I am privileged to have a job that I love.
Yep, you heard that right. I love my job.
But how did I get here? And did I always love it?
When I started college my major was pre-veterinary medicine. I was going to be an equine (horse) Veterinarian. I was good at science, I loved horses, and was obsessed with James Herriot (check out the BBC miniseries, or his books), DVM.
But life had other plans.
About half-way through my first year I came to a realization that I did not want to get called out at 3am in the middle of a blizzard (I was in Wisconsin) to stick my arm up a horse's butt... What can I do with people, and normal hours?
At this same time, I was deep in diet culture. I was restricting, losing weight, and reading every women's heath diet article magazines had to offer. Yep, I had an eating disorder (though I didn't know it). While I was reading all those articles, I started noticing some bylines had "Registered Dietitian" as their title. Hmmm, a job helping people lose weight? I'm good at that! So I went to my career counselor and set off to change majors and schools so I could go into nutrition.
Fast forward to the end of my undergrad experience, and I was not using ED behaviors anymore (thank you to my amazing nutrition professors for helping me see the light through the science of the human body) though my mind still had work to do, and I was off to my dietetic internship and becoming an RD.
Why did I just tell you all that?
To explain where I came from.
Now we can get into how I got to where I am today, and why it is more meaningful to me.
My first client was a young woman with anorexia nervosa. Working with her I found a deep passion for psychology and figuring out what makes people have disordered behaviors around food.
Because of her, so many things happened for me:
- I found eating disorder dietitian mentors that helped me figure out what to do next
- I read everything I could get my hands on about eating disorder nutrition therapy and eating disorders in general
- I took some psychology classes at a local community college
- I got a business license and officially went into private practice (I had other jobs throughout the years as well, but PP was my first "real job" as a RD)
- I really began to believe the body positivity I was preaching
Today, I have the joy of helping amazing people realize just how amazing they are. I get to spend time getting to know them week after week, as we dig into their fears and dreams, and kick ED to the curb!
I get to teach students and interns about eating disorders, and healthy living.
I get to inspire the next generation to love themselves and ditch diets.
What a great career to be in.
My very favorite things are the moments of watching someone "get it," make change in their life, shift in their mindset, and ultimately work me out of a job (I know, weird - I want you to not need me). The texts and DMs, of how I made an impact in your life, make my day.
You all are amazing. Thank you for giving me my dream job!
Libby Parker, MS, RD
What are important things to know when thinking of performance nutrition for dancers (professional and pre-professional)?
Find out in this video interview with 2 dance-dietitians:
In this video: Registered dietitians, Libby Parker & Emily Harrison, chat about dancer nutrition/health, what to do if a director/choreographer asks you to lose weight, why diets are not a good idea, longevity (with quality of life), and more!
Emily Harrison, MS, RD, LD is a former professional ballet dancer, and has worked as the dietitian for dancers in seven countries, and with prestigious ballet companies. Emily frequently writes for dance publications, and published her own book/video series, Nutrition for Great Performances. Find Emily at: www.dancernutrition.com
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?
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!
With everyone and their brother having an opinion on how to eat or live a healthy life, how do you discern if information is legitimate?
It is important to remember that nutrition is a science, and not an opinion. And, scientific facts are allowed to change as we learn more through more advanced technology and research studies. Science is constantly evolving, so it is smart of us to double-check what the current best-practices are, especially when it comes to healthcare.
Several factors need to be considered when deciding if a product or diet plan is safe and effective. I review these in the following short video:
Health and diet does not need to be difficult or over-analyzed... But, you do need to know that studies done have been done in ways that can be extrapolated to larger populations, just like with any drug trial.
If you learn nothing else from me, I hope you watch this video and learn how to determine for yourself if what you are reading is true and safe.
Let me know what your top takeaways were in the comments. Did anything get you thinking?
Clifford D, Curtis L. Motivational Interviewing in Nutrition and Fitness, 1st Edition. New York, NY: The Guliford Press, 2016 (1). This review was written for graduate nutrition class "Obesity," 2016.
Elizabeth Parker, MS, RD
About the Authors
Author Dawn Clifford is an Associate Professor and Director of the Chico State University Didactic Program in Dietetics (1). She earned her B.S. in Dietetics from Northern Arizona University, and M.S. and PhD in Nutrition Science from Colorado State University (2). Clifford is a speaker on topics of motivational interviewing (MI) and non-diet health and wellness, as well as a published researcher. She has received the “Outstanding Dietetics Educator,” and is a member of the “Motivational Interviewing Network of Trainers” (1).
