Recently, I was asked to speak at the San Francisco dance school "ODC" for the "Dancer's Day of Health." This day was all about health information and free screenings for freelance professional dancers. We had medical doctors, mental health professionals, physical therapists, and of course - dietitians, all giving their time to screen and educate the dancers.
The panel I spoke on asked us each to briefly say what our role is on the dance medicine team. Here are my bullet points of what the Registered Dietitian does:
“The #1 goal of nutrition counseling is behavior change” – Herrin & Larkin
We help dancers specifically:
When you work 1-on-one with a RD you are going to get help on eating for your individual lifestyle, medical needs, and your personal preferences. No generic meal plans, and any RD worth their salt will come from a place of “all foods fit” and “health at every size” meaning we can focus on health behaviors and risk factors without weight being the focus or “fix.”
Do you need a RD in your dance life?
In just a few weeks I will be speaking at the San Francisco / Bay Area "Day for Dancer's Health" at the ODC!
And dancers, it's totally FREE to attend!!!!
In case you are going, here is what my breakout session is going to be about:
"Fueling the dancer's body for long rehearsals"
With Libby Parker, MS, RD; Registered Dietitian and owner of Not Your Average Nutritionist.
This session will cover how to eat for rehearsals and show days with the foods you love. Libby will cover timing of meals and snacks, hydration (and what’s the deal with sports beverages), and you’ll learn what macronutrient is the MVP for energy. Bring your performance nutrition questions. This is one topic from Libby’s more extensive online course “Whole Health For Performers” which covers all the health topics for stage performers that you never learned in school. Learn more or register here:
Find out more about the conference:
Facebook Event Page: https://www.facebook.com/events/221721465441739/
Facebook Fundraiser: https://www.facebook.com/66436867466/posts/10156027814407467/
ODC’s event webpage: https://odc.dance/DancersHealthDay
Indance article: http://dancersgroup.org/2019/01/injury-prevention-longevity-odcs-healthy-dancer s-clinic/
Libby Parker is a Registered Dietitian specializing in eating disorder recovery. Her private practice, Not Your Average Nutritionist, LLC, is in San Luis Obispo, CA, and she also does virtual counseling. She is in the final stages of her first book, Permission To Eat, coming late 2019. Libby started dance at the age of 3 (thanks, mom!) and is happiest when she is on stage in musical theatre productions. She just got back to CA from NYC where she auditioned for Broadway’s Mean Girls. Libby wants every dancer to love their body and never diet. @DietitianLibby www.NotYourAverageNutritionist.com
Check out this podcast episode I was interviewed in!
Episode 35 of "Ignite Her Fire"
Key takeaways: All foods fit in a healthy lifestyle, and you don't have to be hospitalized/look "sick" to get help with your eating, Registered Dietitians are different than "nutritionists" or "health coaches," sugar is not evil, keto is not a good diet plan, we need to STOP talking about our bodies!, a little about my acting...and I'm sorry you have to hear me sing (and yes, I know the lyrics are out of order).
http://www.igniteherfire.com/ or on itunes
A podcast full of stories of badass women living life on their own terms.
Thanks to Sabrina and Shawna for hosting me!
Want to learn more? Sign up for my monthly newsletter for free nutrition/health info, and body positive messaging!
The concept of choreographing meals is one that I came up with when working with a client.
As a dancer, I like to bring art and creativity to my work with eating disorders. Here is a fun way of looking at food if you are stuck in a food rut.
Today I wanted to explain a little more about my virtual nutrition counseling (eek! I'm excited).
I have been counseling individuals with eating disorders for 5 years now, and have had an occasional phone or facetime client (they signed papers stating they knew it wasn't HIPAA compliant), and with that I learned what worked/didn't work for me.
Along with some research into security, and my own policies, I now have HIPAA-compliant (secure, from a health-care/insurance standpoint) video ability along with my already HIPAA compliant electronic health records.
That's a lot of fancy words for saying that I have confidential video conferencing ability wherever you can get internet.
Virtual counseling can be just as effective as in-person counseling. If you show up, not just physically - but mentally, and do the work, it is not really different from in-person counseling.
It is great for those who cannot get to a specialist in their area either due to travel ability/time, or availability of counselors; as well as those who are more comfortable having the distance (for instance, because of social anxiety).
When we work together virtually, I can send you handouts via email (paperless = save the earth, and you are less likely to lose track of them), and pull up notes and your types questions/food journal while we chat. I treat the time just like an in-person session (same length of time, same information covered, same contact/communication). The only downsides are that I (usually) cannot see your whole body (which might sound great to you, but visuals are important for some medical issues, and body language is such a big part of how we communicate), and I can't give you a hug if you are having a rough day.
