Smart Bites Dec 2021 Issue by editorsmartbites

Issue 15 December 2021

Smart Bites

The what, why and how of great supervision

Body positive and intuitive eating approaches

Six years in a desert hospital

Julie Carter

Maria Casale

Kristy Pemberton

Smart Bites is the quarterly magazine of Dietitians New Zealand. We exist to build a strong and sustainable profession that empowers New Zealanders to make informed food and nutrition choices and inspire change that enhances the health and wellbeing of Aotearoa, New Zealand. Smart Bites has taken the baton of informing and updating our members from "News and Views", which for 56 years was the voice of the New Zealand Dietetic Association and then Dietitians New Zealand. Ka mua, ka muri. Discover us online: www.dietitians.org.nz IG dietitiansnz Contact us: General Manager: Kath Eastwood admin@dietitians.org.nz Editorial team: Julie Carter, Anna Greenan, Reena Soniassy-Unkovich, Audrey Tay, Lizz Whittred editorsmartbites@gmail.com

Contents 04

From the Editorial Team

From Dietitians NZ

From DNZ Council

From the Dietitians Board

From Massey University

Public Health SIG Update

Sports SIG Update

The what, why and how of great supervision

My experience in food service

All bodies are summer bodies

Southern Branch Update

My journey as a new graduate dietitian

Six years in a desert hospital

We've been loving...

References

FROM THE EDITORIAL TEAM

It's time to celebrate! Earlier this year, I volunteered to lead a new workplace wellbeing initiative. My colleagues were tired, stressed and burned out - and this was before the extended lockdown. We focused on building a culture of gratitude in the workplace. As a team, we began to notice the good things in life, savour the positive feelings and express or act on our gratitude. It sure made a difference. The summer holidays are an opportune time to slow down, consider what we are grateful for and celebrate them. Celebrate our loved ones. Celebrate the cultural and religious values that are important to us. Celebrate our resilience in the face of this year's challenges.

In this issue, we reflect on the year that was and draw on the wisdom and experience of many incredible dietitians working in different areas. By reading their stories, we celebrate their success. I hope you find something that challenges or inspires you. Thank you all to our amazing contributors in this year's issues. We simply could not have done it without you. If you're interested in joining our team in 2022, please email us at: editorsmartbites@gmail.com We'd love to hear from you! Have a lovely summer; we'll see you again in the next issue in March 2022.

On behalf of the Smart Bites editorial team, I wish you a restful break with a good dose of gratitude-filled celebrations.

Audrey Tay

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FROM DIETITIANS NZ

Meri Kirihimete! As we near the end of the calendar year, it seems timely to reflect on the last 12 months and reassess our goals and plans for 2022.

We welcomed Daena Moller as Kaimahi to Te Kahui Manukura o Kai and acknowledge her significant impact in assisting the rōpū.

In April, the Minister of Health announced major reforms to our health system to create a more equitable system and focus on prevention and primary care. At around the same time, we shared a report demonstrating the value that dietitians in primary care could deliver, easing the burden of preventable disease on the health system.

We look forward to providing all members greater support in this area in 2022 as we move towards creating a culturally safe environment where all dietitians, especially Māori, can thrive - a critical step to increasing the diversity of our profession.

This, along with ongoing collaboration with our allied health colleagues, has enabled valuable engagement with the Transition Unit teams within the Department of Prime Minister and Cabinet. This advocacy has recently gained some momentum, and we look forward to seeing its impact in 2022. It is certainly an exciting time to be involved in healthcare in Aotearoa! Of significance this year has been the continuation of our work to become an honourable Te Tiriti partner, working in partnership with Te Kahui Manukura o Kai Ora, and supporting the capability and capacity building within the Māori dietetic network.

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We have continued to improve Dietitians NZ's value for members, as demonstrated in the feedback from this year's engagement survey. The pandemic gave us opportunities to reduce access barriers to professional development by creating more virtual events and the Professional Development Hub. Our virtual 3-day conference was also a highlight. Again, thank you to the many members, particularly SIG convenors, who contributed to making the event so successful! Finally, thank you to those who continue to give so much of their time, energy and expertise to Dietitians NZ to enhance our profession. Many of you go above and beyond, and we thank you for your ongoing support and significant contribution. Teamwork makes the dream work!

FROM DIETITIANS NZ

We appreciate that 2021 has thrown some significant challenges, especially those who have spent the last 3-months or so in lockdown. We hope you can all take some time over the holiday period to reflect, rest and recharge. Meri Kirihimete! Ngā manaakitanga Kath

Kath Eastwood Dietitians NZ General Manager

FROM DNZ COUNCIL

Update from Council December has arrived again. As we reflect on the year, it seems to have gone very fast and very slow all at the same time. At Dietitians NZ, we acknowledge that lockdown is hard for everyone, whatever your situation. The extended lockdown in Tamaki Makaurau and stretching into the Waikato and Northland for a significant time has challenged both the way we live and work. An extended Level 2 lockdown for the rest of Aotearoa continues to make daily life more difficult. The hope of being able to enjoy summer holidays with our loved ones around the country provides some light at the end of this lockdown. Changing alert levels, alert level systems and restrictions within those levels have added stress and uncertainty for many. Telehealth has been invaluable at this time. With the recent clarification of the health order regarding Allied Health professionals, we hope that this has allowed you to see patients in person at Level 3 safely.

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Tracy Coote & Tyla Goodsell-Matthews

During these times as a council, we have continued to meet via Zoom and had our first meeting in October with our new look council. We have finalised the Dietitians NZ Statement of Intent and look forward to publicly releasing the final version. We want to thank those who provided feedback at the Dietitians NZ conference and completed the Dietitians 2021 survey. This feedback is invaluable as we move to navigate a big 2022. As a council, we are focused on preparing Dietitians NZ as an organisation to move to a Te Tiriti o Waitangi based governance model, as well as Health Authority, and no doubt some Covid-19 curve balls thrown in.

