Nutrition Entrepreneurs Spring 2024

Ventures

SPRING 2024

EDITOR

Leda Medina, RDN, LDN, CDCES

INCOMING EDITOR

Amy Brownstein, MS, RDN

EDITORIAL BOARD 2023-2024

Lauri Egan, RDN, CPT

Jessica Oswald, MS, RDN/LD

Leah Tsui, MS, RDN

Stephanie Dorfman, MS, RD

The newsletter pertains to the Nutrition Entrepreneurs Dietetic Practice Group of the Academy of Nutrition and Dietetics and reproduction rights are reserved Publication of an advertisement in the Ventures newsletter should not be considered as an endorsement of the product or advertiser by the DPG Viewpoints and statements in this newsletter do not necessarily reflect policies and/or positions of the Academy of Nutrition and Dietetics

© 2024 Nutrition Entrepreneurs

All rights reserved

WE WELCOME FEEDBACK FROM OUR MEMBERS. PLEASE CONTACT THE EDITOR:

Leda Medina, RDN, LDN, CDCES newsletter@nedpg org

SUBSCRIPTION INFORMATION OR QUESTIONS:

Email NEadmin@NEdpg org

Note From the Editor

LEDA MEDINA RDN, LDN, CDCES NEWSLETTER EDITOR

As we welcome the vibrant energy of spring, it's a great time to pause and reflect on the state of our businesses

Just like the kiwi fruit requires careful pruning to bear its sweetest fruit, our businesses also benefit from periodic "spring cleaning" to ensure they are thriving and aligned with our goals

In this edition of our newsletter, we delve into the concept of "Kiwiing It Real" - AKA “keeping it real” – which will explore what REALLY works vs what doesn’t This is about embracing authenticity, innovation and intentionality in every aspect of our entrepreneurial endeavors It's about acknowledging the strengths of our businesses while recognizing areas for growth and improvement

Throughout this newsletter, we'll explore strategies, insights and experiences shared by fellow nutrition entrepreneurs We'll hear stories of success, resilience and wisdom from the collective expertise of our community�

But first, let's take a moment to acknowledge the significance of spring cleaning in our businesses Just as we declutter our homes to create space for new beginnings, springcleaning our businesses involves assessing, refining and revitalizing our strategies and operations

As nutrition entrepreneurs, our passion lies in empowering others to lead healthier, happier lives Yet, in our pursuit of this noble mission, it's easy to overlook the health of our own businesses This newsletter serves as a gentle reminder to prioritize the well-being of our businesses, just as we do for our clients

Throughout the pages ahead, we'll explore topics such as: redefining success- spring-cleaning your mindset - planning for retirement - and hiring outside help to help you in your business

As we embark on this journey of reflection and renewal, let's approach it with curiosity, openness and a commitment to continuous improvement Together, let's "kiwi it real" and create businesses that not only thrive but also make a meaningful impact on the health and well-being of our communities

Here's to a season of growth, transformation and abundance in our nutrition businesses!

Leda Medina, RDN, LDN, CDCES, is the founder of Dietitianyourwaycom, an online directory of Registered

Dietitian Nutritionists with the goal to help RDNs thrive in their businesses When she isn’t working to help our communities’ health one dietitian at a time, she is spending time with her English bulldog, Capone, in sunny Florida She is always excited to connect over a cup of coffee with fellow RDNs

Letter from the Chair: Kiwi-ing it Real: Dealing With and Overcoming Imposter Syndrome

JESSICA OSWALD MS, RDN/LD CHAIR

I am serving as the Nominating Committee Chair for another organization that I have been part of for years The nominating process with this organization is quite different than the nominating process for the Academy of Nutrition and Dietetics We only slate one candidate per position despite the number of nominations we may receive� Part of the nominating process includes a period of feedback from the voting members on the candidates

During this feedback period, one of the candidates sent me a few questions and during our exchange, the candidate said - “You know imposter syndrome is a REAL thing and this is how it’s showing up for me today ” This individual is currently serving on the board� She knows she can do this� She’s been serving on the board for almost two years at this point Yet, she is still experiencing imposter syndrome This, of course, got me thinking

Imposter syndrome is a REAL thing I know many of us experience imposter syndrome and if we’re going to “kiwi it real,” we should own that we feel imposter syndrome I’ve felt imposter syndrome a number of times as I’ve served as your Chair this year What am I doing as a leader of an entrepreneurship group? I’m not an

entrepreneur I’m not pulling in six figures from my side hustle Who’s going to trust me to lead? These are just some of the thoughts that roll through my head when I experience imposter syndrome� One of the recommendations for overcoming imposter syndrome is to flip the script on your thoughts and change your mindset about your abilities Flipping the script on my thoughts (and I sometimes write it all out - pen to paper helps me with many things) looks like this…

y I am an entrepreneur I do have my own business I also have a fulltime job working with children with developmental disabilities that I love and do not want to leave It’s perfectly fine that my business is small and will stay small�

y I am a leader and can lead a group I’ve done this before I served on the board of the organization mentioned at the beginning for four years I was asked to run for president of that group - I said nope - but people do trust me to lead�

y I can lead a group of entrepreneurs I will make mistakes I’ll definitely screw something up but that’s okay I will also do a good job in the role of chair While I truly hope none of you experience imposter syndrome - I know that is not realistic We all feel it There are other ways to deal with imposter syndrome besides flipping the script Here are some other things you can do:

y Share when you are feeling imposter syndrome You won’t be alone in the feeling and you may help someone else share their feelings

y Celebrate your wins Take time to acknowledge that you did something really good Pause to applaud yourself when you have a win

y Ask yourself - “facts or feelings?” You may feel like an imposter or a fraud, or you may feel stupid Those are feelings What are the facts? You are smart You do know what you are doing You are a great nutrition entrepreneur

Do you experience imposter syndrome? How do you “kiwi it real” and work through it?