Some important things to note if you do want to work with me:
1. I only take outpatient-level eating disorders, disordered eating, and occasional performance artists.
2. Because of state licensure I cannot work with individuals from most states (or out of the U.S.A.). At the moment I can work with individuals in the following states: California (always, as I live in CA), New York, Alaska, Washington state, Colorado, Michigan, New Jersey, Connecticut, Massachusetts, Pennsylvania, Arizona, and Virginia. (Subject to change at any time).
3. I REQUIRE that you have an in-person therapist that I can communicate with about your care. This is for your safety, to make sure we are on the same page with helping you, and that I know there is someone seeing your whole-self that can help you if things go downhill or you need other local services.
See the details page of my website for all the info.
Interested? Contact me to discuss if we would be a good fit.
I can't wait to meet you!
A while back I posted about the body positivity I see in the drag queen community.
Due to a good friend who stage manages the local drag shows, I have had the fantastic opportunity to help out with a few events recently and have had a blast hanging out with the queens in the dressing room.
And, girl, can they teach us all a thing or two about body acceptance!
For those that don’t know, a drag queen is (typically a man, but can be female/non-binary) who dresses up in women’s clothes (usually gowns and over-the-top makeup, complete with huge false eyelashes), typically for purposes of entertainment (ex: drag show).
As I watch these queens get ready I noticed several things that I think us unconfident biological females can take away from the experience:
1. Curves. Many of the queens actually add padding to accentuate curves. They add hips and breast, and it is not in jest. They genuinely think this is beautiful. How many of us have tried to hide our feminine form? To starve or run-off the curves? The queens would be appalled. Takeaway: rock the curves you were given.
2. They take up space. Even when getting ready the world is their stage. The tables, floor, and every surface is “theirs,” they don’t try to contain their fabulousness. It almost seems a point of pride to have more space and to drive out another queen (though the locals here tend to get along well and help each other, too). Takeaway: It is ok to take up space!
3. They are unapologetic in how they present. Queens don’t shuffle-along with heads hung low trying to disappear, they f-ing shine! A queen sashays in her stilettos, head up, shoulders back, checking that her lipstick is on-point. She does not apologize for being there, being the center of attention, or walking in front of you. Takeaway: Hold your head up proud, walk confidently, and as Coco Chanel said, “if you are sad add more lipstick and attack!”
Today I want you to think of one way you can live a little more like a drag queen (and I am not saying you need to load on the makeup if that is not you!). How can you stand confidently in a room? What will it take to look up instead of at your feet? What clothes make you feel fabulous in your current body? Wear them!
You are fabulous darling!
What is the current best-practice for prevention of eating disorders among adolescent/young adults based on reduction of eating disorder risk factors (as determined by previously validated eating disorder behavior questionnaires)?
Elizabeth Parker, RD and Margery Lawrence, PhD, RD
December 6, 2017
Introduction: The purpose of this study was to determine the current best intervention program for reducing the risk of developing an eating disorder (ED), based on previously validated eating disorder behavior questionnaires. With over 10% of adolescent/young adult females developing eating disorders, prevention is increasingly important. Method: An evidence-based review was conducted looking at programs designed to reduce risk factors that have been shown to be associated with developing an eating disorder among high school and college students. The research found was limited to females, and primarily focused on those experiencing body dissatisfaction. Results: Twelve studies were reviewed, nine of which found cognitive-dissonance prevention programs to be significantly more effective than control groups. Conclusion: Cognitive dissonance-based programing (the Body Project) was found to be the most effective way to change negative beliefs and behaviors that lead to EDs among females. Further research should include studies that look at broader population bases, creating programming for males and those of the lesbian, gay, bisexual, transgender, and queer community (LGBTQ).
The prevalence of eating disorders (ED) has grown quite high, with approximately 10% (or more) of adolescent girls/young women meeting the diagnostic criteria for eating disorders based on the DSM-IV or DSM-5.1, 3, 4, 6, 7, 9, 10, 11 Additionally, roughly 50% of college-age women may have subclinical disordered eating behaviors.10 Behaviors and conditions commonly associated with disordered eating include: dietary restraint, purging (self-induced vomiting, over exercise, laxatives, diuretics, diet pills), binge-eating, self-deprecation, negative affect, difficulty regulating emotion, anxiety, depression, self-harm, thin-ideal internalization, and body dissatisfaction to name a few.
