An Examination of the Practice Approaches of Canadian Dietitians Who Counsel Higher-Weight Adults Using a Novel Framework: Emerging Data on Non-Weight-Focused Approaches
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Development and Validation of the Practice Approach Classifications
2.3. Development, Validation, and Pilot Testing of the Full Survey
2.4. Participants and Recruitment
2.5. Analysis
3. Results
3.1. Practice Approaches Used and Views
3.2. Practice Techniques Used When Working with Higher-Weight Clients
3.3. Summary of the Practice Approach Categories Used by Participants
3.3.1. Weight-Focused Approaches
3.3.2. Characteristics of Combined Approaches
3.3.3. Characteristics of Non-Weight-Focused Approaches
3.4. Education and Training for Non-Weight-Focused Approaches
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Practice Approach | Description |
---|---|
(A) Solely weight-focused |
|
(B) Moderately weight-focused |
|
(B) Combination |
|
(D) Weight inclusive |
|
(E) Weight liberated |
|
Practice Approaches | p Value a | ||||||
---|---|---|---|---|---|---|---|
All (n = 383) | Solely Weight Focused (n = 3) | Moderately Weight Focused (n = 51) | Combination (n = 155) | Weight Inclusive (n = 142) | Weight Liberated (n = 32) | ||
Gender | |||||||
Woman | 363 (94.8) | 2 (0.6) | 45 (12.4) | 149 (41.0) | 139 (38.3) | 28 (7.7) | <0.001 |
Man | 11 (2.9) | 1 (9.1) | 5 (45.5) | 3 (27.3) | 2 (18.2) | 0 (0.0) | |
Non-binary | 1 (0.3) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (100.0) | |
Prefer not to answer | 8 (2.0) | 0 (0.0) | 1 (12.5) | 3 (37.5) | 1 (12.5) | 2 (25.0) | |
Race b | |||||||
White, e.g., European | 315 (82.2) | 1 (0.3) | 38 (12.1) | 126 (40.0) | 124 (39.4) | 26 (8.3) | 0.061 |
East Asian, e.g., Chinese, Korean | 29 (7.6) | 0 (0.0) | 3 (10.3) | 13 (44.8) | 10 (34.5) | 3 (10.3) | |
Other, e.g., Middle Eastern, Latin American, Indigenous | 27 (7.0) | 1 (3.7) | 6 (22.2) | 11 (40.7) | 6 (22.2) | 3 (11.1) | |
South/Southeast Asian | 12 (3.1) | 1 (8.3) | 4 (33.3) | 5 (41.7) | 2 (16.7) | 0 (0.0) | |
Province and Territories c | |||||||
Ontario | 154 (40.2) | 1 (0.6) | 17 (11.0) | 63 (41.0) | 60 (39.0) | 13 (8.4) | 0.037 |
Alberta | 120 (31.3) | 1 (0.8) | 25 (20.8) | 53 (44.2) | 34 (28.3) | 7 (5.8) | |
British Columbia | 35 (9.1) | 0 (0.0) | 2 (5.7) | 11 (31.4) | 19 (54.3) | 3 (8.6) | |
Saskatchewan | 17 (4.4) | 0 (0.0) | 0 (0.0) | 8 (47.1) | 9 (53.0) | 0 (0.0) | |
Quebec | 14 (3.7) | 0 (0.0) | 2 (14.3) | 1 (7.1) | 6 (42.9) | 5 (35.7) | |
Manitoba | 14 (3.7) | 0 (0.0) | 3 (21.4) | 5 (35.7) | 4 (28.6) | 2 (14.3) | |
New Brunswick | 12 (3.1) | 1 (8.3) | 1 (8.3) | 7 (58.3) | 2 (16.7) | 1 (8.3) | |
Nova Scotia | 9 (2.3) | 0 (0.0) | 1 (11.1) | 4 (44.4) | 3 (33.3) | 1 (11.1) | |
Newfoundland and Labrador | 4 (1.0) | 0 (0.0) | 0 (0.0) | 2 (50.0) | 2 (50.0) | 0 (0.0) | |