Jessica Oswald, MS, RDN/LD, is a dietitian living in Fort Worth Her primary dietitian role is as a pediatric dietitian at a small hospital for children with developmental disabilities Jessica also owns her own business, Friendly Nutrition, which has recently gone through a change in direction and is now focusing on meal planning Jessica is obsessed with Peloton (yes, it’s a problem) You can find her on the leaderboard as @Go_JesO_Go

Check out our webinar on taming feelings of insecurity & imposter syndrome

Hiring a Virtual Assistant for Dietitians

ADERET DANA HOCH MS, RD, CDN SECRETARY

Virtual assistants are self-employed individuals or a team of professionals who provide administrative, technical or creative assistance to clients remotely They are a beneficial tool for nutrition entrepreneurs, whether your practice is fully grown or in the growing stages In this article, we'll explore the benefits of hiring a virtual assistant as a dietitian and provide some tips on how to find the right fit for your practice�

WHY HIRE A VIRTUAL ASSISTANT?

A virtual assistant for a dietitian, or any small business-owner, will free up your valuable time and resources to focus on your client care and

growing your practice Leave the administrative tasks, like scheduling, emailing and organizing, to your assistant, to increase your productivity in areas of your practice that may be neglected for your attention - giving you the space to focus on what you enjoy and what you do best!

STEP-BY-STEP GUIDE TO HIRING THE VA THAT WORKS FOR YOU:

y Start with what tasks you would delegate to your VA Make a list of what you would hand over, such as your calendar, drafting blog posts and answering patient emails

y Search for whom to hire by using online platforms such as VA agencies or freelancing platforms like Fiverr Reach out to colleagues who have hired VAs and ask for their guidance

y Now it’s time to go through the interview process Choose candidates you want to screen and interview, ask them about previous experience, what their availability is, and about their work style - determine if they are a good fit for your workflow

y Once you find your hire, be sure to communicate your expectations clearly; work hours, how you communicate, recurring deadlines and how you plan to evaluate the person’s work You may want to create a short orientation guide that your new hire can always refer back to

y Give your new VA a two-week training period� Shadow the new VA as the person learns your processes and systems - and be sure to provide constructive feedback Remember you are relying on the person to act as an extension of you on a daily basis In conclusion, hiring a virtual assistant can be a valuable investment for dietitians looking to optimize their efficiency, productivity and client experience By delegating administrative tasks to a skilled professional, you can focus on what matters most – providing exceptional nutrition care and growing your practice With careful planning and clear communication, you can find the perfect virtual assistant to support your journey toward success in the field of dietetics

Aderet Dana Hoch, MS, RD, CDN, lives in New York and Tel Aviv, Israel Aderet has been a practicing RD for over two years She is the owner of Dining with Nature by Aderet and works full time for a health tech company You can just as easily find her roaming around the farmer’s market as you can with a glass of white wine in hand while binge watching Chopped

How Bringing An Intern In Can Be a Win-Win

MARIA MORGAN-BATHKE MBA, PhD, RD, CD, LD, FAND TREASURER

Do you have a side project you have been meaning to start or a topic you want to research, but just don’t have the time? Bring in an intern!

While the first couple of weeks working with an intern can be some added time on your plate as you train the person to your system, once the intern has these first couple of weeks under their belt, your intern can really function as staff relief, allowing for a mutually beneficial relationship

I’ve worked with multiple interns in my business and truly appreciate not only all the products they have created for me but also the fresh eye they bring to my content and processes� Interns have created blog posts, online selfpaced nutrition courses, recipes and grocery store tours They have also expanded my social media reach to include Facebook, TikTok and YouTube Plus, bringing on interns has allowed for a fresh view to my website and processes, and how I can improve them� I had to put in some additional time, for me about 20 hours, to get them oriented to my business and

processes, but the amount of content the interns have created for me would have taken me 10 times the amount of time I put into training them A win-win!

POTENTIAL CONCERNS OF PRECEPTING:

y Additional time for training and oversight

y Meeting competency requirements

y Privacy for clients/patients

LET’S ADDRESS THESE CONCERNS.

I truly appreciate the fresh eye interns bring to my content and processes�

Of course, the interns receive their benefits as well They complete some of their supervised practice hours, gain valuable experience in the field and have another mentor to guide them through their careers

BENEFITS OF PRECEPTING:

y New content for your business

y Fresh outlook on your business processes and content

y Research on new topics

y Mentoring experience

y Potential new hire for your business

y 3 CPEUs!