Many women who do receive treatment do not fully recover from their ED (e.g. 44% of those with bulimia nervosa do not, and that percentage is greater for those suffering from anorexia nervosa)10 which is why prevention of these disorders is so important. Early assessment and intervention is crucial for the best odds of recovery and restoration of health, especially in those under the age of 19.4 EDs generally develop in adolescence and prevention programs are more effective in early adolescence.6 On average, body dissatisfaction peaks in later adolescence but these older adolescents may be able to better comprehend the need for intervention of socially promoted “thin ideal.”6
It is concerning that only one-third of people with an ED have been asked about eating-related issues by their primary health care provider.4 Furthermore, less than one-third of people with EDs receive treatment!4, 6 Given that more people will see a primary medical provider than a specialist, primary care providers have an opportunity to assess patients for eating disorders and should be trained in how to screen for them.4 Many medical providers said they felt “ill-equipped” to screen for or treat eating disorders.4 Since schools have a unique opportunity to track and influence students over a longer period of time, many studies have looked at prevalence and prevention strategies among students.
Prevention programs are relatively new in the field of ED research, and are not widely practiced. In fact, most of the available studies performed to evaluate these programs were performed by the same pool of researchers. The purpose of this evidence-based review was to determine the current best intervention program for reducing the risk of developing an eating disorder, based on previously validated eating disorder behavior questionnaires.
Several programs were seen repeatedly among the various studies, suggesting that there was already some consensus on what programs might yield the most significant reductions in ED risk factors. The studies looked at reduction of ED risk factors, especially surrounding thin-ideal internalization, dieting practices, body dissatisfaction, depression/negative affect, and used similar self-reported scales.
Overall, the studies indicate that features of useful ED prevention programs include: cognitive-dissonance-based programing, multiple sessions (instead of a single session), interactive sessions (group, or other interaction), facilitation by professionals (as opposed to peers, teachers or other endogenous staff), use of validated assessments, and avoiding education about EDs and effects of EDs.
A Pubmed search was performed on August 21st, 2017 using the following search criteria: ((feeding and eating disorders/prevention & control*)) AND ((young adult OR adolescent) AND students) AND (risk factors AND eating disorders) AND ("last 10 years"[PDat] AND Humans[Mesh] AND English[lang])
The search yielded 35 articles, twenty of which were initially selected based on the abstract. This was further reduced to twelve by excluding any age groups that were not high school or college (undergraduate/graduate level). Since this is a relatively new topic (especially in areas of peer leaders; 2,9,12 internet-based program; 7 and female athletes 10), all study designs were initially included due to the small number of available studies. The significance was held at p= or <0.05 for all studies.
Of the resulting 35 articles, 23 were excluded due to: age of population, abstract not indicating ED prevention, or study types such as interview, reviews or meta-analyses. Twelve articles were selected for review as follows in table 1.
Of the 12 articles, 10 looked at cognitive dissonance-based (CD) prevention programs. Of those 10, 9 concluded that CD programs produced more significant reductions in ED risk factors than other prevention programs. The one exception was the study that focused specifically on athletes.10
Table 1. Study Comparison Table (click file to see PDF of table)
There are previously validated assessments for mental health and eating disorders as seen in the assessment methods used in the studies (see “key to abbreviations” at the end of this paper). These assessments were used to determine if there was a reduction in negative thoughts and disordered behaviors among participants.
The four most common interventions examined in studies were in-person cognitive dissonance-based programs (CD), internet-based cognitive-dissonance based programs, the NEDA brochure, and the documentary “Dying To Be Thin.” The most effective of these was in-person cognitive dissonance-based programs.
Cognitive Dissonance-Based (CD) ED programs (The “Body Project”):
Cognitive dissonance “is based on the presumption that creating an inconsistency between a belief and a behavior will elicit a feeling of discomfort in an individual”2 and that the individual will need to change the behavior to remove the discomfort. Programs focused on CD help to promote behavioral changes because consistency between beliefs and behaviors is human nature. By challenging disordered beliefs, behaviors are challenged; and to remain consistent behaviors must change along with the belief.7
The Body Project is an in-person CD group program, typically: 4 weekly 1-hour sessions, with 7-9 participants per group, led by a trained (for 9 hours) and scripted facilitator (counselor or peer).1 CD programs had the greatest effect on reducing ED symptoms in all the studies that included the “Body Project” as an intervention. 1, 2, 3, 4, 6, 9, 11, 12 CD challenges the thin ideal by creating cognitive dissonance with written, verbal, and behavioral exercises.1 With adequate training it worked for peers to “teach” the material, but not facilitate difficult discussions.10 Group programs, like the Body Project, further increase behavior change by the extra layer of public accountability.7
The Body Project has the greatest amount of research (relative to similar programs) and has a strong evidence-base.12 All researchers who used this intervention cited efficacy trials for dissonance-based programs that showed promise. The American Psychological Association (APA) supports dissonance-based prevention programs for interventions, for creating replicable results, and creating significant results against the control groups at 2 and 3 years, and to a 60% greater effect than assessment-only control groups.10 Many of the study authors commented that more sessions may have produced greater results.2, 4, 10
Internet-based Cognitive Dissonance Based Programming (The “eBody Project”):
The e-Body Project is CD-based like the Body Project, but delivered via the internet. The program was designed to remain interactive, and contains 6 modules to be completed over 3 weeks, at 30-40 minutes/session.1 The internet has become a constant source of thin-ideal, so to have the internet challenge that ideal through this program is very timely.1
Two studies reported that many schools and other settings found it difficult to recruit clinicians (school counselors/nurses/teachers) to learn the Body Project and lead the groups.7, 9 With over 95% of adolescents having internet access,1 a larger population can be reached via the internet.