FROM THE DIETITIANS BOARD

From the Registrars Desk...

... Prescribing Project, Oxygen Masks, Welcome By Penny Field, Acting Registrar

Prescribing Project For many, COVID-19 greatly influences how we practice and live day to day. This reality is shared across the health sector. Despite the disruptions caused by the pandemic, the health system is progressing an interesting piece of work of interest to Dietitians - Safer Prescribing and Dispensing. In October, the Ministry of Health (MoH) convened a hui to identify some system-level improvements that could progress in the next 12 months. Responsible Authorities (including the Dietitians Board), colleges, associations (including DNZ), practitioners, and agencies came together to discuss safer prescribing and dispensing pathways.

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We learnt of the capability of MoH’s digital medicines management system and of the Pharmacy Council’s prescribing competencies project. Four workstreams were agreed as the priority actions for improving the quality and safety of prescribing and dispensing, to enable improved outcomes for our communities. Responsible Authorities were asked to nominate one person to contribute to a workstream. Hugh Davoren (Convenor Dietitians Board Prescribing Expert Advisory Committee) is contributing to the Process stream.

FROM THE DIETITIANS BOARD

Pharmacy Council are leading a project to identify the core aspects of each profession’s prescribing competency standards. The latest development is agreement across Regulatory Authorities that a joint statement is the best method of conveying the commonalities of prescribing across professions and of achieving a level of standardised regulation for the prescribing activity. There is full acknowledgement that this approach requires the input of cultural advisors.

Oxygen Masks In these uncertain times Dietitians along with other front-line workers need to remain mindful of looking after themselves:

Welcome Mid November we welcomed Sherin de Souza to the Secretariat Office. Following a review of systems and roles we established the new position of Operations Manager, Registration Officer. Sherin takes over Margaret Needham’s position of Registration Officer and assumes additional Operations Management responsibilities. As Margaret’s temporary contract came to an end we held a thank you morning tea attended by many staff from other authorities.

“put on your own oxygen mask first before helping others”. We understand changing from Alert Levels to the COVID-19 Protection Framework Traffic Light system may be challenging personally and for those we work with and care for. Check out Mental Health Foundation resources here.

Sherin will be the first point of contact for Dietitians contacting the Board.

Ngā manaakitanga Penny

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FROM MASSEY UNIVERSITY

Celebrating our new Professor Promotion to Professor recognises a world-class standard of academic and research performance, with high levels of peer recognition and esteem. Strong evidence of sustained distinction in key areas of expertise is essential as well as recognition as a renowned authority in the discipline, in New Zealand and internationally. In November 2021, Dr Rozanne Kruger's exemplary contribution to the field of Nutrition and Dietetics, both locally and globally, was formally recognised by the University through promotion to Professor of Nutrition and Dietetics. Rozanne is the second dietitian to obtain Professorial title at Massey University and the third Dietitian in New Zealand to become Professor - a wonderful achievement for our profession!

Rozanne is the Director of the Dietetics programme at Massey University. Before moving to Auckland in 2007, she was a Senior Lecturer and Head of the Food and Nutrition Section, Department of Consumer Science at the University of Pretoria in South Africa. From her first role as a dietitian, she was involved in shaping new services; setting up a rural dietetic hospital service and establishing a foodservice in a new retirement village. When working as a surgical and renal dietitian at Johannesburg General training hospital, she also took on the student training role. She later accepted the Senior Dietitian Training role at the University of Pretoria Dietetics training programme, SMART BITES | PAGE 10

followed by a lecturing position where she was involved in developing three successful food and nutrition programmes. In South Africa, her research journey started with the intake and feeding practices of toddlers and preschoolers, as well as doing some of the first qualitative work in nutrition. She also conducted research on determinants of obesity in adolescents, household food security and implementing food-based approaches within vulnerable communities. In New Zealand, together with the team at Massey University, she established a strong human nutrition research presence and grew the human nutrition programmes.

Rozanne developed and established the second Dietetics training programme in NZ in 2012. She is active in the profession, serving on various working groups, committees and councils, including contributing to national guidelines and surveys. As a nutrition researcher, Rozanne is passionate about developing novel dietary assessment methodologies to explore dietary patterns and behaviour. Her PhD laid the foundation for her journey in obesity and metabolic health research. She piloted the body composition profile concept in 2008, later using it to design and attract funding for the Explore study; a major success investigating determinants (diet, physical activity, taste, miRNA) influencing body composition profiles in Māori, Pacific and NZ European women.

This expertise led to her being responsible for the body composition and dietary assessment strategies in the Health Research Council-funded ‘Promise’ study, investigating the gut microbiome and metabolic health in NZ women. She is currently involved in another HRC project investigating novel dietary assessment strategies, as well as research in the clinical and dietetics training settings.

"Dietetics has allowed me to explore my love and passion for food and its impact on human health, and to instill that passion in my profession by training the next era of dietitians."

Humble beginnings in 2012 with Rozanne's first cohort of 10 students. The programme has blossomed to training 45 students across the two years in 2021 , with wellrounded Dietitian graduates entering the workforce each year.

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PUBLIC HEALTH SIG UPDATE

Advocating on Public Health Nutrition Issues The Public Health Special Interest Group aims to cultivate dietitians’ interest in public health, connect dietitians with each other, support the interface between public health and the practice of dietetics, and encourage opportunities to create tangible change. Building on previous years’ activities, the SIG has identified the promotion of member engagement and networking as key priorities. We strive to engage with public health and community nutrition within and beyond the Dietitians NZ network, and when usual strategies are not possible (e.g. due to COVID 19). In 2021, the Public Health SIG has focused on: 1. Food sustainability and food systems: Rajshri Roy has been involved in the Mana Kai Framework dialogues. Leanne Young continues her research in food systems and environments. Lily Henderson and the Heart Foundation have weighed in on plantbased diets for heart and planetary health.