Prince Edward Island | 3 (0.8) | 0 (0.0) | 0 (0.0) | 1 (33.3) | 2 (66.7) | 0 (0.0) | |
Northwest Territories | 1 (0.3) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (100.0) | 0 (0.0) | |
Years of Practice as a Registered Dietitian | |||||||
0–5 | 120 (31.3) | 2 (1.7) | 15 (12.5) | 43 (35.8) | 48 (40.0) | 12 (10.0) | 0.973 |
6–10 | 86 (22.5) | 0 (0.0) | 11 (12.8) | 37 (43.0) | 32 (37.2) | 6 (7.0) | |
11–15 | 76 (19.8) | 1 (1.3) | 9 (11.8) | 32 (42.1) | 26 (34.2) | 8 (10.5) | |
16–20 | 48 (12.5) | 0 (0.0) | 6 (12.5) | 21 (44.0) | 19 (39.6) | 2 (4.2) | |
>20 | 53 (13.8) | 0 (0.0) | 10 (18.9) | 22 (41.5) | 17 (32.1) | 4 (7.5) | |
Highest Level of Education | |||||||
Bachelor’s | 274 (71.5) | 2 (0.7) | 41 (15.0) | 105 (38.3) | 100 (36.5) | 26 (9.5) | 0.315 |
Master’s | 96 (25.0) | 1 (1.0) | 9 (9.4) | 43 (44.8) | 39 (40.6) | 4 (4.2) | |
Other | 13 (3.4) | 0 (0.0) | 1 (7.7) | 7 (53.8) | 3 (23.1) | 2 (15.4) | |
Primary Area of Practice | |||||||
Primary care | 195 (50.9) | 0 (0.0) | 17 (8.7) | 76 (39.0) | 81 (41.5) | 21 (10.8) | <0.001 |
Outpatient | 126 (32.9) | 3 (2.4) | 26 (20.6) | 55 (43.7) | 40 (31.7) | 2 (1.6) | |
Other | 62 (16.2) | 0 (0.0) | 8 (12.9) | 24 (38.7) | 21 (33.9) | 9 (14.5) | |
Type of Community | |||||||
Urban | 208 (54.3) | 2 (1.0) | 35 (16.8) | 73 (35.1) | 78 (37.5) | 20 (9.6) | 0.192 |
Suburban | 90 (23.5) | 1 (1.1) | 7 (7.8) | 49 (54.4) | 30 (33.3) | 3 (3.3) | |
Rural | 65 (17.0) | 0 (0.0) | 7 (10.8) | 26 (40.0) | 26 (40.0) | 6 (9.2) | |
Remote | 4 (1.0) | 0 (0.0) | 0 (0.0) | 2 (50.0) | 2 (50.0) | 0 (0.0) | |
Do not work in a single community | 16 (4.2) | 0 (0.0) | 2 (12.5) | 5 (31.3) | 6 (37.5) | 3 (18.8) |
Approach | n (%) | Descriptive Labels Participants Used to Characterize Their Practice Approach a |
---|---|---|
Solely weight focused | 3 (0.8%) | Patient led |
Moderately weight focused | 51 (13.3%) | Patient/client centred, lifestyle and behaviour focused, individualized dietary behaviours, flexible, health centred, goal focused, inclusive, supportive and directive, weight management |
Combination | 155 (40.5%) | Non-diet, patient/client centred, health focused, behaviour focused, weight neutral, HAES informed, weight inclusive informed, intuitive eating informed, modifying weight, non-weight focused, best weight, obesity management |
Weight inclusive | 142 (37.1%) | Healthism, weight inclusive, normalized eating, anti-diet, HAES, client/patient focused, inclusive, intuitive eating, non-judgmental, non-diet, strength based, self-compassion, eating skills, body liberation, humanist, body diversity, mindful eating |
Weight liberated | 32 (8.3%) | Weight inclusive, non-diet, fat positive, HAES, social justice oriented, anti-oppressive, trauma informed, patient/client focused, values based, well-being focused, body diversity, lived experience, anti-diet |