The e-Body Project showed promising results where the in-person Body Project could not be performed. The ED risk reduction results were not as strong which may be due to the fact that participants could go through this program faster, meaning that there was less time submerged in the messaging. This had less impact on reduction of thin-ideal internalization.7
“Dying To Be Thin”:
This is a 55-minute documentary (McPhee, 2000). Widely-available at no-cost, this video covers body image, pressures to be thin, eating disorders, treatment, recovery, and consequences of eating disorders.1
This is a two-page brochure (National Eating Disorders Association, 2002) covering negative and positive body image and how negative body image may lead to eating disorders. The brochure lists ten steps to positive body image.1, 11
Quality of Studies:
The studies were inconsistent in quality. Though the majority (8 of 12) were randomized control trials (RCT), the criteria and methods left many of them lacking, with five of the twelve receiving a negative (-) grade. Four were well organized and received a positive (+) rating. Most of the studies had a strong conclusion, but due to lack of generalizability (homogeneity) or sample size, most (8 of 12) were categorized as a grade II, with only one study deserving of a grade I. Overall, the grade of research is: II, neutral.
All of the studies focused solely on females, with relatively homogeneous populations. Demographically, studies were representative of female students at American universities, but not the population at large.1, 3, 4, 5, 7, 11 Additionally, all of the studies had sample sizes of less than 1000 participants, the majority having less than 200.
There was a great likelihood of selection bias in all of the studies, as participants could voluntarily opt-in to the study or opt-out at any time. Several researchers noted that the participants who stayed in the studies may have had more interest in the topic of body image. Therefore, it is difficult to draw conclusions on how effective the interventions would be with a more universal population. Furthermore, as the study assessments were self-reported surveys, there was potential for error in interpretation of questions, or in answering questions how they think the researchers want to hear.
In conclusion, based on the studies reviewed, cognitive dissonance-based prevention programs in group settings (such as the Body Project) created the greatest reduction in ED risk factors, even at 3 years-post intervention, compared to control interventions. These CD-based programs have a greater likelihood of success in settings such as schools, especially Colleges/Universities. This is because of the unique setting schools offer in which it is often easier to deliver prevention programs. Although trained counseling clinicians were most effective, several studies noted that training peer leaders or other endogenous staff (such as teachers or school nurses) led to a statistically significant reduction of ED risk factors compared to control groups.
The one study that had participants go to a medical clinic, rather than having programming done at school, had high dropout rates.4 The authors explained that this was due to the greater time and effort needed to go to an off-campus clinic. This further shows how much more effective campus settings can be for prevention programs. With over 11.5 million female college students in 2017 in the U.S.13 (meaning approximately 1.15 million of which will develop a diagnosable eating disorder, given a 10% prevalence) this is utterly important.11
Universal programs (inclusive of all genders):
It was stated in one paper that there was research showing that programs targeting high-risk participants led to greater effects than programs that were “universal.”9 However, none of the studies evaluated for this review were universal, in that they were aimed at only females with body image concerns who did not have a diagnosed eating disorder. We believe that further studies could be done to assess whether or not cognitive dissonance-based prevention programs would be effective for males or those of the LGBTQ community. Due to body image differences among genders/gender identity, there would likely have to be different content for the CD programming to make it effective.
Programs for those with active EDs:
Potential participants with diagnosable EDs were excluded from all of the studies reviewed. This leads us to believe there is a gap in the research for programs that will reduce ED risk factors in those with clinical levels of EDs. This may be because at the point of having a diagnosable ED, it is not “prevention” anymore, but rather treatment. The disheartening piece is that according to background research in two studies (Linville, Cobb, Lenee-Bluhm, et. al; and Muller and Stice) over two-thirds of people who have EDs do not get diagnosed or receive treatment.4,6 Further research in programming that can help those with active EDs (who have not yet been identified as such) would help bridge the treatment gap.