With reports that vegan customers have doubled in the past year, Deb Sue has been investigating flexitarian products at Countdown. Jennie Verstappen has developed non-perishable meal kits for food insecure communities in the Nelson region. 2. Development of a peer-review form for public health CCP activities. 3. Contributions to Dietitians NZ submissions on important public health issues including: Review of the Food Standards Australia New Zealand Act 1991 – draft Regulatory Impact Statement. Policy guidance for menu labelling in Australia and New Zealand. Food Standards Australia New Zealand Added Sugar Labelling Consultation. Plus we presented a joint symposium, in collaboration with the Dietitians in Food Industry SIG, at the Dietitians NZ Conference in September. If you’re interested in connecting with the Public Health SIG, or would like more information about any of these activities, please get in touch.

Dr Rajshri Roy PH SIG, Convenor r.roy@auckland.ac.nz

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SPORTS SIG UPDATE

Year in Review from the Sports SIG The Sports Dietitians SIG comprises over 100 members who are a keen bunch of Dietitians wanting to learn more about sports nutrition. This year, a survey indicated that members were keen on sports nutrition mentoring/supervision, ongoing CPD sessions and workshops. As a result of the feedback, we offered a preconference workshop before the Dietitians NZ 2021 conference this year. This inaugural Sports Nutrition workshop was held Tuesday the 7th of September 2021 and well attended with over 75 dietitians, indicating how keen practitioners are to learn and understand more about sports nutrition. We had a range of incredible speakers, including sports doctors, researchers, sports dietitians and athletes who shared their knowledge and expertise. Special thanks to Tom Shand, Kath Eastwood, and Lea Stening for chairing and facilitating the pre-conference workshop. Next year we plan to have monthly professional development workshops for SIG members to share case studies, research, product updates, journal reviews, all focussing on upskilling the sports nutrition knowledge of our group. Sessions will be filmed and archived for all Dietitians to view.

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Rachel Scrivin (Sports SIG Convenor)

We look forward to building on our experiences and offering more learning opportunities for our members next year. On a personal note, I want to thank the committee for their ongoing support; it makes it all worthwhile. Rachel Scrivin

Reflections from the Sports SIG Rachel Scrivin - Sports Dietitians SIG convenor • This year has been super busy focusing on my PhD commitments (research area is FODMAPS and exercise-associated gastrointestinal syndrome), tutoring at Toi Ohomai in the health faculty, and being on several committees, including the Sports Dietitians Australia committee to facilitate the SDA 2021 conference. Lea Stening – Committee member • This year has been dedicated to completing my book ‘How to grow an athlete-from playground to podium’. This project has taken nearly four years and has been an enormous exercise in patience as I have navigated peer reviews, additions, copyrights, editing, food photography and Covid-19 challenges (slowing down the feedback process). Nevertheless, reviews have been good, and I hope my book will appeal to parents, coaches, P.E. teachers and sports enthusiasts. Michael Lie – Committee member • Michael’s reflections for 2021 on the impacts of Covid-19. The biggest lesson from working remotely during lockdown is the adaptability of both ourselves and our clients.

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Normality being disrupted for such a long time has shown how much resilience dietitians and other health professionals have. Social media usage has been at an all-time high during this lockdown for me, but it is also currently the best way to contact both people in my personal and professional life. Focusing and using social media intentionally has been the biggest gamechanger in keeping client relationships strong and will be a permanent fixture moving forward.

We have two members stepping down from the committee next year and we are looking for keen sports dietitians to join our committee. Please email rachel@megabitenutrition.com if you are interested.

As Dori says to Nemo (regarding 2021) 'Just keep swimming, just keep swimming'... Sports Dietitians SIG committee 2021

The What, Why, and How of Great Supervision By Julie Carter

Through fifteen years of receiving and providing supervision, I have shared great korero, clever ideas and made plans to resolve tricky issues. I’ve achieved some goals and ignored others – sometimes rightly, and other times because I lacked the autonomy, back-up, or courage to act. As my supervision practice has grown, so has my awareness of achieving the right balance between support and challenge. To “sharpen my axe” (1) this year, I completed the University of Auckland’s postgraduate certificate in professional supervision. While this korero may be familiar to some of you, I'm hoping that some of the gold

that I've unearthed also resonates with you. Supervision is a tool to help practitioners make sense of, and improve the quality of, their work through lifelong reflective learning and the subsequent development of their professional practice and personal skills.

Supervision Requirements for NZ Registered Dietitians Practice Supervision is mandated by the Dietitians Board for new graduates in their first year of practice, dietitians changing their practice area, returning after more than two years away from the profession, or to resolve a competence deficit. This addresses all four supervisory functions and requires formal review with a trained NZRD supervisor with at least three years’ experience in the same practice context. Once completed, the supervisor must confirm the supervisee’s fitness to practice dietetics. Professional Supervision, while strongly recommended by both the Dietitians Board and Dietitians NZ, is not mandatory. This could be with an experienced dietitian or interprofessional supervisor in the form of individual, reciprocal, or group supervision.

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The Right Fit – Can I trust you, and can you trust me? The relationship is THE most important aspect of supervision. When you choose who you work with, consider what you want to achieve from supervision, the approach of a potential supervisor, their skills and experience, and your preferred learning style. How can they meet your needs? Which personalities do you work well with? How might your similarities and differences impact your rapport? Supervisees: the more you understand your own goals, the better you can shape your supervision to meet them. Are you developing experience and confidence, seeking new skills, making connections, looking for a challenge – or something else? Supervisors: you will not be the best supervisor for everyone – and that’s okay. This is so important that many supervisors offer their first meeting to assess ‘fit’ free of charge.