Additional time for training the intern: While the amount of time training an intern can vary depending on the individual intern and your business needs, I can guarantee that after the first couple of weeks the intern will be essentially providing staff relief for you, freeing up your time to work on those projects you just don’t have time for� Remember, with the new education requirements you will be working with graduate students or those who have already obtained a master’s degree

Meeting competency requirements: Program directors take a lot of this burden for you They will not only outline the competencies that need to be met for the intern during the person’s rotation with you but also provide examples of how each competency can be met

Privacy for clients/patients:

Whether you are working with an intern on-site or remotely, the intern has been trained in HIPAA compliance and understands the importance of patient/client confidentiality

Whether you have interns working with you to see clients and chart, or have them working on educational materials for your website, or anything in between, I can guarantee this is a win-win situation and you will not regret bringing on an intern

Maria MorganBathke, MBA, PhD, RD, CD, LD, FAND, received a B S in Dietetics with a minor in Spanish from UW-Stout in May 2009 She received her Ph D in Nutritional Sciences with a minor in Cancer Biology from the University of Arizona in July 2013 and her MBA with an emphasis in health care management from Viterbo University in 2020 Maria also recently started her own business

Redefining Success: Spring-Cleaning Your Entrepreneurial Mindset

JESSICA CORWIN MPH, RDN DIRECTOR OF MEMBER SERVICES

For me, success once meant name recognition, popularity, and respect Yet as time passes, I realize success, much like myself, is a work in progress, forever shifting and entirely subjective It is a highly individualized process shaped by personal experiences, values and a broader perspective beyond That being said, I am not certain we realize this shift until we reach the requirements of our own initial definition�

As I was kicking off my career in corporate dietetics, presenting on big stages, writing for nationwide magazines and leading our local dietetic association, I relentlessly pursued the dream forecasted from fellow interns as a media dietitian Ultimately, my youthful definition of success - or perhaps a definition I allowed to be determined by the affirmations of others - had been achieved

And yet

If success had been reached, why did my need for greater fulfillment remain?

It was then, after five years in corporate marketing, writing and editing, that I chose to shift gears I realized this world of food and nutrition was far too heavily influenced by food politics and if I wanted to make a difference (for both human and planet wellbeing), if I wanted to fulfill this empty space within, I needed to get closer to my roots … my reasons for becoming a dietitian Therefore, I graduated with my MPH and transitioned over to community nutrition Here, I could still write while also leading cooking classes, meeting with patients in their homes and helping new moms learn to “nourish and play” Here I reignited my passion for nutrition� Here, I redefined success�

Success is becoming who we are meant to be, time and time again

Then the pandemic hit and success became one focused on motherhood and helping my family remain rooted together During this time “off,” I was able to explore other passions and allow time for my innate love for learning to return In time, I realized my newfound tendency was leaning toward women’s health and thus, success was once again redefined into one in which I was working in this field And voila, here I am

Success is subjective It evolves just as we do Success is becoming who we are meant to be, time and time again�

Success is defined by who you are in this season

Success is defined by what is important to you in each season

Success is defined by what makes you FEEL as though you are where you are meant to be

My current career goals may be more quiet than they once were and with greater gaps in between to build in space for my family, and yet, perhaps that is where my success can be found In time, success may shift once more - perhaps even coming full circle and returning back to my start in marketing and writing Each season has its own success and I can only hope each of us can allow ourselves the space and grace to determine just how and where each of us can feel our fullness

QUESTIONS TO PONDER:

y When you ponder your current career or business, what feels right to you?

y What is your first definition of success that comes to mind?

y Where do you need to be to feel on top of your game?

y Who do you need to be for success to feel fulfilling?

Give yourself some time Grab a journal Step outside Dream about how your definition of success may be shifting�

Jessica Corwin, MPH, RDN - Despite transitioning away from entrepreneurial work this year as Jessica jumps into new roles in the field of Women's Health, she couldn't pass up the opportunity to give back to a DPG that has inspired her for over one decade The variety and depth of information shared in this group is just incredible, whether you are an entrepreneur or not! Jessica has 15+ years of experience in public health, culinary medicine, group education, as well as writing and editing That being said, she works hard in order to play hard, soaking up the sun on the sandy shores of Lake Michigan with her three children, husband, and boxer dog

Spring-Clean Your Business: 10 Proven Methods to Boost Efficiency and Inspiration

KATIE BREAZEALE MS, RD, LD INCOMING DIRECTOR OF MEETINGS

Spring cleaning is not just for your home Businesses need a boost, or spring cleaning, as well I have 10 tips for spring-cleaning your business to help it be its most efficient and inspirational

10 TIPS TO BOOST EFFICIENCY AND INSPIRATION

1 Time Management. Time management can make or break some people

Some like to live like their tails are on fire; for others, that could set them into a downward spiral Time management helps you and your employees improve workplace efficiency It is very easy to get distracted, especially with emails, texts and social media

There are many task-oriented sites to help you stay on track such as Asana, Monday, Google Tasks and Notion By spring cleaning your time management you’re able to get more accomplished, delegate easier and work better overall

2 Collaboration. Whether you have several employees or are a solopreneur, collaboration is a great way to improve your efficiency and possibly inspire you to do a project you normally wouldn’t, or learn a new skill that will help you in your business

3 Be Comfortable Saying No. No means no and you have to be willing to say it When building/working on your business, you cannot take on every task, project or patient If you have employees, give them the chance to shine This boost of confidence in your staff will help inspire them, creating a great work environment Not every job is right for you, and prioritizing what aligns with your business and beliefs is key It is also key for avoiding burnout

4 Take a Break. Speaking of burnout, take a break When I was a manager, we went to quarterly leadership training One of the agenda items was PTO It was recommended to take two to three days every quarter to help avoid burnout and recharge Most people think of PTO as the only way to take a break Breaks during your day are just as important Do they need to be an hour? No But a chance to stand up, look away from the screen and stretch

is a great break I know you know what I am talking about Being glued to your computer, tablet and phone for fear of missing an email, constant patient treatments and documenting, working on projects and creating social media/ blogs can take its toll on you mentally, hence the burnout/exhaustion

