By Justinne Lou Go, RND
I’VE given you ideas on when to see a Nutritionist-Dietitian (ND) in my article last week. Now that you know that there are a host of other health concerns beyond weight management and digestive issues which can also be directed to an ND, let me help iron out your thoughts on what to expect when booking a nutrition consultation.
Now, I know most people are only familiar with Nutritionist-Dietitians being based in the hospitals. And yes, you may find us there, but there are now a few who are in wellness clinics/centers and private practice as well, who are more focused on out-patient care. This article will be referring to the out-patient care process as I believe that this is where NDs are needed most.
Like all other health care professionals, NDs follow a standard protocol in assessing your health. Screening or assessment is always the first step that health care professionals perform when meeting a patient. For medical doctors, requesting laboratory tests and doing a physical exam are their standard assessment procedures.
For NDs, we follow the ABCDs in assessing our patients/clients:
This pertains to the body measurements such as weight, height, waist circumference, waist-hip ratio, and sometimes (though rarely) can include the mid-upper arm circumference and skin-fold measurements. In a more advanced or modern practice, if the ND has a body composition analysis machine, we can also obtain details of your body fat percentage, total body water percentage, bone mass, muscle mass, and visceral fat. Body Mass Index is usually calculated. I can talk about each of these terms in a separate article.
This is when we review all recent (within the last six months) and relevant laboratory test results that you may have, as requested by your doctor. Hence, yes, we do work hand-in-hand with doctors because we are meant to be part of the multi-disciplinary team that manages your health. This is one of the assessment factors that we would review from time to time as this is the most objective aspect which will indicate your progress in the nutrition management.
The clinical aspect is equivalent to the physical exam of a doctor. We can perform this, but most of the time, we review your doctor’s assessment. This section checks for physical signs particularly for nutrient deficiencies (ex. thinning hair, dry skin, brittle nails, pale inner eyelids, etc.)
The aspect that is most relevant to us. This is usually done in the form of either a 24-hour food recall, food frequency questionnaire, or a three-day food journal. In my case, I usually ask my clients to fill up a three-day food journal wherein they record their meals and activities (including exercise and sleep habits) for three days and this is obtained before I meet with the client. Questions regarding the client’s diet history and current practices will also be asked such as the presence of any food allergies or intolerances, any previous or current diet restrictions, who prepares the client’s meals, food preferences and dislikes, frequency of eating out, etc.
Assessment is the first step we need to perform because this is the probing phase which will help us identify problems objectively and thoroughly. As with problem solving, the first important thing to do is to identify the problem, right? Being aware of this protocol can help you prepare the documents that your ND may need from you as well as help you understand why your ND needs these from you.
The crucial process of obtaining initial and comprehensive information from you helps provide us with a better perspective and is the foundation for creating your nutrition program. This may be done within one to two sessions — prior to meeting you (pre-assessment) and during the Initial Consultation (first session). And, of course, this step is performed by both hospital NDs and out-patient or wellness NDs. The assessment questions may just differ as adjusted to the setting (i.e. episodes of vomiting, diarrhea, etc.).
What to prepare
So, in booking a consultation, you can expect that the assessment above will take place. Thus, it would be best to prepare the necessary documents (recent lab test results and list of current medications and supplements) and please do allow us to take your anthropometric (weight and body composition) measurements, because it’s not to judge you but is a way for us to help you.
Duration and frequency
Also, when it comes to out-patient care, do expect that you would have to see your ND regularly for follow-ups to monitor your progress in the program. This would usually be a minimum of three months. Depending on the ND, follow-ups are usually done every two weeks or monthly. The initial session would take at least 90 minutes and the succeeding sessions would usually take an hour.
Condition the mind
Lastly, it would be wise to be aware that you are setting yourself up for a lifestyle and behavior change when you decide to meet with an ND. That is also the reason why the program is a minimum of three months, because it involves behavior change—building healthy habits to replace unhealthy ones. And, we know that habits take time to build or change. Hopefully, you can prepare your mind when you meet with a Nutritionist-Dietitian. It would also be good if you would be willing to record and share your meal details with your ND, because that is our way of monitoring your progress and helping you along the way.
From what you have read today, I hope you have gained an understanding that NDs put in a lot of work to help you achieve your health goals. I also hope that the details encouraged you to approach an ND if you need one. If you have any questions regarding more of the topic for today, feel free to reach out through my email or message me on Facebook. I would be glad to share more details with you.