Practice Approaches | p Value a | ||||||
---|---|---|---|---|---|---|---|
All (n = 383) | Solely Weight Focused (n = 3) | Moderately Weight Focused (n = 51) | Combination (n = 155) | Weight Inclusive (n = 142) | Weight Liberated (n = 32) | ||
A complex and progressive chronic disease | 194 (50.7) | 2 (66.7) | 32 (62.7) | 106 (68.4) | 52 (36.6) | 2 (6.2) | <0.001 |
Characterized by abnormal, excessive body fat (adiposity) that impairs health | 186 (48.6) | 2 (66.7) | 36 (70.6) | 89 (57.4) | 55 (38.7) | 4 (12.5) | |
Body mass index [BMI] >30 kg/m2 | 104 (27.2) | 2 (66.7) | 24 (47.0) | 45 (29.0) | 30 (21.1) | 3 (9.4) | |
I do not recognize or use this language | 102 (26.6) | 0 (0.0) | 0 (0.0) | 8 (5.2) | 66 (46.5) | 28 (87.5) |
Practice Approaches b | p Value a | ||||||
---|---|---|---|---|---|---|---|
All (n = 383) | Solely Weight Focused (n = 3) | Moderately Weight Focused (n = 51) | Combination (n = 155) | Weight Inclusive (n = 142) | Weight Liberated (n = 32) | ||
Assessment | |||||||
Monitor health behaviours (e.g., diet and exercise) as an indicator of changed health risk | 367 (95.8) | 3 (100.0) | 49 (96.1) | 150 (96.8) | 138 (97.0) | 27 (84.4) | 0.048 |
Assess metabolic parameters (lipid profile, blood glucose, liver enzymes, vitamin and mineral status, etc.) | 366 (95.6) | 3 (100.0) | 48 (94.1) | 150 (96.8) | 137 (96.5) | 28 (87.5) | 0.194 |
Assess mental health status (e.g., depression, addition, and eating disorders) | 360 (94.0) | 3 (100.0) | 47 (92.2) | 145 (93.5) | 134 (94.4) | 31 (96.9) | 0.860 |
Assess social health (e.g., social support, connection to care givers, and living conditions) | 350 (91.4) | 3 (100.0) | 41 (80.4) | 146 (94.2) | 130 (91.5) | 30 (93.8) | 0.075 |
Assess financial health by collecting economic information, including food security | 314 (82.0) | 3 (100.0) | 41 (80.4) | 129 (83.2) | 111 (78.2) | 30 (93.8) | 0.275 |
Assess mechanical health (e.g., back pain, osteoarthritis, and sleep apnea) | 308 (80.4) | 2 (66.7) | 39 (76.5) | 121 (78.1) | 117 (82.4) | 29 (90.6) | 0.341 |
Weighs clients | 150 (39.2) | 3 (100.0) | 43 (84.3) | 71 (45.8) | 28 (19.7) | 5 (15.6) | <0.001 |
Calculate body mass index (BMI) to assess health risk | 142 (37.1) | 2 (66.7) | 41 (80.4) | 71 (45.8) | 26 (18.3) | 2 (6.3) | <0.001 |
Measure body composition | 32 (8.4) | 0 (0.0) | 8 (15.7) | 17 (11.0) | 7 (4.9) | 0 (0.0) | 0.042 |
Other | 52 (13.6) | 0 (0.0) | 5 (9.8) | 17 (11.0) | 21 (14.8) | 9 (28.1) | 0.130 |
Nutrition Therapy Approaches | |||||||
Increasing fruits and vegetables | 364 (95.0) | 3 (100.0) | 46 (90.2) | 151 (97.4) | 138 (97.2) | 26 (81.3) | 0.014 |
Increasing intake of whole grains | 338 (88.3) | 3 (100.0) | 40 (78.4) | 141 (91.0) | 130 (91.5) | 24 (75.0) | <0.001 |
Increasing dietary variety | 333 (86.9) | 3 (100.0) | 39 (76.5) | 135 (87.1) | 127 (89.4) | 29 (90.6) | 0.215 |