Author Laura Curtis is the Director of Nutritional Services at Glenn Medical Center (1), she also teaches Medical Nutrition Therapy at Chico State University where she earned her B.S. and M.S. in Nutrition, and where she followed-up with her dietetic internship (2). She had held several positions as a Registered Dietitian, including nutrition counseling where she pairs her extensive MI skills with non-diet principles and “Health at Every Size” (1).
This book, written for nutrition and fitness professionals, is broken down into five sections, with an introduction and appendix. The introduction covers motivational interviewing basics, starting with an introduction mentioning the latest research in a shift of how health practitioners counsel - from “weight-focused” to “weight neutral”(1). This helps prevent eating disorders, fat-shaming, yo-yo-dieting, and “miserable exercise regimens” (1). The focus has shifted to more realistic lifestyle changes for health and emotions that occur with eating, not weight-focused counseling. The chapters aim to break down parts of Motivational Interviewing (MI) both in descriptions, and examples of dialogues in vignettes.
Section one: Motivational Interviewing Basics
Chapter one briefly discusses why habits form (benefit or reward outweighing the cost), and the “Stages of Change” or “Transtheoretical Model,” that was created by Prochaska and DiClemente (1). Other topics explained are “ambivalence” or uncertainty of wanting to change, neural plasticity, when your client wants a “quick fix,” and the “righting reflex” of the practitioner to correct the client’s wrong beliefs.
Chapter two talks about the “Spirit of MI”: partnership, acceptance, compassion, and evocation. This puts the practitioner and client on the same level, and places the client as the “expert” of their own body, instead of the practitioner telling them “you should [do what I say]...” This chapter is about respect and building a trusting relationship between the client and practitioner.
Section two: The Four Processes of Motivational Interviewing
Chapter three starts with two of the processes: engaging and focusing. This is the start of the MI process, where rapport is built and the focus of the session is determined. This is done through warm interactions and asking questions that invite the client to pick a direction or topic to focus on. Chapter three also points out the similarities of MI and the Nutrition Care Process (NCP) of “Assessment, Diagnoses, Intervention, and Monitoring” (1), as well as the importance of nonverbal communication (body posture, eye contact, etcetera).
As any good practitioner knows, listening is of utmost importance, and this chapter devotes a section to the benefits of really listening. By listening effectively, the practitioner can help the client choose a topic to focus on for change, and can break an overwhelming health concern into smaller, simpler, steps. By working on just one step at a time, the client is set up for success, is more likely to build confidence in tackling future change, and the practitioner has a solid topic to bring focus back to when conversation strays.
Chapter four: Evoking. Listening for certain communication cues, the practitioner can pick up on the client’s ambivalence and/or preparation to make a change. A mnemonic device that the authors like to consider where a client stands, is “D.A.R.N. C.A.T.” (4); this stands for: “Desire to change, Abilities to change, Reasons to change, Needs for change, Commitment to change, Activation, Taking steps.” When these intentions are missing the client is likely using “sustain talk,” or the lack of desire to change.
Chapter four explains how to respond to ambivalence to nudge a client toward “change talk” (1). One way that this can happen is by using “scaling questions” which ask the clients, on a scale of 1-10, where do they stand in terms of confidence to change, importance of changing, or readiness to change (1). Additional sections of chapter four go over what to do if a client is crying in a session, and why to not “jump the gun” when getting to the planning process, at risk of losing motivation for follow-through.
Chapter five offers advice on how to plan for change without giving unsolicited advice. Asking permission is a key concept to MI, in which the practitioner asks the client if they would like to hear the information they have. This can be done in many ways, but overall it follows the format of “elicit-provide-elicit”(1). Elicit-provide-elicit, means finding out what the client already knows and asking them if you can give them information they are missing, providing the information once you have their permission, and following up with a check-in to see how they feel about that information. Chapter five finished up with assessing confidence to change, and potential barriers to making the change.
Section Three: Mastering the Microskills: OARS
Chapter six, the “O” in OARS is for “open-ended questions.” Open-ended questions (versus closed-questions) elicit thoughtful responses that are more likely to promote change talk (1). The chapter gives several examples of good open-ended questions for a variety of ways to direct the conversation, as well as closed-questions to avoid. Scaling questions are once-again used to question readiness to change.
Chapter seven, “Affirmations” is the “A” in OARS, building self-efficacy through how the practitioner acknowledges positive changes. This chapter explains that affirmations are not “cheerleading,” but building self-confidence through empowering the client by acknowledging what they have done and how they have noticed the benefit of the change. Affirmations can also help reduce defensiveness.