The main functions of supervision have been summarised (1,2) as:

Development of supervisees’ skills, understanding and abilities.

Resourcing supervisees with skills to keep them safe and build their resilience – enabling them to reciprocate for their clients, organisations, and profession.

Addressing the quality of the supervisee’s work.

Occasionally mediating for supervisees with employers or professional bodies .

Contracting Is Key! Where I previously used a ‘one-size-fitsall’ template, this year, I’ve developed a checklist to address a range of issues with my supervisees, enabling them to individualise their contract. In addition to the practicalities of meeting – where, when, how long, and who sets the agenda (the supervisee!) – this promotes discussion about participation and trust, preferred learning styles, feedback frameworks and ways to identify and manage ambivalence or conflict within the relationship. Acknowledging the participants in a supervision relationship includes understanding who you both are.

Naming and exploring your differences and power imbalances (for example in gender, religion, age, culture, expertise, sexual orientation, etc) may feel awkward but is more likely to strengthen your connection than undermine it (1). The contracting discussion also includes issues of clinical safety, ethics, confidentiality – and the duty of care (where issues of safety have the potential to affect supervisees).

Professional Supervision IS: A negotiated relationship between two people – both with rights and responsibilities Involves power and authority Focused on the supervisee’s agenda Ongoing and regular Educative – but not education Supportive and empowering About being a better practitioner and providing a better service Ethical Confidential Accountable – to the employer and profession

Preparation: You get what you give Supervisees: if you don’t set the agenda, it won’t meet your needs. You can bring anything to supervision that you want to solve, ruminate, or reflect on. Make a note in your diary of issues you want to explore as they happen - you’ll forget them if you don’t. And think about your goal for each issue. What do you want – or not – from your supervision korero? How will you know it’s been resolved? A good session will have you ‘percolating’ your discussions long after its completion.

Celebrate and engage Given how critical we can be of ourselves, celebrating our supervisees’ achievements (large and small) is a wonderful way to start each session. Sometimes our wins are obvious and other times, not going backwards is progress itself. There are a multitude of models that can be employed in the depths of supervision; the reflective learning model (1), the

Professional Supervision is NOT: Friendship, a chat, or gossip Counselling Management - as not likely to be the supervisee's agenda Appraisal (this is a key difference for Practice Supervision) For the supervisor to share their own issues

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seven-eyed model (2), kaupapa Māori (4) and strengths-based approaches. Despite their differences, these all incorporate three qualities considered essential for a positive supervision relationship (1): Authenticity: the supervisor’s genuine interest and support for their supervisee’s development creates a trusting environment. Both parties modelling respect and positive regard encourage the supervisee to share high-risk material for discussion. Openness to learning feeds on the willingness of both parties to share and reflect on the issues brought to supervision in a respectful and empowering way.

“Never know better and never know first” (for supervisors) In 2010, Vicki Paulin interviewed a group of senior dietitians who revealed that they were likely to disengage with highly directive supervisors – preferring the facilitation of in-depth reflections. As a supervisor, asking more and telling less has been my greatest challenge (just ask my earlier supervisees). Davys and Beddoe’s ‘Reflective Learning Model (1)’ has been a game changer for me this year. This structure has given me the confidence to 'not know' the solutions and work through a logical, supportive process empowering my supervisees to find their own gems. That, and developing a bank of all those rich and wonderful ‘open’ questions have helped me create space (and silence) for my supervisees to reflect more deeply… What have you done so far? Have you been in a situation like this before? What assumptions are you making? If you were to give yourself wise counsel, what would it be? What are the advantages, disadvantages, or possible consequences of doing this?

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So, how did we do this session? Evaluating each session has also been a positive change in my practice this year, ensuring that my supervisees feel heard, valued, and empowered. And if they’re not, I really want to know how to rectify this. Again, there are so many rich questions… How has the issue been addressed? What have you discovered / learned? What can I do more or less of to help you develop? Professional supervision is a wonderful addition to our baseline skills in

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questioning, listening, teaching, and empowering our clients. In this context, the beneficiaries are our peers, and we have the added privilege of witnessing their development over a longer term. As my practice has evolved, I have loved seeing my supervisees become more engaged and offering more of themselves. I could share so much more of this supervision journey, including some fabulous models and tools. Perhaps if you're interested, or have specific questions, we'll arrange a follow-up in 2022? Let me know – at julie.carter@xtra.co.nz or editorsmartbites@gmail.com.

My experience working in food service Food service. Possibly one of the most unglamorous areas of dietetics. Or so a lot of people think. Most other dietitians I meet will ask me “Is food service what you wanted to do?” And truthfully, the answer is no. I, like many other graduates, wanted to go down the clinical dietetics pathway, specifically in a hospital environment. Currently, I am working as the Food Service Dietitian at Capital and Coast DHB (CCDHB). It is my first job as a dietitian in New Zealand. I applied for it and never really thought that I would get it, but I did. I would have been foolish not to have taken the opportunity. One thing that you may not realise about working in food service is the kind of people interactions you will have. For example, working with staff with English as a second language and various levels of comprehension, or staff who are cautious about change. Their trust needs to be earned first and foremost.

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Elizabeth Whittred

It can also be difficult to achieve what others want. Food service requires a practical approach to juggle resources and restrictions - such as what can feasibly be produced in the kitchen, or what impact changes have on food service staff. Aside from learning new skills, I initially felt rather isolated as I didn’t know any food service dietitians in New Zealand. I have since reached out to some and I am very thankful for the time they have given me. Also, after less than four months in the role, I was required to supervise two students for their twoweek food service placement. Sadly, we couldn’t complete their placement as the country went into lockdown. I really enjoyed my brief time with them and I look forward to supervising more students in 2022.