Using this information in practice, we believe that all colleges should offer cognitive dissonance-based group programming (the Body Project). Ideally these groups would be led by trained counselors, but training peer leaders was also proven to reduce ED risk factors, and in remote areas (distance-learning / places where they cannot recruit leaders) internet versions of the Body Project can be offered. Challenging what people believe about body image and eating habits changes their behaviors to remain consistent with new beliefs. By inviting them to publically (in a group setting) denounce the thin-ideal (or other body image fads) they set themselves up for creating positive changes.
*Key to abbreviations:
AIM = Affect Intensity Measure (Larsen, 1984)
BDI = Beck Depression Inventory (Beck, Steer, & Garbin, 1988)
BMI = Body Mass Index
BSQ = Body Shape Questionnaire (Cooper, Taylor, Cooper, & Fairburn, 1987).
CDI-SF = Child Depression Inventory - Short Form (Kovacs, 1992)
CES-D = Center for Epidemiologic Studies - Depression Scale (Radloff, 1977)
DERS = Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004)
DRES = Dutch Restrained Eating Scale (van Strien, Frijters, Van Stavern, Defares, & Deurenberg, 1986)
DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. (American Psychiatric Association, 1994)
DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. (American Psychiatric Association, 2013)
EAT-26 = Eating Attitudes Test (Garner, Olmstead, Bohr, & Garfinkel, 1982)
ED = Eating Disorder
EDDI = Eating Disorder Diagnostic Interview (Stice, Burton, & Shaw, 2004)
EDE = Eating Disorders Examination (Fairburn & cooper, 1993).
EDE-Q = Eating Disorder Examination-Questionnaire (Fairburn & Beglin, 1994).
EDDS = Eating Disorder Diagnostic Screen (Stice, Fisher, & Martinez, 2004)
EDI = Eating Disorder Inventory (Garner et al., 1983)
HWI = Healthy Weight Intervention (program) (Stice, Chase, Stormer, Appel, 2001; Stice, Shaw, Burton, & Wade 2006)
IBSS-R = Ideal Body Stereotype Scale-Revised (Stice, Ziemba, Margolis, & Flick, 1996).
PANAS-X = Positive Affect and Negative Affect Scale-Revised (Watson & Clark, 1992)
PSPS = Perceived Sociocultural Pressure Scale (Stice, Presnell & Spangler, 2002)
PSPS^ = Perceived Sociocultural Pressure Scale (Stice, Ziemba, Margolis, & Flick, 1996)
SATAQ-3 = (Sociocultural Attitudes Towards Appearance Questionnaire - 3 (Thompson et al., 2004)
SD-BPS = Satisfaction and Dissatisfaction with Body Parts Scale (Berscheid, Walster, & Bohrnstedt, 1973)
TOSCA-3 = Test of Self-Conscious Affect-3 Scale (Tangney, Dearing, Wagner, & Gramzow, 2000)
1. Stice E, Rohde P, Durant S, Shaw H. A Preliminary Trial of a Prototype Internet Dissonance-Based Eating Disorder Prevention Program for Young Women with Body Image Concerns. Journal of Consulting and Clinical Psychology. 2012;80(5):907-916. doi:10.1037/a0028016.
2. Black Becker, C, Bull, S, Smith, L, Ciao, A. (2008). Effects of Being a Peer-Leader in an Eating Disorder Prevention Program: Can We Further Reduce Eating Disorder Risk Factors? Eating Disorders.16(5), pp.444-459.
3. Stice E, Rohde P, Shaw H, Gau J. An Effectiveness Trial of a Selected Dissonance-Based Eating Disorder Prevention Program for Female High School Students: Long-Term Effects. Journal of Consulting and Clinical Psychology. 2011;79(4):500-508. doi:10.1037/a0024351.
4. Linville D, Cobb E, Lenee-Bluhm T, López-Zerón G, Gau JM, Stice E. Effectiveness of an Eating Disorder Preventative Intervention in Primary Care Medical Settings. Behaviour Research and Therapy. 2015;75:32-39. doi:10.1016/j.brat.2015.10.004.
5. Levitt DH. Participation in Athletic Activities and Eating Disordered Behavior. Eating Disorders. 2008;16(5):393-404. doi:10.1080/10640260802370556.
6. Müller S, Stice E. Moderators of the Intervention Effects for a Dissonance-Based Eating Disorder Prevention Program; Results from an Amalgam of Three Randomized Trials. Behavior Research Therapy. 2013;51(3):128-133. doi:10.1016/j.brat.2012.12.001.
7. Stice E, Durant, S, Rohde P, Shaw H. Effects of a Prototype Internet Dissonance-Based Eating Disorder Prevention Program at 1- and 2-year Follow-up. Health Psychology. 2012:77-86. doi:10.1093/med:psych/9780199859245.003.0007.