Chapter eight, “R” is for “Reflections,” or a statement paraphrasing what the client has said in a way that shows they are heard and understood. Reflections can be used after nearly every client statement, and the book covers several types of reflections for different occasions or goals. These include: how to reflect when the client is expressing change-talk, ambivalence, or sustain talk; using metaphors or reframing negative statements, double-sided reflections (using “and” in place of “but” when listing both sides); and several other types of strategic reflections.
Chapter nine, “Summaries,” rounds out OARS. Similar to reflections, summaries can, and should, be used frequently throughout a counseling session. Summaries work well to show the client you are hearing them, and are a way to assess if you have understood exactly what the client is expressing. Summaries are good for transitioning to another topic, bringing the conversation back on track, and bringing closure to a session.
Section four: Beyond The Basics
Chapter ten covers common pitfalls of trying to direct a client that is not ready for change. Some poor choices include, “the expert trap,” the “question and answer trap,” using “scare tactics,” “information overload,” and others. The chapter goes over how to “read” and work with a client who feels forced to be in the session.
Chapter eleven covers “what to do when there’s little time.” How to use MI with brief interactions, covering all four processes of MI, is coupled with how to keep a client on track. The chapter emphasizes the importance of staying true to the MI structure and focusing on one small change instead of taking on too much and/or driving the client away by providing information without asking permission.
Chapter twelve teaches how to address misinformation that the client has picked up, in an unthreatening way. This involves the practitioner letting go of their own agenda, and focusing on what the client finds important. Diminishing the “righting reflex,” or “temptation to provide unsolicited advice” (1) gives the client autonomy and feel they are in control. Providing information (in easy to understand terms) should only come after asking permission from the client. This chapter also covers how Cognitive Behavioral Therapy (CBT) fits into the MI process.
Section Five: A Closer Look at Motivational Interviewing in Nutrition and Fitness Industries
Chapter thirteen is about how to use MI in nutrition counseling, specifically. This is broken down into subtopics, including: dealing with a new diagnosis, meal planning, grocery shopping, expanding food variety, and more. This chapter does a good job addressing emotional eating, disordered eating, and when it would be helpful to refer to someone when the issue is out of the practitioner’s scope, or needs other professionals on the treatment team.
Chapter fourteen explains how to use MI in fitness counseling. It problem solves how to fit depth of MI into training sessions, when talking becomes more limited. The differences in “autonomous” (internal) and “controlled” (external) motivation are explained, with tips to progress each type through the stages of change. This chapter addresses potential barriers to change with tips to guide a client through each.
Chapter fifteen, “putting motivational interviewing to work to address weight concerns and disordered eating,” focuses on weight-neutral talk, and “health at every size” (HAES) (1). It takes away using weight as a measure of “goals” to meet, and focuses on being healthy and happy at whatever size your body wants to naturally maintain. Although this chapter addresses eating disorders, it does not go into depth on counseling clients with eating disorders. This chapter does promote a smart way to speak to any person to not trigger negative body image feelings.
Appendix 1 covers when and how to make a referral to a therapist or other health professional. It covers “scope of practice,” specifically the scope of a registered dietitian, and when it is smart to add to the treatment team or refer to a specialist. This chapter gives a script of what to say to a client when making a referral, so the client feels supported and is more likely to follow-through.
Appendix 2 is additional resources for counseling techniques. This appendix lists more books on MI, resources for nutrition counseling techniques, resources for fitness counseling techniques, and resources for addressing body image concerns.
Personal commentary and evaluation
The authors are extremely qualified to write this book on MI. Both are registered dietitians with a master’s degree (and Clifford has a PhD in Nutrition), and have had personal experience using MI to counsel and teach the principles of it in their other work. Curtis was a student of Clifford’s, so they should be of the same mindset and training.
The authors have written a strong book for teaching the essential counseling skills, laying them out in a well-organized fashion. Although this book was somewhat “dry” reading, it could not have come to me at a better time, as I was finding my counseling becoming very complacent. Working slowly though this book, I was able to shake-up my counseling practice and have better interactions with clients using the MI skills I had let slide.
The only weaknesses I can think of with this book are not covering every area of
nutrition and fitness that could come up in a session (which would be impossible to do), and that there are already many books on MI available, many of which from the same publisher. This being said, a strength is that they filled a specific need by tailoring the book to the specific issues that credentialed nutrition and fitness professionals face, staying true to science-based information and not teaching fad diet principles. I was very pleased to see the use of weight-neutral talk and how to speak to promote positive body image.