Increasing intake of pulses | 328 (85.6) | 2 (66.7) | 35 (68.6) | 141 (91.0) | 125 (88.0) | 25 (78.1) | <0.001 |
Doing more physical activity | 317 (82.8) | 3 (100.0) | 46 (90.2) | 133 (85.8) | 113 (79.6) | 22 (68.8) | 0.130 |
Alternative foods for snacking | 269 (70.2) | 3 (100.0) | 42 (11.0) | 123 (32.1) | 89 (23.2) | 12 (3.1) | <0.001 |
Replacing saturated/trans fats with unsaturated fats | 246 (64.2) | 3 (100.0) | 25 (49.0) | 113 (72.9) | 89 (62.7) | 16 (50.0) | 0.004 |
Mediterranean dietary pattern | 211 (55.1) | 1 (33.3) | 27 (52.9) | 89 (57.4) | 85 (59.9) | 9 (28.1) | 0.963 |
Canada’s Food Guide | 206 (53.8) | 1 (33.3) | 23 (45.1) | 89 (57.4) | 81 (57.0) | 12 (37.5) | 0.018 |
Low-glycemic index dietary pattern | 160 (41.8) | 2 (66.7) | 17 (33.3) | 79 (51.0) | 55 (38.7) | 7 (21.9) | 0.405 |
Dietary Approaches to Stop Hypertension dietary pattern (DASH) | 128 (33.4) | 0 (0.0) | 17 (33.3) | 58 (37.4) | 46 (32.4) | 7 (21.9) | 0.476 |
Modifying specific macronutrients, e.g., low carbohydrate and high protein | 112 (29.2) | 2 (66.7) | 26 (51.0) | 49 (31.6) | 32 (22.5) | 3 (9.4) | 0.077 |
Intake of certain foods to reduce calories | 95 (24.8) | 3 (100.0) | 32 (62.7) | 45 (29.0) | 14 (9.9) | 1 (3.1) | <0.001 |
Reducing overall caloric intake | 50 (13.1) | 2 (66.7) | 25 (49.0) | 21 (13.5) | 2 (1.4) | 0 (0.0) | <0.001 |
Reducing total fat intake | 49 (12.8) | 2 (66.7) | 17 (33.3) | 21 (13.5) | 8 (5.6) | 1 (3.1) | 0.003 |
Vegetarian dietary pattern | 46 (12.0) | 0 (0.0) | 6 (11.8) | 18 (11.6) | 19 (13.4) | 3 (9.4) | 0.006 |
Time-limited feeding, i.e., intermittent fasting | 23 (6.0) | 0 (0.0) | 8 (15.7) | 12 (7.7) | 3 (2.1) | 0 (0.0) | 0.157 |
The Nordic dietary pattern | 9 (2.3) | 0 (0.0) | 2 (3.9) | 2 (1.3) | 4 (2.8) | 1 (3.1) | 0.004 |
A ketogenic diet | 6 (1.6) | 0 (0.0) | 3 (5.9) | 2 (1.3) | 1 (0.7) | 0 (0.0) | <0.001 |
Other | 69 (18.0) | 0 (0.0) | 5 (9.8) | 19 (12.3) | 31 (21.8) | 14 (43.8) | <0.001 |
Nutrition Therapy Techniques | |||||||
Techniques of mindful eating | 337 (88.0) | 2 (66.7) | 44 (86.3) | 136 (87.7) | 127 (89.4) | 28 (87.5) | 0.649 |
Recognize clients’ lived experiences impact their lives in ways that are often hidden to providers | 304 (79.4) | 2 (66.7) | 32 (62.7) | 115 (74.2) | 124 (87.3) | 31 (96.9) | <0.001 |
Discuss the structural barriers to their being/feeling healthy or well | 289 (75.5) | 2 (66.7) | 38 (74.5) | 113 (72.9) | 108 (76.1) | 28 (87.5) | 0.433 |
Principles of intuitive eating | 271 (70.8) | 0 (0.0) | 15 (29.4) | 102 (65.8) | 124 (87.3) | 30 (93.8) | <0.001 |
Principles of compassion-informed counselling | 250 (65.3) | 3 (100.0) | 31 (60.8) | 92 (59.4) | 96 (67.6) | 28 (88.0) | 0.015 |
Principles of Health At Every Size® | 248 (64.8) | 1 (33.3) | 13 (25.5) | 84 (54.2) | 121 (85.2) | 29 (90.6) | <0.001 |