8. Gupta S, Rosenthal MZ, Mancini AD, Cheavens JS, Lynch TR. Emotion Regulation Skills Mediate the Effects of Shame on Eating Disorder Symptoms in Women. Eating Disorders. 2008;16(5):405-417. doi:10.1080/10640260802370572.
9. Stice E, Rohde P, Durant S, Shaw H, Wade E. Effectiveness of Peer-Led Dissonance-Based Eating Disorder Prevention Groups: Results from Two Randomized Pilot Trials. Behaviour Research and Therapy. 2013;51(4-5):197-206. doi:10.1016/j.brat.2013.01.004.
10. Becker CB, Mcdaniel L, Bull S, Powell M, Mcintyre K. Can We Reduce Eating Disorder Risk Factors in Female College Athletes? A Randomized Exploratory Investigation of Two Peer-Led Interventions. Body Image. 2012;9(1):31-42. doi:10.1016/j.bodyim.2011.09.005.
11. Stice E, Rohde P, Butryn ML, Shaw H, Marti CN. Effectiveness Trial of a Selective Dissonance-Based Eating Disorder Prevention Program with Female College Students: Effects at 2- and 3-year Follow-Up. Behaviour Research and Therapy. 2015;71:20-26. doi:10.1016/j.brat.2015.05.012.
12. Greif R, Becker CB, Hildebrandt T. Reducing Eating Disorder Risk Factors: A Pilot Effectiveness Trial of a Train-the-Trainer Approach to Dissemination and Implementation. International Journal of Eating Disorders. 2015;48(8):1122-1131. doi:10.1002/eat.v48.8.
13. Back To School Statistics. National Center for Education Statistics Website. https://nces.ed.gov/fastfacts/display.asp?id=372 Published 2017. Accessed November 11, 2017.
Hello my lovely readers,
I know post a lot of educational and technical stuff, and I bet you wonder (if you don’t know me in real life) what I am actually like. Honestly, I’m a normal (albeit, busy!) person. So here is a bit about me, and an action for you to take.
Probably my biggest passion is musical theatre. I have been on stage since I was 11 years old, and continue to find my happy place on stage especially when I am dancing. Last year, among my jobs I was in 4 musicals, and a short film. Acting, dancing & singing are my personal anti-depressants.
One of those musicals, Hairspray, was especially meaningful in regards to my practice (for those who think this musical is just “fluff” - look deeper!).
Here’s why it was so meaningful to me:
One major theme in this show is body acceptance. The main character, Tracy, and her mother, Edna, are very overweight. This causes bullying and rejection in their lives (anyone else been there?), but they learn that their clothing size does not determine how far they can dream. The learn how to love themselves as the amazing women they are and rise above the criticism to prove to everyone that size does not determine who you are or what you can achieve.
“I’ll eat some breakfast then change the world.” - Tracy, Hairspray
Another important theme in the show is racism. In addition to rejecting people of larger sizes, the (1960’s set-show) white characters reject the black characters and try to prevent integration on TV. This was supposed to be a historical context, but unfortunately our world is still proving the relevance of needing to learn to accept everyone for who they are.
It is never ok to judge someone by the color of their skin, the size of their body, or by other trivial means! Thankfully, the show has a happy ending (sorry, spoiler alert!) and by the end of the show everyone is singing and dancing together on television, proving that it takes all kinds. This is the kind of show I love, it sparks hope for the future.
If you haven't seen Hairspray - watch it for some inspiration (the movie version with Zach Efron is good).
So, obviously I don't act every day. And I often have people ask me (especially when they find out I am majorially self-employed) What are my typical days like?
Well, “typical” is a stretch, as I feel like no two days are the same, but I wouldn’t have it any other way.
Normally, a few days a week I go to a coffee shop for several hours and work on my business (including writing these emails), If not at a coffee shop, then my home office (but it is harder to work from home). I actually really enjoy this work, and often 4+ hours slide by before I even think to look at the clock. It takes a lot of work to keep up the website, write emails and blog posts (looking for guest bloggers - btw!), posting and responding on social media, coming up with video ideas/scripts, responding to client emails, answering journalist requests (check out the articles I have been quoted in HERE), and all of the tiny tasks of running a business.
I see clients most days of the week, some days only 1, or up to 8 on fridays! I take dance classes, watch netflix with my dogs, clean the house/run errands, sleep in when I can, and eat pizza frequently (hubby recently got a pizza oven - we have been eating a lot of pizza!).
Why did I just tell you all of this?
To show you I am a person, just like you. I’m not a machine, or “wonder woman” as one client called me. I am a complex, passionate, (and lately tired) human being.
I am not defined by my body.
Neither are you.