It was too difficult to pick out very specific tidbits of information that were supported by other works of literature, because MI is so prevalent in the counseling world. In light of that, I choose two books that I have used, as support for Motivational Interviewing in Nutrition and Fitness. In their book on treating eating disorders, authors Herrin and Larkin state that the process of nutrition counseling should allow clients to make their own decisions (except in the case of harming self or others), and that advanced training in counseling skills including MI is expected of the nutrition professional (5). A section on MI is included in their book, highlighting the same skills that are laid-out in depth in Motivational Interviewing in Nutrition and Fitness. Likewise, the book Counseling Overweight Adults (6) has a section devoted to MI practice and its importance in the counseling process for nutrition professionals, including using “scaling questions” to determine confidence in making a change.
I would highly, highly, recommend this book to nutrition and fitness professionals (and even other health professionals). This resource breaks down each step of MI into useable tactics, and gives clear examples of when the principles are being used or not used. While the general public might not need this nutrition and fitness-specific book on MI, MI is a skill all professionals should have, regardless of what type of counseling you do, and this book is a wonderful resource to teach it.
1.Clifford D, Curtis L. Motivational Interviewing in Nutrition and Fitness, 1st Edition. New York, NY: The Guliford Press, 2016.
2.Linked-in profile: Dawn Clifford. https://www.linkedin.com/in/dawn-clifford-38210b19. Accessed October 17, 2016.
3.Linked-in profile: Laura Curtis. https://www.linkedin.com/in/lccurtis. Accessed October 17, 2016.
4.Rollnick S, Miller WR, and Butler CC. Motivational Interviewing in Health Care. New York, NY: The Guilford Press, 2008.
5. Herrin M, Larkin M. Nutrition Counseling in the Treatment of Eating Disorders. New York, NY: Brunner-Routledge; 2013.
6. Kushner RF, Kushner N, Blatner DJ. Counseling Overweight Adults: the Lifestyle Patterns Approach and Toolkit. Chicago: American Dietetic Association; 2009.
I have been working on this for a while, and now can share that my first YouTube video has been posted!!!!
This first video is a shorter version of my free course on the different types of eating disorders.
Other videos are coming soon on debunking popular fad diets (starting with the "keto" diet) and medical complications of eating disorders.
Please go check out my channel, and subscribe to the channel to be notified when a new video comes out. Here is the link: www.youtube.com/channel/UCfmXodqj-5iWPqLYOVQI67Q
....and the video!
Make sure to sign up for the nutrition education newsletter for monthly education and inspiration!
NYAN is growing fast, and I would love to share RD business knowledge/ED counseling knowledge in exchange for some help.
Looking for people to:
-Write blog posts
-Create social media posts/graphics
-Do research for articles/videos
-Help come up with ideas for YouTube educational videos
-EXPERIENCED COPYWRITER for sales pages (this can be a paid contract position)
-Other things I haven't thought of??? I'd love your creative ideas!
Ideally, upper level nutrition or psychology students; but the most important part is personality and philosophy that mesh with the business. More details (click button)
I can't wait to meet you!
nsurance companies are sooooo frustrating to deal with - you are not alone!
Due to individual insurance regulations and federal rules there is no "set" coverage that all insurance companies have to go by. Your best bet when seeking coverage is to call your insurance company and get a Case Manager to walk you through the to-dos.
The earlier you contact your insurance company in the process, the better. Additionally, the more "evidence" for need of treatment (doctor's referral notes, lots of documentation) that you have the better.
I made a round-up of the previous 3 blog posts (updated the links so they are current)
that I wrote about on insurance and packaged it up in a PDF for you.
Get it here:
How to get your insurance company to pay for treatment
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Unfortunately, unless it is part of a treatment program, Dietitians are very rarely covered by insurance. (Wha?!)
You can petition your insurance for some reimbursement by asking your RD ("nutritionists" without the RD credential are never covered because they are not qualified) to send you a "superbill" for services that have been provided (typically annually or quarterly) to submit to insurance (after paying out of pocket) to try for reimbursement. With enough supporting documentation (again, referrals from medical doctors help a lot!!) you can often get reimbursement (no promises, each company has it's own ways of dealing with each individual).
Good luck!! I hope this helps!
If you have more tips on how to get insurance to pay please leave them in the comments below, or email me to have it included.
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).
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.