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Shifting negative attitudes toward food and body. Part 2 Dietetic counselling for stages of change by Marina Payne, APD, CEDC

The process of guiding individuals through the stages of change can be intricate, requiring a personalised and client-centered approach to effectively address and manage food and body concerns in the long term.

With reference to a  practical and real-life case-study outlined in Part 1, Marina Payne, APD and credentialed eating disorder clinician, guides us through a framework and practical trouble-shooting in working alongside clients during each stage of change. She explains the importance of rapport building, regardless of the clients’ stage of change.

In the pre-contemplation stage, remaining consistent, transparent and integrating the basic skills of motivational interviewing through providing well-timed and relevant open-ended questions, affirmations, reflections and summaries can ensure that this stage of change is appropriately navigated. Any client resistance should be explored in an emphathetic manner, with the clinician reflecting on change talk, rather than on sustain talk.

Marina explains that during the contemplation stage, pschoeducation can be introduced but ideally only once permission has been obtained to provide information. This could include providing education on diet culture, diet cycles, the set point theory, debunking BMI, and exploring the pros and cons of weight changes. In the preparation phase, food rules and behaviours can be explored and challenged more directly. In the action phase, facing food fears through active exposure utilising a food hierarchy, as well as potential body exposure and focusing on reducing body checking behaviours, can ensure that thoughts and behavious are challenged. During the maintenance phase, continuing to identify and address any harmful diet or body ‘triggers’ through setting healthy boundaries is key to prevent long-term diversion to previous negative attitudes and associated behaviours.  

Overall, working through the stages of change alongside clients is not linear, and it is critical that individuals are met with empathy and understanding regardless of their current stage of change in shifting negative attitudes towards food and body.

Summary:

• The process of guiding individuals through the stages of change can be intricate, requiring a personalised and client-centered approach to effectively address and manage food and body concerns in the long term.
• Motivational Interviewing can be a useful tool in navigating each stage of change through providing well-timed and relevant open-ended questions, affirmations, reflections and summaries.
• Psychoeducation should ideally not be emphasised until the preparation phase, and only once permission has been obtained from the client; this psychoeducation could include providing education on diet culture, diet cycles, the set point theory, debunking BMI, and exploring the pros and cons of weight changes.
• Working through the stages of change alongside clients is not linear, and it is critical that individuals are met with empathy and understanding regardless of their current stage of change in shifting negative attitudes towards food and body.

Marina Payne is a credentialled eating disorder clinician and APD who has worked in a collaborative team of healthcare professionals in the area of eating disorders for four years. Marina understands the need to tailor her approach appropriately as she recognises that her clients will bring forth their own unique experiences. Marina uses the non-diet approach and works within a weight-inclusive healthcare paradigm to assist her clients in turning towards their own body’s inner wisdom.

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