5 Create an Inspiring Environment. This could be your personal workspace or the one you create for your team An inspiring workspace is both mental and physical Is where you work messy and disorganized? This can be more distracting than helpful when you’re working� Unable to find items or distracted by what you find in the mess lowers your efficiency and management of your time Do you need inspirational quotes all over the place? No I will be honest when someone tells me something is meant to be “inspirational,” I cringe inside because that doesn’t line up with my personality But to be organized and manage my time to create better products and interact with my patients better, inspiring me to do my best work - that I can agree to Having an inspirational work environment is part two Encouraging your employees to try new tasks that build up their skills, engage in collaborations that inspire the person to look at something differently, and develop courage in their current skills creates a greater sense of their capabilities and value of the company they work for

6 Goal Setting. You have goals for your business, typically quarterly and yearly Next step: your daily goals to help reach these big goals We set goals to help grow as a business, but also to create excitement and motivation It shows your staff what they are working towards, and when they reach a goal, how valuable the time and energy you and they put in was to reach that outcome

7 Work-Life Balance. This is sometimes the hardest tip to achieve� When running your own business, there are so many moving parts you feel as though taking a break will slow down production This also causes burnout, exhaustion, poor eating habits, and lack of exercise and family time� Setting boundaries for yourself is

important for work-life balance and efficiency in your business Stepping away from work to recharge and come back refreshed is great for creativity, productivity and your sanity

8 Work Smarter, Not Harder. Sounds silly because we have always been told to work hard� When it comes to improving your work efficiency, working smarter is also crucial Matching the skills of your employees to tasks will help with this You don’t want someone who is horrible at blogging to start writing for you Minus the fact that you’re going to make them break out in hives, it is also not efficient for your business� You want to choose the person who writes the best, is comfortable with writing and finds joy in it to start helping you write blogs

9 Find Your Rhythm. This is important for you and your business� Everyone works at different paces and has different thought processes There may be some decisions you make instantly and others you want to think about You may be the type to know what the end goal is you want but must work backwards to the starting point� Understanding your work rhythm will help you better allocate your time for tasks and improve your efficiency

Continuing Education. While it is a requirement for us, it can also be motivating and boost our efficiency

Learning about new trends and software is crucial for a business It can be the reason we chart faster, create content better and learn whom we want to collaborate with Continuing education is also inspiring to employees� People feel valued when their employer is willing to spend money on them to better their skills

I hope that you found inspiration for your business and areas where you may want to do a little spring cleaning yourself

Katie Breazeale, MS, RD, LD, lives in Texas Katie loves to play tennis and plays on a USTA league team When she is not working you can find her shopping for shoes, playing with her two children, or reading a book

Make Your Retirement Dreams a Reality (Your Future Self Will Thank You)

KIRSTEN DEUMAN MPH, RDN GUEST AUTHOR

If you are like me, you may find yourself daydreaming about retirement every now and then I daydream about traveling, reading books at the beach and spending quality time with family For others, a retirement dream may be spending time on a favorite hobby or volunteering for a local organization� Everyone has different goals for retirement, but what we all have in common is that we need to have a plan so that we can make those daydreams a reality

Planning for retirement looks a little different for business owners than for employees� Employees have access to employer-sponsored retirement options, such as a 401K, and the employer typically contributes a percentage toward that plan Business owners don’t have these benefits and instead have to set up their own retirement plans You may have questions about how to do this and may be unsure about where to go for answers It can feel overwhelming, especially when there are a bazillion other things you oversee for your small business

When I started my business, I had a lot of questions too� Fortunately, around the same time I started my consulting business, my husband had also just started his practice as a financial advisor at a major firm I honestly had no idea that he would soon become one of my most valuable resources Through his advising and, in partnership with my CPA, we determined the right retirement option for me and my business Now I know that if I stick to my plan, my retirement daydreams will someday become a reality

For help with developing a retirement plan, you may also find it beneficial to seek professional assistance While you are speaking with a financial professional, you should know the person’s primary focus for the conversation should be on

what your goals are for the future Be prepared to share the age at which you want to retire and what you envision your retirement looks like for you� The conversation should focus on how the advisor can help you reach your retirement goals - the process of getting you from where you are now to where you want to be

If you have never worked with a financial professional before, here are some questions that could be useful to ask during the first meeting:

1 As a business owner, what are my retirement planning options and what is the best for my specific situation? The financial professional will need to know some information about your business such as the business type, yearly gross business profit and if you have employees

2 How could the recommended retirement program affect my taxes? This is where putting your finance professional and your CPA in contact will be especially helpful

3 What can I do with my old retirement plan from a past employer?

If this article has inspired you to start planning for your future (which I hope it has), my final piece of advice is to find a financial professional that a) you trust and b) is a fiduciary A fiduciary is a designation provided to financial professionals who are required by law to act only in your best interest� Happy daydreaming!