Recommend keeping a hunger awareness diary | 239 (62.4) | 1 (33.3) | 25 (49.0) | 98 (63.2) | 93 (65.5) | 22 (68.8) | 0.192 |
Recommend that clients do not weigh themselves | 206 (53.8) | 0 (0.0) | 14 (27.5) | 81 (52.3) | 84 (59.2) | 27 (84.4) | <0.001 |
Principles of culturally safe care | 192 (50.1) | 1 (33.3) | 12 (23.5) | 83 (53.5) | 72 (50.7) | 24 (75.0) | <0.001 |
Recommend keeping a food intake diary | 183 (47.8) | 3 (100.0) | 37 (72.5) | 93 (60.0) | 45 (31.7) | 5 (15.6) | <0.001 |
Principles of harm reduction counselling | 162 (42.3) | 0 (0.0) | 15 (29.4) | 59 (38.1) | 63 (44.4) | 25 (78.1) | <0.001 |
Recommend eating smaller, more frequent meals | 136 (35.5) | 1 (33.3) | 25 (49.0) | 68 (43.9) | 39 (27.0) | 3 (9.4) | <0.001 |
Principles of trauma-informed counselling | 121 (31.6) | 0 (0.0) | 9 (17.6) | 42 (27.1) | 48 (33.8) | 22 (68.8) | <0.001 |
Draw on equity-seeking clients’ experiences of oppression | 93 (24.3) | 0 (0.0) | 5 (9.8) | 28 (18.1) | 36 (25.4) | 24 (75.0) | <0.001 |
Recommend limiting snacking | 81 (21.1) | 2 (66.7) | 25 (49.0) | 43 (27.7) | 10 (7.0) | 1 (3.1) | <0.001 |
Recommend weight loss | 20 (5.2) | 2 (66.7) | 12 (23.5) | 6 (3.9) | 0 (0.0) | 0 (0.0) | <0.001 |
Recommend keeping a weight diary | 15 (3.9) | 1 (33.3) | 11 (21.6) | 3 (1.9) | 0 (0.0) | 0 (0.0) | <0.001 |
Recommend commercial weight loss products | 1 (0.3) | 0 (0.0) | 1 (2.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0.219 |
Other | 26 (6.8) | 0 (0.0) | 3 (5.9) | 9 (5.8) | 10 (7.0) | 4 (12.5) | 0.635 |
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Lichtfuss, K.; Franco-Arellano, B.; Brady, J.; Arcand, J. An Examination of the Practice Approaches of Canadian Dietitians Who Counsel Higher-Weight Adults Using a Novel Framework: Emerging Data on Non-Weight-Focused Approaches. Nutrients 2023, 15, 631. https://doi.org/10.3390/nu15030631
Lichtfuss K, Franco-Arellano B, Brady J, Arcand J. An Examination of the Practice Approaches of Canadian Dietitians Who Counsel Higher-Weight Adults Using a Novel Framework: Emerging Data on Non-Weight-Focused Approaches. Nutrients. 2023; 15(3):631. https://doi.org/10.3390/nu15030631
Chicago/Turabian StyleLichtfuss, Kori, Beatriz Franco-Arellano, Jennifer Brady, and JoAnne Arcand. 2023. "An Examination of the Practice Approaches of Canadian Dietitians Who Counsel Higher-Weight Adults Using a Novel Framework: Emerging Data on Non-Weight-Focused Approaches" Nutrients 15, no. 3: 631. https://doi.org/10.3390/nu15030631
APA StyleLichtfuss, K., Franco-Arellano, B., Brady, J., & Arcand, J. (2023). An Examination of the Practice Approaches of Canadian Dietitians Who Counsel Higher-Weight Adults Using a Novel Framework: Emerging Data on Non-Weight-Focused Approaches. Nutrients, 15(3), 631. https://doi.org/10.3390/nu15030631