms of disordered eating. It is important that the dietitian doesn’t play into the patient’s scenario but instead helps them to acknowledge disordered eating and address it appropriately.

Deane-Williams makes it clear that the dietitian who works with people with eating disorders needs to acquire particular expertise and skills.

“It is important for the dietitian to understand how the different eating disorders develop and are maintained by patients, as well as to have sound knowledge of the medical, psychological and physiological aspects of the range of eating disorders. In order to play their role effectively on a multi-disciplinary team, they also need to have a general understanding of the mental health issues as well as the various psychological interventions and their applications. It would be an advantage to the dietitian to have expert communication, counselling and behaviour change skills. This is a relatively new role for dietitians, and the complexity of eating disorders demands education and training that goes beyond the minimum required to simply qualify as a registered dietitian.”

The dietitian who works with people with eating disorders plays an important role in the assessment, treatment, monitoring, support and education of the patient. As advocates of evidenced-based science, they serve as important resources of nutrition knowledge for the patient, the patient’s family and the other health care professionals on the treatment team. They need to be skilled at determining a patient’s nutritional status, eating patterns and behaviour, food rules and beliefs. It is the dietitian who takes into account the patient’s meal planning, food shopping and cooking skills. The dietitian works closely with other team members to understand how the patient’s underlying psychological and emotional issues impacts on their eating behaviours, as well as their motivation and capacity for behaviour change. The dietitian will work collaboratively with the patient to develop the nutrition aspect of the treatment plan, and to support the patient and the rest of the team throughout its implementation.

In the light of recent research in the UK that has attributed more deaths to eating disorders than any other psychiatric disease, Deane-Williams urges people with unhealthy relationships with food to seek help sooner rather than later.

“Using food, or the lack of it, to cope with distressing emotions and situations is a maladaptive way of managing life,” she says. “All eating disorders are addictions, and it is the nature of an addiction to further and further alienate a person from their own inner truth. Addictions also usually drastically stunt emotional growth. Once a person accepts that they have an eating disorder, and they seek good medical help, the healing journey is one that is difficult yet immensely rewarding. Not only can they recover, but they find out who they really are – bright and exceptionally intuitive people who had developed a coping mechanism to keep their ‘heads above water’ during extremely challenging times in their lives. Once they develop healthy ways of managing difficult emotions, they can go on to thrive, and create healthy and very happy lives.“

If you think you or a loved one might be struggling with an eating disorder, consider visiting a registered dietitian for expert guidance and advice. If you are looking for a dietitian in your area, please visit www.adsa.org.za