Overall, I’m learning the skills and qualities that make a good food service dietitian, which include: You must be pragmatic You need to have the ability to bring together different opinions and balance clinical expectations with the overall ability of the food service staff and systems You need to be able to prioritise You need to be adaptable and able to respond to incidences on short notice (a.k.a putting out fires!) You need to have an appreciation for the importance of the budget and be financially savvy when improving or adjusting menus

You must have great communication skills and the ability to translate high level clinical rationale into key messages that are easy to interpret and adhere to by all staff You need to be respectful and patient with all your colleagues You must be approachable, relatable, authentic, and trustworthy within your team You need amazing customer service skills! So, while food service might not have been the area of dietetics I wanted to go into after I graduated uni, I am thankful for the experience it has afforded me.

One of our cooks cooking up a storm!

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All bodies are summer bodies: body positive and intuitive eating approaches Maria Casale, Dietitian and Health at Every Size (HAES) advocate, shares her motivations for adopting a body positive mindset as well as her thoughts and strategies when supporting clients. It’s that time of year - summer is making its grand entrance along with an onslaught of toxic messages about “summer bodies”. But guess what: your body is already ready for summer! Your body is not a problem. Imagine this. You’re 10 years old, and it’s the first day of a new school. You have a brand new uniform, you feel a mixture of nerves, excitement, and hope – hope for new friends and experiences, and all the future has to bring. You stand, squinting into the morning sun as your proud parents take a photo to mark the occasion, with the neighbour watching on. “I'm worried about how big she's getting...” If you have had comments made about your body (and I’d hazard a guess almost everyone has), you share a collective experience – one that we often don’t talk about - yet shapes our perception of

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ourselves and indeed, the core of our very identity. Often these comments can be couched in concern for our health or wellbeing from well-meaning friends and family members. Add to that the impact of the media - particularly social media, on developing adolescent brains and there is no wonder our relationship with food and our bodies can be so fraught.

It was my first job after graduation. I was in the lunchroom eating a toasted cheese sandwich. A colleague who had recently lost a significant amount of weight walked in and unpacked his lunch, telling me it was “approved” by his nutritionist. A seed was planted – maybe I could also lose weight and finally feel like I was accepted, like I was enough. I asked for the nutritionist’s number and rang her that afternoon and booked in for an appointment. Two years later, 40kg down, I was in the throes of an eating disorder that continues, two decades on, to haunt me. I had never been more miserable, but the constant praise and congratulations I received for my weight-loss convinced me I was happy and had done the right thing - and that I should try and help others to do the same.

So what can you do to help improve your relationship with food and eating, and help build a strong healthy body and mind, if you’re not dieting?

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The most important thing to keep in mind is that focussing on removing, restricting, or cutting out is destined to fail. Rather, your goal should be to introduce new helpful and positive habits that will help repair your relationship with your food and with your body.

Intuitive Eating: practical strategies that work Intuitive Eating was coined by Evelyn Tribole and Elyse Resch, but has deeper roots that go as far back as the 1970’s. In brief, intuitive eating is an evidencebased approach to eating that, in the words of Evelyn Tribole, is a “personal process of honouring health by listening and responding to the direct messages of the body in order to meet your physical and psychological needs”.

It was the summer of ’92. We were painting the school pool in readiness for the start of term. I was 13, and a classmate who was helping out while wearing a bikini on her objectively small body said “Oh my god, I’m so fat, I’ll have to stop eating or I’ll be shamed out.” Overt and subtle comments alike are easily internalised by the adolescent brain, shaping how a person feels about themselves. This is often carried through to adulthood, where we are cajoled, inveigled and often straight-out bullied into trying to shrink our bodies, if not to look “acceptable” for summer, then in the name of “health”. There are terms for this; “concern trolling” and “food police” to name just two. This kind of messaging hits home for a reason - our brains are hard-wired to be on the lookout for danger, for example, if we cross a road we instinctively check a truck isn’t about to run us over. Because this ability to be on the constant lookout for danger is critical to our survival, it’s natural that we focus on the negative. Our brains have been taught from a very young age that "fat" bodies are something to be feared and avoided at all costs, and the diet and wellness industry profits off this to the tune of $72 billion a year. So when the inexorable march of “get fit for summer” and “get your body beach ready” messages start rolling in this year, what can you do to change your internal narrative?

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Remind yourself: you are enough exactly how you are – you are a full and valuable human being and you are loved not for your body but who YOU are. Stop the stream of unhelpful messages: unfollow, block, unsubscribe from people and advertisements that promote dieting and glamourise weight loss. Make your social media a safe place to be. Challenge any unhelpful thoughts: for example, replacing “my legs are too fat” with “my legs are strong and incredible, carrying me where I need to go”.

But what does this actually mean? Essentially, the goal of intuitive eating is to reject external diet rules while developing and nurturing greater awareness of what your body needs. Intuitive eating centres YOU as the expert of your body. You, and only you, know when you are hungry and when you are full. You know how you feel, and you know what your body really needs. The good news is that everyone was born an intuitive eater. We are born with the ability to perfectly regulate our energy intake. Babies want to eat when they are hungry, and they want to stop eating when they are full. But, with the best of intentions, this ability is often trained out of us from a young age.

Were you ever told you had to finish everything on your plate? Or did you have to eat your vegetables to get dessert? What about when you hurt yourself – were you comforted with something deemed a “treat”? We quickly learn to override our hunger and fullness signals – and combined with certain foods being placed on a pedestal, we have a perfect storm for a problematic relationship with food and eating.

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The decision to leave a good job in the IT industry to study nutrition was an easy one. I was going to change people’s lives for the better, one at a time – just like mine had been changed. This seemed so clear, as long as I ignored the constant daily struggle and misery to maintain my weight loss. The missed nights out socialising as the food would be too tempting, and my aching knees from so much running. The endless tins of tuna, and the horrible guilt if I missed a gym class. Then came a lecture on the non-diet approach which changed my life forever.