Kirsten Deuman, MPH, RDN, is the owner of RDNutrition, Policy & Research, LLC

In her free time, she enjoys practicing yoga and going on walks while listening to her favorite podcasts Her current favorite podcast is “Do All of The Things” with registered dietitian Christine Thomson

Product Reviews

Title: KaiZen® RD EMR/Telehealth Platform

Owner: Karen Patalano, MBA, RD, LDN, CDE, NHA

What is included in the price?

y 1-10 patients: $50/month

y 10-60 patients: $85/month

y Over 60 patients: pricing is tiered and ranges from $1 to $1 50/patient/month

Required/recommended equipment: Computer/tablet/phone with internet capabilities

Major Function: Electronic medical record and telehealth

Target Audience: Dietitians in private practice and health coaches

Capabilities: HIPAA-compliant medical records

Limitations if any: Does not allow clients to log on to view their own records or make their own appointments Cannot send documents or messages directly from the program�

Review:

As a new RD I spent three to four months last year researching and overanalyzing EMR options, so much so that I was terrified to decide, lest I choose the wrong one So, when the opportunity came up to review the KaiZen®RD EMR program, I jumped at the chance Developed by an RD with over 30 years of experience, KaiZen®RD EMR was originally released in 2012� It has been updated over the years and a telehealth component has been incorporated along the way�

KaiZen®RD EMR is a simple-to-use program The video on its website will walk you through the whole program (kaizenhealthcare com/our-work/), and it offers a free trial so that you can try it out before making a commitment� It is a simpleto-use, HIPAA-compliant EMR that walks you through a nutrition counseling session, generates bills for insurance and allows you to upload those bills to your clearinghouse at the end of the day The program includes Pedi/Eating Disorder, LEAP, ADIME and SOAP notes, and a tab for you to create a basic meal plan   A logo can be added to the ADIME and SOAP notes but customization options for the forms are limited beyond that

For those RDs looking for a HIPAA-compliant portal that allows clients to log in and see their chart notes and schedule with you, this is not the EMR for you This EMR does not have the capability of directly communicating with a client or sending documents or messages directly through the program The visit notes must be downloaded to the computer, then sent via regular email

This program is perfect for those who want a simple to learn and use program with no fuss For those RDs looking for additional capabilities and customization options, there are more affordable programs available

Reviewer: Grace Monroe, MS, RD

Title: Registered Dietitian

Affiliation: The Sweat Shop PT, LLC

Do No Harm: Reducing Weight Bias in Dietetics Practice

CARRIE DENNETT MPH, RDN CPE ARTICLE

LEARNING OBJECTIVES

After reading this article, the participant will be able to:

1 Explain why weight stigma and bias contribute to healthcare avoidance

2 Understand the unique impacts of implicit and internalized weight bias

3 Apply strategies for reducing weight bias in healthcare settings�

PERFORMANCE INDICATORS

4.2.2 Reflects on own values, beliefs and biases�

8.2.3 Analyzes new information and how it impacts medical nutrition therapy�

9.6. Applies behavior theories in nutrition counseling

It’s no secret that we have a lot of weight bias - negative, prejudiced attitudes and beliefs about individuals due to their weight in our society This can have a profound impact on patients and clients across the weight spectrum, as well as on dietitians themselves, who are not immune to societal pressures

Weight bias manifests as weight stigma, the labeling of someone with stereotypes based on their weight, and even overt discrimination based on body size 2 It’s a common belief that weight stigma will motivate individuals who don't meet body size ideals to change their behaviors in order to conform and avoid further stigma 3 However, weight stigma not encouraging people to lose weight or improve their health has been overwhelmingly demonstrated in research Instead, it has negative effects on both psychological and physical health, contributing directly to anxiety, depression, poor body image and self-esteem, increased stress, disordered eating behaviors, avoidance of physical activity, high blood pressure, high cortisol levels and systemic inflammation 4-14 Ironically, this may lead to additional weight gain - and additional stigma 8,15

Data from national studies typically shows that about 40% of the general population reports that they have experienced some type of weight stigma - whether it be weightbased teasing, unfair treatment or discrimination 16,17 One of the most common types of weight stigma is inappropriate comments from family members,18 which is significantly associated with unhealthy behaviors 8 Other common sources of weight stigma include media, society, employers, educators and healthcare providers�19 When dietitians and other healthcare providers have weight bias, the harm can be particularly acute,18,20,21 in part because the resulting stigma, when perceived by patients, may lead to avoidance of healthcare 21-23 This is one reason that the World Health Organization

says weight bias is a fundamental cause of health inequalities 24

TYPES OF WEIGHT BIAS

Weight bias, also referred to as antifat bias, can be explicit or implicit, externalized or internalized

y Explicit weight bias is conscious, often represented by intentional discrimination and prejudice against people in larger bodies 25 For example, a healthcare provider with explicit weight bias may believe their patients with BMIs in the “overweight” or “obese” range are non-compliant, lazy, sloppy and lacking selfcontrol, less adherent to lifestyle recommendations, and personally responsible for their weight

y Implicit weight bias is unconscious, yet still affects our understanding and actions� These biased attitudes may exist somewhere in our memory, and are often distinct from our conscious values and beliefs - for example, unconscious assumptions about higher-weight patients that may affect healthcare treatment 26

A 2012 study from a large representative sample showed that both medical doctors and the general public hold strong explicit

and implicit weight-biased attitudes,27 and a 2017 systematic review found that healthcare professionals have the same levels of implicit bias as the general population 26

When weight bias manifests as weight stigma, it can take the form of labeling, stereotyping, ostracizing, separation, status loss and discrimination When embedded in institutions - including healthcare - and the broader society, this is known as structural or institutional stigma When it’s perpetuated by others, including friends, family, co-workers, individual healthcare providers or strangers, it’s known as externalized stigma Stigma can also be vicariously experienced through knowledge of others' experiences with stigma, such as hearing about stigma or discrimination in the media or witnessing the direct experiences of friends and family 28