Who are you without the labels others put on you? What are your passions and hobbies? What gets you fired-up? What would life be like if you didn’t use food as a crutch to hide behind?
Are you ready to re-define yourself?
Share who you really are on the Not Your Average Nutritionist facebook page or Instagram with the tag #MoreThanILook
I can not wait to hear who you are!!
In the words of another powerful musical (Newsies):
“Now is the time to seize the day,
Stare down the odds and seize the day,
Minute by minute that's how you win it,
We will find a way,
But let us seize the day.
Courage cannot erase our fear,
Courage is when we face our fear.
Tell those with power safe in their tower,
We will not obey!”
Love, Your complex Dietitian,
In 2012 I started my private practice with one client, a pad of paper, pen, and a business license.
5+ years later I have a thriving business of clients, online work, contractor positions, and my own office; but it took some work to get there and figure out all the details along the way.
In this article, I am going to give you the quick guide of necessary things to do/get and what to skip to get your practice up and running without taking out a loan.
Assuming you are already a licensed professional (RD):
1. Get malpractice insurance. You want to be covered if any lawsuits come up (RDs are very low risk). As a sole-proprietor I think I paid $99/year, now I pay $118/year as an LLC (I will explain what these are below). If you have worked elsewhere you might already have malpractice insurance. For RDs, "Mercer Proliability" is the main company used.
2. Depending on where you will be practicing, you need to go to the city or county for a business license. This has an annual fee as well, but it establishes you as a business. There are a few kinds of business structures, but as a one-person business you really only need to know about 2 of them: "Sole-proprietor" and "Limited Liability Company" or "LLC." I am no legal expert, so I won't go too deep into this, but here are the basics (google "sole-proprietor" or "LLC" or "business legal structures" for more info):
A sole-proprietor is what most RDs choose/start as. This is what I chose to start with, and it was easy. It has the lowest fees, and for legal/tax purposes you and your business are one in the same.
LLC is a step-up from sole-proprietor, in that it separates you from the business and adds a buffer of legal protection. LLCs can be single-member, or multiple "members." The cost and taxes are higher/more complicated, but you can hire employees.
3. Choose a "Doing business as" name (aka: "DBA"). This can be your own name (easy) or a business name. Make sure your name has not already been taken. Wherever you register your business they can guide you in how to search names, and the requirements. Chose carefully - this is how the public sees your business; but it can also always be changed later (I did this. It was a hassle, but worth it).
4. Separate your personal money from the business's money. When I started my business I opened a business checking/savings account (which I recommend doing as soon as your business name/license go through) and put $3K of my own money in it to get started (you can probably do this all with $1K, but I didn't know at the time). The fact that that money was basically my whole savings made it so I couldn't fail - it was my money on the line. I recommend this for starting a business. Take a risk on yourself and prove that you can succeed.
5. Get the bare office essentials (you probably have most of this): notepad and pens (I like to use legal pads) for taking notes during a session; hanging file folders; a way to lock up client notes (filing cabinet with lock or locking briefcase - I got a locking briefcase for $20 that became my traveling "office" the first 2 years); cards and stamps (it's nice to handwrite thank you notes to clients - I aim to send one to all my new clients).
6. Business cards: don't bother getting more than 250, you will change your info/logo/etc once you figure your business out more. You don't have to have business cards, but it looks/feels more professional.
*bonus tip - skip other physical marketing materials (flyers, banners, rack cards, newspaper ads) when you are just starting out. They are expensive, and really don't work that well. This comes from my personal experience. I spent 100's of dollars on marketing materials that got me maybe 1-2 clients. NOT WORTH IT until you are in the big-time (and maybe not even then).
7. Have a website - even if it is a work in progress! Everyone looks online nowadays, this should be listed on your business card, and potential clients can look at it to see a photo of you and services you offer/philosophy/etc. There are several free (starting) website builders out there. I use Weebly, but Wordpress is very popular, as are Wix and Squarespace. See what you like/seems easy enough for your skill level. I like weebly because it is drag-and-drop, but it doesn't have all the features that something like Wordpress has with "plug-ins."
Things you can wait on:
Ready to go start your practice? I hope this helps you get started with lower start-up costs!
If you have questions feel free to shoot me an email. I am contemplating taking business start-up clients for mentoring (there is a cost for this).
(A lot of people ask me how I started my business, and why I got into the field of eating disorders. While I do usually tell whomever asks, I have put-off writing this for a while. Maybe because I haven't felt that I have really "made-it" yet, maybe because I don't want to get that personal. Anyway, here's how I came to be "Not Your Average Nutritionist."
When I first passed my Registered Dietitian exam, I was about to get married, and was looking for a local job in my field.
That was going to be a lot harder than I first realized.