The non-diet approach is multi-faceted with many layers; there’s never a onesize-fits-all approach. However, I’ve drilled down to my three favourite strategies for improving relationships with food and eating. These are adapted from the 10 intuitive eating principles by Evelyn Tribole (a must-read!) 1. Reject the diet mentality and make peace with food. One of the reasons diets don’t work and damage our relationship with food is because they put certain foods off-limits – or maybe the diet simply limits calories. This creates feelings of tension and deprivation which can intensify to a point where you obsess over food and often binge. This results in feelings of guilt and shame and resolve to “start again”. If food isn’t off-limits, it ceases to have this power over you. It’s ok to eat ice cream on a hot day, or hot buttered toast and hot chocolate after being caught in a wintry storm – and by having the thing your body REALLY wants you are far less likely to have feelings of guilt, shame and remorse.

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2. Tune into what your body really wants and needs. When you tune into your body and really listen to your body’s signals - spiritually, mentally and physically, and eat what you really want, you will gain great pleasure from your food and feel satisfied in both body and soul. While tuning into your body’s hunger and fullness signals is important, it’s also ok to eat something just for the sheer pleasure of it. This will prevent those feelings of deprivation from sneaking in. Be mindful of your body’s signals that you are comfortably full – check in with yourself while eating about how the food tastes and what your current hunger level is. A good check in question is “Am I still enjoying this?" or "How does it feel in my mouth and stomach?” Similarly, take note when you are starting to feel hungry. Try not to let yourself get to a point where you are so ravenous you want to inhale everything in sight.

3. Eat mindfully Mindful eating is a powerful way to restore joy, satisfaction and connection to your food and eating. Think about how we usually eat – there is a myriad of distractions: the TV might be on, maybe you’re dealing with emails or catching up with social media, or could be watching a movie or a rugby game while distractedly eating something you would normally find delicious and appreciate, but really not tasting it at all until you suddenly realise you’re uncomfortably full. Mindful eating is about eating with attention and intention. Attention to your food – how it looks, smells, sounds, and tastes. And with intention to nourish yourself and honour what your body wants, and to derive pleasure from your food. By tuning into your food in this way you will feel truly satisfied, physically and mentally.

We are bombarded with messages about the morality of food on a daily basis, and heaped on top is an ingrained societal expectation that our bodies should look a certain way. While it is possible to claim a better relationship with food and eating, there can also be a lot of past trauma and guilt associated with food that you may need careful help to work through; but I can promise you one thing - your body is not the problem. Let me repeat that - your body is not the problem. Your body is summer ready, right now!

Maria Casale HAES and Non-Diet Advocate NZ Registered Dietitian PhD Candidate SMART BITES | PAGE 27

Help and Support HAES / Non-Diet Dietitians and Nutritionists: Anna Greenan, Non-Diet Dietitian Dietitian At Your Table Email: info@dietitianatyourtable.nz Mobile: 027 3787238 Emily Jakubcik, Dietitian Nurture Psychology Email: hello@nurturepsychology.co.nz Diane Stride, Dietitian & Wellbeing Coach www.dianestride.com Mobile: 0275056247 Elisa Weiss, Registered Nutritionist Email: weissnutrition@gmail.com Anna Williams, Nutritionist & Personal Trainer Email: hello@annajane.co.nz Mobile: 022 476 2828

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Body-positive Psychologists: Jenni Beckett, Registered Psychologist Emotions Matter Email: emotionsmatter@outlook.com Mobile: 021 065 3604 Kate Hebenton & Dr Zara Godinovich, HAES & Non-Diet Clinical Psychologists Nurture Psychology Email: hello@nurturepsychology.co.nz Emma Thomas, Weight Inclusive Counsellor NZ Eating Disorders Clinic www.nzedc.co.nz Phone: 09 962 6236

Southern Branch Update On the 6th of their Annual world: Lou Fangupo

November 2021, the Southern Branch held Study Day titled "Working in an uncertain Dietitians in the time of Covid-19". shares her highlights of the event, hosted for the first time on Zoom.

The Southern Branch has a long, proud tradition of holding an annual ‘Study Day’ where dietitians from around our geographically large region meet in person for a stimulating day of learning, networking and socialising. In 2020, the study day was not held due to uncertainties caused by Covid-19. In October 2021, we needed to decide whether or not to continue planning for an in-person event in November. The day of the relevant committee meeting coincided with when the government first announced their “roadmap” for moving Auckland out of lockdown. It quickly became apparent that nobody could reasonably predict what would happen next and that continuing to plan for an in-person event would mean needing to have Plans A, B, C and D in place for Alert Levels 1, 2, 3 and 4. This wasn’t feasible for our small committee of busy volunteers, so we reluctantly decided to hold the 2021 event online.

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Some of the Southern Branch Committee Members (L-R): Laura Peat, Lou Fangupo, Silke Morrison and Millie Keown.

If nothing else, we realised that this move aligned neatly with the alreadydecided theme of “Working in An Uncertain World: Dietitians in the Time of Covid-19”!

Our committee met and delivered the study day together from a seminar room at the University of Otago, with our speakers and delegates Zooming in from around Aotearoa. One of the silver linings of moving the day online was that we could open it up to our colleagues nationwide, and we were delighted that lots of you chose to join us – thank you! The day started with presentations from dietitians whose mahi had been considerably affected by the pandemic: Kirsty Hayr from WellSouth, who as a new graduate dietitian found herself thrown into work in a CommunityBased Assessment Centre (CBAC); Finau Taungapeau from Pacific Trust Otago, who became a “Jill of All Trades” within a vaccination centre in Dunedin; and Fiona Kendall from Dietary Specialists who presented two long-Covid case studies.