Research suggests that internalized weight stigma - when someone accepts weight-based stereotypes to be true about themselves - has the greatest impact on physical and mental health�29,30 When patients internalize weight stigma and feel bad about themselves because of their weight, they feel less confident in their ability to engage in health behaviors - and become less likely to do so - while becoming more prone to binge eating and other behaviors that may harm health�29,31-34

When people try to lose weight and fail, especially if they place an

extremely high value on weight and body shape, this can strengthen internalized stigma 34 But even with “successful” weight loss, internalized stigma may not lessen A 2019 study of 133 adults in the “obese” BMI range who lost about seven percent of their body weight over 66 weeks of follow-up found that weight loss was not associated with a reduction in internalized weight bias 35 Additionally, individuals in thin bodies may internalize weight bias, and that internalization is associated with clinically significant eating pathology, driven by the fear of weight gain 36 A more technical way to look at how fear of weight gain can lead to internalized weight stigma is through modified labeling theory 37,38 This is the idea that individuals understand from a very early age how society treats members of stigmatized groups, including individuals who are deemed “overweight ” This can lead to the fear that they themselves could be looked down upon or rejected if they were to become a member of that group So the mere potential of being devalued or rejected, even without direct experiences of discrimination, can still undermine health

HOW WEIGHT BIAS AFFECTS

HOW DIETITIANS CARE FOR

PATIENTS AND CLIENTS

A 2015 systematic review found that dietitians tend to have less-negative attitudes toward obesity than the general public and other healthcare professionals� However, six of the eight studies found that dietitians were prejudiced against people with obese BMIs to some degree - either being explicitly “fat-phobic” or simply having a preference for thin patients Four studies found that dietitians viewed people with obese BMIs as being personally responsible for their weight and associated health conditions�21

The Academy of Nutrition and Dietetics’ code of ethics39 includes three principles that aren’t compatible with weight bias�

Non-maleficence (“do no harm”) says that dietitians should act in a caring and respectful manner, mindful of individual differences

Beneficence (“acting to help others”) includes making decisions that contribute to the well-being of patients and clients, and refraining from harassment

Justice calls on dietitians to help reduce health disparities, protect human rights, and provide fair and equitable treatment

Dietetic education at many institutions remains weight centric, emphasizing weight and weight loss when defining health and well-being� Primary care guidelines also recommend that medical providers automatically provide patients with a BMI over 30 with weight-loss interventions and nutritional advice even if they are being seen for something unrelated to body weight, like strep throat 40

When providers believe negative stereotypes about patients with an obese BMI, patients pick up on the resulting attitude shift and lose trust 20,22 Patients - especially women - who experience weight bias from providers may cancel or delay appointments and preventive health care screenings, especially if they have gained weight since the previous visit21-23 or have internalized weight stigma 41 Failure to get adequate preventive healthcare - whether due to weight stigma, lack of access to healthcare or other factors - could be responsible for some of the negative health outcomes typically associated with having a BMI in the “obese” range 21

HOW TO REDUCE WEIGHT BIAS

“Person-first” language is often cited as a way to exhibit non-bias with patients in larger bodies - saying “you have obesity” instead of “you’re obese,” or “people with obesity” instead of “obese

people/the obese ” However, personfirst language can still be stigmatizing when the word in question is “obesity,” because that word carries stigma no matter how it’s used in a sentence

In a 2016 opinion piece, titled “What’s in a Word?,”42 the authors suggest that the word “obesity” be discarded, because it's become “mired in the medicalization of body state ” They recommend doing away with the words “obese” and “obesity” altogether in research, publishing and healthcare, instead using neutral terms like “weight” and “higher weight ” If a dietitian needs to refer to a patient’s body size, “larger-bodied” is another option, or ask the patient or client what terms the person prefers when referring to the person’s own body Some prefer simply “fat,” a word that’s increasingly being reclaimed as a neutral descriptor of body size 43

But choosing the “right” words is not enough to fully counter the harmful effects of weight bias in providerpatient interactions Unfortunately, research on how to reduce implicit bias is far from robust, but a place to start is with intentional reflection�44 What are your personal beliefs, attitudes and assumptions about body weight, health and appearance? For example, do you automatically assume, before you know details about a person’s health history, that a thin patient has fewer health

concerns than a fat patient? That the thin patient will be more “compliant” with your recommendations? Do you automatically recommend weight loss for a fat patient with a particular health concern, whereas you would recommend nutrition and lifestyle changes for a thin patient with that same concern? Harvard’s Implicit Associations Test is an online tool for measuring implicit bias about weight and several other individual characteristics 45

This process can be uncomfortable, because it does not feel good to examine your biases and realize that you actually have them, especially if there’s a chance you may have caused harm in previous patient encounters However, implicit biases played a vital survival role early in human evolution Today even good people possess implicit biases, passively acquiring them through “cultural immersion,”46 which includes literature, entertainment and news media, and long-established practices of many public and private institutions 47 Research on obesity and weight loss also contains significant confirmation bias 44,48

Pairing exploration of your biases with self-compassion can help you remain open to challenging preconceived notions� The three components of self-compassion are mindfulness, self-kindness and common humanity You too are human and humans make mistakes - but when you know better, you can do better As dietitians, we can:

y Challenge weightbased stereotypes

y Optimize psychological and physical health and well-being for patients of all sizes

y Focus on treating the condition rather than the weight�

y Model respect, sensitivity and compassion to people of diverse body sizes in front of colleagues, staff, students and interns

y Set up our practice environment to be accessible and friendly to people of size

y Be a safe harbor for patients who might be experiencing weight stigma from other providers�

y Call out weight stigma in the healthcare setting when we see it

Pairing exploration of your biases with selfcompassion can help you remain open to challenging preconceived notions�

Finally, while dietitians in certain niches, such as eating disorder treatment, may actively work with patients to reduce internalized weight stigma, dietitians in any niche may find that they have their own internalized weight stigma, affecting their own well-being and possibly affecting their encounters with patients in higherweight bodies Doing their own healing work with a weight-inclusive dietitian or therapist who specializes in body image work is highly recommended

Carrie Dennett is a Pacific Northwestbased nutrition therapist, certified Intuitive Eating Counselor and owner of nutritionbycarrie com She’s the nutrition columnist for The Seattle Times and contributes regularly to Today’s Dietitian Magazine

REFERENCES

References for this article can be found at the QR code to the left�

RESOURCE LIST FOR MORE INFORMATION

y Self Compassion: Self-compassion org

y Center for Mindful SelfCompassion: centerformsc org/

y Dennett C Weight bias in dietetics education� Today’s Dietitian� March 2019:36�

y Dennett C Weight-centric health care is status quo, but it’s not helping patients The Seattle Times July 11, 2022

y Dennett C What will it take to get weight-inclusive health care? The Seattle Times July 18, 2022

Head over to NEdpg.org CPE library to take the quiz and claim your certificate.

Legislation: U.S. Farm Bill

ELIZABETH REED MPH, RDN, LD DELEGATE

No matter how long you’ve been a dietitian, you have most likely heard about the Farm Bill either from university instructors or news coverage of Congress Maybe you, like me, didn’t pay much attention to the details My interest in the Farm Bill was piqued last fall while visiting my senator on Capitol Hill in Washington, D C Before the visit I contacted The Academy’s Office of Legislative and Government Affairs where I was encouraged to discuss the details of the Farm Bill with the senator’s staff Luckily, they provided the necessary background with many details of the Farm Bill and included the Academy’s recommendation

Enacted in 1933 under President Franklin Roosevelt, the Farm Bill was crafted in response to the dual crises of the Great Depression and the Dust Bowl The original Farm Bill had three goals: to keep food prices fair, to ensure an adequate food supply, and to sustain and protect America’s natural resources Currently the Farm Bill has 12 sections covering all things food and nutrition

The Farm Bill is how the federal government shapes our food and agriculture systems Because of this the Farm Bill has a tremendous impact on rural communities, food security, farmers’ livelihoods and the environments our food is grown The Farm Bill ensures we have a safe and affordable food supply that protects the health of the nation

The Farm Bill is usually reauthorized every five years, and the next Congressional vote will be September 2024 The Academy is advocating for the 118th U S Congress to pass a Farm Bill that maintains the integrity of nutrition assistance programs, ensures vital funding for nutrition education and research, and allows equitable access to nourishing foods In preparation for the reauthorization vote, the Academy’s Farm Bill Work Group has developed goals:

1 To strengthen and expand federal nutrition programs and intervention that improve nutrition security and promote health equity. The Academy supports funding nutrition education through training programs, expanding SNAP benefits

and providing sufficient funds for EFNEP The Academy supports federal nutrition programs encouraging technology to help consumers afford healthy foods; lowering barriers to SNAP so military families, college students, immigrants and people with disabilities can participate; authorizing mandatory funding of the Emergency Food Assistance Programs to meet the sustained high demand of food banks nationwide; and supporting farm-to-school programs

2 Adequate funding for development programs to strengthen consumer education by utilizing a strong science portfolio. The Farm Bill allows the Secretary of Agriculture to provide funding opportunities which provide incentives to income-eligible consumers� One program with this mission is the Gus Schumacher Nutrition Incentive Program (GusNIP), a produce prescription program which supports and evaluates the impact of fresh fruit and vegetable prescriptions to increase consumption, reduce individual and household food insecurity, and reduce healthcare usage

3 Support food producers and retailers to meet current and future demand for healthful and diverse foods. The Academy supports increased funding to expand regionally grown food, incentivize healthful food, improve diet quality and food security

TITLES OF THE FARM BILL (P.L.

115-334)

y Title I, Commodities: Provides support for major commodity crops, including wheat, corn, soybeans, peanuts, rice, dairy and sugar, as well as disaster assistance

y Title II, Conservation: Encourages environmental stewardship of farmlands and improved management through land retirement programs, working lands programs or both�

y Title III, Trade: Supports U�S� agricultural export programs and international food assistance programs

y Title IV, Nutrition: Provides nutrition assistance for low-income households through programs, including the Supplemental Nutrition Assistance Program (SNAP)

y Title V, Credit: Offers direct government loans and guarantees to producers to buy land and operate farms and ranches

y Title VI, Rural Development: Supports rural housing, community facilities, business and utility programs through grants, loans and guarantees

y Title VII, Research, Extension, and Related Matters: Supports agricultural research and extension programs to expand academic knowledge and help producers be more productive

y Title VIII, Forestry: Supports forestry management programs run by USDA’s Forest Service

y Title IX, Energy: Encourages the development of farm and community renewable energy systems through various programs, including grants and loan guarantees�

y Title X, Horticulture: Supports the production of specialty crops, USDA-certified organic foods, and locally produced foods and authorizes a regulatory framework for industrial hemp

y Title XI, Crop Insurance: Enhances risk management through the permanently authorized Federal Crop Insurance Program

y Title XII, Miscellaneous: Includes programs and assistance for livestock and poultry production, support for beginning farmers and ranchers, and other miscellaneous and general provisions�

I will be watching the upcoming vote of the Farm Bill and hope you join me!