I spent about a year and a half (!!!) applying for, interviewing (several rounds), and networking for various jobs in any position as a dietitian. Unfortunately, there was always someone with 10 years of experience, or bilingual speaking, that would swoop in and get the job. (Eventually I did end up with a temp job with County Public Health after that year and a half).
While I was looking for my first "real job," an email had come through our local dietetic association from a young woman who was starting college locally, and was relapsing into anorexia nervosa (for which she had previously had some outpatient treatment). She was looking for a female, Christian, dietitian to work with her. I sent an email back asking if she wanted to give me a try (being new and all).
Now to give a little more background on the eating disorder part of this, in school/internship we spend very little time on eating disorders as undergraduate nutrition majors. Of course we had to learn some about it, but it just does not go very deep at that level of education (which is also why I went back for my Master's). So why did I think I could do it?
#1, I was desperate; and #2, I had struggled with restrictive eating during my early college years, and understood her mindset. She agreed, and I met with her and her mom to see if we would be a good fit. This was the start of my entrepreneurial journey.
Fast forward a few months and I had read countless books on eating disorders and sought out a mentor in (who I didn't realize at the time was a founding expert in the field, and whom many others call "a rock-star!") a local RD, Francie White, who allowed me to come watch her work, and help with the IOP/PHP treatment center in Santa Barbara, CA. Since I (still) didn't have another job (other than teaching some group fitness classes), I set my mind towards making a legal business.
With the help of a local non-profit organization, SCORE, I figured out what I needed to do to get a business license, and set up bank accounts. My first business name was "Libby's Fit Nutrition." I thought I would focus more on helping stay-at-home moms with weight loss and fitness. I did have a handful of those clients (whom I met in their homes), but pretty quickly I was finding that a lot of people who desired "weight loss" really had disordered eating or bad dieting practices, and I found myself doing more education around that. The more I worked with these clients and learned about EDs, the more passionate I became. I took some more psychology classes through community college, and contemplated what to get a Master's degree in.
Fast forward another 2 years or so, I was working as a teacher (Allan Hancock College) and in Corporate Wellness (Provant/PG&E). My online presence had generated a lot of interest from college students who were having issues with disordered eating. I was seeing so many students from Cal Poly (the local college), that I was talking on the phone almost every week with one of the school's nurse practitioners (the amazing, June Stanley) about shared clients. One night as we were talking about how many students she was seeing with eating disorders, she (I thought, jokingly) said "we should just have you on campus." Little did I know that conversation would lead to BIG things for me.
A few months later, I turned on my phone to see a voice mail from Dr. David Harris, Cal Poly's Executive Director of Campus Health and Well-Being. His message asked me to call back and set up a time to meet. He heard I was THE person to go to for eating disorders, and wanted to hire me to be on campus to work with the students at no cost to them. (Fun fact: when I walked into that first meeting after saying hello, his first words were, "when can you start?")
I started working at Cal Poly in Spring of 2016, as the first Registered Dietitian (as far as we know) to be specifically hired at a CSU to work with students with eating disorders!
I love my job! It is so nice to have co-workers who respect me and my opinion, since starting we have developed a multi-disciplinary treatment team, getting involved with athletic trainers and coaches for more open communication about the college athletes health and eating disorders, and I have been able to provide some in-service trainings to the medical staff.
This past year I changed my business name to "Not Your Average Nutritionist," to better represent what I was doing (not many RDs are competent in the area of eating disorders, and even less seem to focus more on the person and coping skills than the food piece), and I was no longer focusing on the fitness aspect. I also changed the legal structure from a sole-proprietorship to a LLC, for more legal support and the ability to hire staff in the future. I have a lot of lofty goals for my business in the next 10 years or so, but for right now I want to slow-down and savor the process.
So, where am I with my business now?
- Still working part-time at Cal Poly (over-booked, but feeling competent)
- Seeing some private clients.
- Almost done with my M.S. in Nutrition Science (emphasis in EDs).
- Working with a supervisor (Cynthia Saffell, MS, RD, LCSW, CEDS) for an advanced credential in EDs (IAEDP - CEDRD).
- Teaching at Allan Hancock
- Feeling better about my own body image than ever.
- ...and getting ready to launch a new phase of my business in 2018! Stay tuned for online nutrition courses!
Moral of the story:
Do great work.
The rest will fall into place.
You got this!
Libby is a non-diet Registered Dietitian focusing on eating disorder treatment and prevention. She approaches health from the inclusive standpoint that any "body" can focus on health regardless of size. She is a ally in diversity.
Not Your Average Nutritionist, LLC
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Disclaimer: This website is for educational & informational purposes only,
it is not a substitute for medical or mental health advice or treatment.