We then heard from Dr Sue MacDonnell, who was already working from home at the time of the first lockdown and so was well versed in the resulting pros and pitfalls of this, and Dr Sara Styles. They gave us some practical insight into using values-based behaviour change techniques with patients/clients over Zoom! We finished with presentations from three Southern Branch dietitians with recent outstanding achievements despite the interruptions caused by the pandemic: Aysu Shahin (who has opened a new takeaway business featured in next article), Nicky McCarthy (who has recently finished her MSc looking at Dietetic Care in Inflammatory Bowel Disease in New Zealand) and Silke Morrison (who has just submitted her PhD thesis looking at how mild sleep deprivation influences food intake and physical activity in children). All in all, it was an inspiring day with lots of great examples of how adaptable, resilient and talented dietitians and their nutrition-related colleagues are. While we are hopeful that we will hold an in-person study day in 2022, we also have a newfound confidence in using Zoom to open up the day to those who cannot attend in person due to geographic or other barriers. Thus, we hope to see lots of you there!

Ngā manaakitanga, Southern Branch Committee

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My Journey as a New Graduate Dietitian Setting up a business is an exciting but daunting affair, even more so if you are a new graduate. Aysu Shahin shares her inspirational journey starting Patate, an innovative business venture supporting healthy food choices. I currently work as a food service dietitian in my own business, Patate. Patate is a local Dunedin baked potato, loaded fries and salad takeaway bar that I started in early 2021 after graduating from the University of Otago. Patate brings the humble baked potato to a whole new level, using a range of toppings, locally sourced produce, and fresh ingredients. My dietetics training enabled me to lead this business from both a food service and business perspective; thus allowing me to create a more health-conscious fast-food option for Dunedin locals. I started to put together the business plan for Patate during the final year of my Master of Dietetics. The inspiration for the business came from my halfTurkish background, where the street food Kumpir is very popular. I adapted the concept of Kumpir for the Dunedin locals and the broader New Zealand palate. My current role is owner and general manager. I do everything - from customer service to menu planning to SMART BITES | PAGE 31

Aysu dishing up one of her delicious potato jacket options at her Dunedin takeaway bar

branding and marketing, to staff training and management. I am not a cook by trade, but I even do some cooking now!

I have learnt so much from this business, but one key learning has been unexpected: potatoes. I now know so much about potatoes, from the obvious nutritional value to baking them, to checking their quality as well as what my local potato suppliers need to do to cultivate this humble vegetable to meet our business’ standard. I have even been referred to as ‘the potato girl’ by locals; a title I wear with pride!

"Young people are not always encouraged or supported to take those risks. We are often told we need more experience, we don’t know enough and could so easily fail; but young people are the ones we should be looking to for fresh ideas and new perspectives."

My dietetics background has given me an edge, in enabling me to start this business with some advantages that others may not have. Firstly, the beloved Food Service Systems model which we are taught in our food service training, was my first point of call when creating the business plan for Patate. It ensured I ticked all the necessary boxes before starting the business. Secondly, having seen first-hand how the health and safety standards, management standards and food safety standards of a kitchen should operate, I felt confident in applying this to my business and managing a team. Finally, I had an amazing support system, from my knowledgeable dietetics supervisor to my wonderful family and supportive friends. I learnt so much from talking to others and hearing about their experiences. I was able to draw on this, relating shared experiences and wisdom to any problems I may have been facing at the time.

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One of the options on the menu which features a range of nutrient dense and satisfying choices

Since we opened our doors, we have been completely blown away by the interest and support people from all walks of life showed in our business and food. While I initially did not intend to push the cultural aspect of the Turkish Kumpir dish we serve by making our menu diverse, I have received much interest in learning about the background of the dish, especially its cultural significance for me. We now tell anyone who asks that this business is a Kumpir shop before anything else. My message to pass on to anyone in Dietetics who wants to take a risk: Just give it a go and start! Young people are not always encouraged or supported to take those risks.

Channelling my "I mean business" look after graduation SMART BITES | PAGE 33

We are often told we need more experience; we don’t know enough and could easily fail, but young people are the ones we should be looking at for fresh ideas and new perspectives. Do make sure though that you take precautions and do your due diligence. Having the support of a trusted mentor and your family and friends is also important. At the end of the day, if you have an idea and can put it on paper as a business plan, nothing is stopping you! I look forward to seeing and supporting more young people to take a leap of faith and take risks to fulfil their goals, especially in considering wider opportunities within the Nutrition and Dietetics field. In the meantime, if you’re in or near Dunedin, I would love for you to come grab a tasty jacket from the team at Patate!

Covid presented various challenges and a very steep learning curve but thankfully Patate is still going strong.

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Six Years in a Desert Hospital Kristy Pemberton, NZRD, shares her experiences as a dietitian working in Abu Dhabi

Seven years ago this week, many long months of anticipation materialised as my husband and I boarded a one-way business class flight to Abu Dhabi. The moment we boarded that plane, our lives would never be the same. Living in the Middle East gave us plenty to be grateful for in the west, and gave pause for consideration of how NZ culture could perhaps improve. In the East, there is poor gender equality and questionable human rights (although the UAE, within the region is the most progressive nation in this area).

On the other hand, there is a benevolent monarchy that rules the nation and the rate of progress with law changes and infrastructure development is staggering because they make a decision and just do it.

CCAD Building

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Opulence in Abu Dhabi was everywhere. Chauffeur driven Audis from the airport, a 5-star suite in the city while they ‘prepared’ apartments, and to top it off, I was working in the most awe-inspiring building I had ever seen: Cleveland Clinic Abu Dhabi (CCAD).

My role as a senior dietitian, and eventually ambulatory dietitian, was to help a foundational team of top-notch health professionals from around the world start up an enormous, cutting-edge quaternary hospital. I was fortunate to work with a great team, initially almost entirely western expats (including the wonderful Adrienne Speedy and Rebecca Baskett).