Elizabeth Reed, MPH, RDN, CNSC, ownerof Apple a Day Nutrition Consulting, LLC since 2004

Afterraising two daughters with celiac disease she opened a gluten-free baking company and provides classes and tours forgluten-free living Elizabeth can be found hiking the Flatirons and zooming around Boulder with her husband on their electric bikes Combining work and pleasure this year she will be traveling to the Amalfi Coast for a conference then off to Machu Picchu this fall to hike with friends - all fueled by a love of great food and continued learning from the Academy of Nutrition and Dietetics

LESLIE EDWARDS

MS, RDN, LD, CSOWM, CPT, RYT

Leslie Edwards, MS, RDN,

LD, CSOWM,

CPT, RYT, is a clinical dietitian at UC Health in Cincinnati, Ohio, and the owner of Cultural Wellness, a privatepractice health and wellness business�

Q: Tell us a little about your background.

A: Growing up, I was an athlete; I ran track and danced I loved movement and fueling your body I went into my undergraduate experience at The Ohio State University as a nutritional sciences major, but pre-med It wasn’t until I did a semester of service with community nutrition and gained hands-on experience that I realized I wanted to become a dietitian Talking to people about food, conducting cooking classes, providing nutrition education, and witnessing people’s excitement about food and nutrition piqued my interest in dietetics

During the clinical nutrition training, I discovered an interest in obesity and weight management I realized I loved the nutrition counseling aspect - being able to sit down with someone and help the person make changes that have an impact over time using whole-person, patient-centered care

Currently, I am a dietitian in a bariatric center, supervising weight-loss programs

Q: How has your background enhanced your dietetic practice?

A: I started teaching fitness classes in undergrad Movement goes hand-in-hand with nutrition - it is so important for healthy aging and preventing injuries I always try to bring in movement when talking to patients, encouraging them to add some intentional movement into their day�

What is your definition of diversity and why is it important in the dietetics field?

Diversity is going to look different to everyone It starts when you’re young and collecting habits from family and culture�

All foods have a value Even if more cultural foods are higher in calories but lower in nutrients, they should

still be incorporated Cultural foods promote a good feeling; they’re part of our identity Staying positive and not singling out one or two foods is essential for fostering a supportive and comfortable environment

Q: How do you encourage people to honor the uniqueness of each individual?

A: Everyone’s diet will look different, so it is essential to ensure that a patient understands that the journey will not be the same as someone else’s, even within the same cultural background I encourage patients not to compare themselves to others and to find grace within themselves

It is crucial to determine the patient’s life outside of food and assess how that impacts eating and food choices As practitioners, we must consider adjusting eating patterns to fit more with nutrition� Maybe we’re working with the patient to change certain foods' frequency or portion size

Q: How do you challenge and promote sensitivity and inclusion in the dietetics field?

A: Challenging and promoting sensitivity and inclusion in dietetics is an ongoing process I attend different diversity events and programming to learn more about other cultures I always look for good resources for patients of different backgrounds and cultures to ensure I understand and meet their needs

As a provider, I aim to be a good practitioner and focus on kindness I’ve seen the need for a Black dietitian in my community, so I am in the process of opening my own private practice to help people gain greater access to a dietitian who may share a similar background, culture, or appearance

Q: How has diversity helped you in your job role?

A: Diversity has helped me in my job by being the person for patients who want to see a Black dietitian It’s nice for patients not to have to explain certain things related to their background or culture I try to be grounded and open as a practitioner, recognizing my biases

Q: What is one tip you have for others to be more culturally sensitive and aware?

A: Body language and facial reactions can say a lot, so we must do our best to remain neutral to prevent patients from turning inward and feeling bad about themselves or their food choices Maintaining an open mind is also vital to being culturally sensitive and aware

Q: How would having more diversity in dietetics providers improve our field?

A: There are so many cultures in the United States, so it helps to have providers and dietitians from all backgrounds Having greater diversity in dietetics would make people feel more welcome and encourage them to see dietitians�

INTERVIEWED BY:

AMY BROWNSTEIN MS, RDN INCOMING EDITOR

Amy Brownstein, MS, RDN is a private-practice dietitian and consultant She is passionate about translating nutrition science into tangible, digestible information and recommendations Amy is an outdoor enthusiast, spending most of her time biking, hiking or running When she’s not outside, she enjoys baking and trying natural wines

Leslie Edwards, MS, RDN, LD, CSOWM, CPT, RYT

Ventures

6301 Snidercrest Rd

Mason, OH 45040

Webinars

Learn More About Courses & Webinars at NEdpg.org/ne-courses

Nutrition and Diet Therapy for IBD

March 11th, 1pm EST

Kelly Issokson, MS, RD

No Design Degree Needed:

Practical DIY Design Tips & Tools for Nutrition Entrepreneurs

April 16th, 1pm EST

Whitney Bateson, MPH, RD

Pro Tips for Food Photography

May 14th, 1pm EST

Sara Haas, RD, LD

Halfie Hours & Masterminds

Learn More & Register at NEdpg.org > Events

Halfie Hour

March 20th, 12:30-1pm EST

Lisa Jones, MA, RDN, LDN, FAND

Take the NE Member Survey We Need Your Input to Do More for YOU!

April Mastermind Session

April 17th, 12-1pm EST

Halfie Hour

May 15th, 12:30-1pm EST

Lauren Minchen, MPH, RDN, CDN