The Original Team

Over time we hired local Emirati dietitians, who despite having to step out of their comfort zone and cultural norms to work at CCAD, were very driven and developed into outstanding dietitians.

In the early days, we were responsible for writing policies, culturally relevant resources, establishing departmental processes and helping define interdepartmental processes. Developing services from the ground. After six months of preparation, we welcomed our first dietetics patients in May 2015. One of my early responsibilities was working with the surgeons to develop and coordinate the bariatric service. My prior experience of bariatric surgery was treating surgical complications, but I had to put my own biases aside. With the support of leadership, I rode the steep learning curve of service development while gaining clinical knowledge. I was fortunate to travel to Cleveland Clinic USA to shadow and learn their best practices and adopt what we could in CCAD. As the service grew, so did my knowledge and appreciation of this lifesaving surgery. When I left, the service was the largest in the hospital and was completing 500+ surgeries per year.

CCAD Team 2020 SMART BITES | PAGE 36

'Working in the hospital was amazing, physically and emotionally exhausting, and fun and anxiety inducing. Sometimes all at the same time'. Basic Hospital Room

I encountered some of the most distressing professional situations I have been in, some of the most surreal situations, and occasionally reminded me of the simple pleasures of our profession. Distressing was maintaining EN or PN on patients with very low brain activity for years on end due to no ‘end of life’ medical legislation at the time in the UAE. Or, having a mother attempt to arrange bariatric surgery for her 15year-old daughter the following month, so “she could be pretty for when school starts and find a husband in a few years”.

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Surreal was consulting to ‘VVIP’ patients (royalty). These were some of the wealthiest, most highly protected people in the world. The hospital would have special protocols to follow, operating hours would be adjusted, a chopper would fly to the helipad or a motorcade would drive up. Once the fanfare had subsided, I would find myself in the room of a member of the royal family. My experience with royals was almost always the same despite the fuss: they were delightful, modest, articulate and intelligent individuals. The simple pleasures in dietetics for me in the Middle East came down to an aspect of the role that I always have and will always love: building rapport with patients and helping to affect meaningful change on their lives.

Our apartment on 45th floor

I am hoping with a slightly broader worldview and a tad extra patience gleaned from working across major cultural divides, I will be able to build even stronger relationships and get even better outcomes for my patients here in the Waikato. Not your typical hospital cafe lunch

It was an odd occurrence that I would find this working in an environment where the patients often spoke no English (my Arabic is limited to foods and greetings) and yet as clunky as it was waiting for translators to arrive, we could connect despite being from entirely different worlds. Seven years on, in returning to NZ (with a couple of gorgeous kids in tow), I was thrilled to be welcomed back to the Waikato renal team. In NZ, usually, I have no language barriers, but cultural barriers still persist in a clinical environment.

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Playing in the local park

We've been loving... The GP Show Podcast Join GP Dr Sam Manger and special guests from around the world discussing the latest in evidence-based medicine and more. This podcast is designed-with-love for medical doctors, scientists, researchers, allied health, nurses, students and anybody else interested in health, science and medicine.

Intuitive Eating, 4th Edition: A Revolutionary Anti-Diet Approach The classic bestseller by Registered Dietitians Evelyn Tribole and Elyse Resch is all about rejecting diet mentality. Intuitive Eating has become the go-to book on rebuilding a healthy body image and making peace with food

Bodies are Cool This heart-warming, inclusive book by Tyler Feeder, filled with detailed and friendly illustrations is a celebration of every kind of body that exists in the world. Through an empowering, rhythmic text that is perfect for reading aloud, little ones can explore various skin tones, body shapes, hair types, and more, in an accessible way that instils body positivity and confidence.

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I'm a Dietitian Podcast Tune in as President of Dietitians Australia, Tara Diversi, interviews inspiring Accredited Practicing Dietitians as they share stories about life, opportunities, and growth within nutrition.

Great inspiration for new and experienced dietitians alike!

NUKU Podcast - with Qiane Matata-Sipu Interviews with 100 kickass Indigenous women doing things differently! An invitation to look at the world through a different lens, a personal lens, a cultural lens, a lens made by and made for indigenous wahine – mā hine, mō hine, kia hine!

If you like this, look for the book at: nukuwomen.co.nz

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References All bodies are summer bodies: body positive and intuitive eating approaches

The What, Why, and How of Great Supervision

1. Tribole, E. (2017). Intuitive Eating: Research Update. Sports, Cardiovascular, and Wellness Nutrition (SCAN), 36(3), 15.

1.Davys, A., & Beddoe, L. (2021). Best Practice in Professional Supervision. (2nd ed.). Jessica Kingsley Publishers.

2. Tylka, T. L. (2006). Development and psychometric evaluation of a measure of intuitive eating. Journal of Counseling Psychology, 53(2), 226.

3. Tylka, T. L., & Kroon Van Diest, A. M. (2013). The Intuitive Eating Scale–2: Item refinement and psychometric evaluation with college women and men. Journal of Counseling Psychology, 60(1), 137. 4. Willer, F. (2013). The Non-diet Approach Guidebook for Dietitians: A How-to Guide for Applying the Non-diet Approach to Individualised Dietetic Counselling: Lulu Publishing.

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2.Hawkins, P., & McMahon, A. (2020). Supervision in the Helping Professions. (5th ed.). McGraw-Hill Education. 3.Paulin, V. (2010). Professional supervision in dietetics: a focus group study investigating New Zealand dietitians’ understanding and experience of professional supervision and their perception of its value in dietetic practice. Nutrition & Dietetics. 67, 106-111. 4.Webber-Dreadon, E. (2020). Kaitiakitanga: A transformation of supervision. Aotearoa New Zealand Social Work. 32(3),68-79.