[00:00:00] In today’s episode, we are in conversation with dietitian Rachael Hartley, who shares her journey into the field of dietetics and how she integrates intuitive eating and Health at Every Size into her practice. We explore the difference between weight inclusive and weight centric care, especially in managing conditions like diabetes, PCOS and even IBS. Rachael also discusses the hidden cost of chronic dieting, how to break free from diet culture and practical steps to build trust with your body, plus, she offers some simple ways to start practicing intuitive eating today. Stay tuned.

[00:00:42] Shireen: Podcasting from Dallas, Texas. I am Shireen, and this is the yumlish Podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease, we hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

[00:01:15] Rachael Hartley is a registered dietitian and author of the book gentle nutrition. At her practice, Rachael Hartling nutrition, she supports her clients in improving their health and well being and navigating health concerns through non diet approaches. Welcome Rachael.

[00:01:31] Rachael: Yes! Thank you so much for having me, glad to be here.

[00:01:35] Shireen: I want to get into some of these things, but before that, I want to learn a little bit more about you, and I want our listeners to learn a little bit more about you. Can you tell us a little bit about your own journey to becoming a registered dietitian? What really led you to become a dietitian, and what is your philosophy around food?

[00:01:53] Rachael: Yeah, absolutely. So, yeah, I’d love to share with people that I became a dietitian because I love food. Food has always been an interest of mine, something that I am excited about, whether it’s trying new foods or making new recipes, that was just always a bit of a hobby or an interest, and it really was in college when I was undergrad with psychology, kind of had that very typical right before junior year experience of, oh my gosh, is this what I want to do? I don’t know what I want to do with my life. And looked into nutrition as a option, as a major and kind of learned about the career path of becoming a dietitian. So yeah, so that, that really was the beginning of leading me to where, where I’m at today. After entering the field, I first worked in clinical and then in outpatient dietetics. Eventually launched my own practice where I can really fully practice with my philosophy, with my own approach, where, which is very much rooted in the idea that nutrition is there to, it’s a tool that we can use to improve well being and overall wellness, that it’s not, you know, that weight isn’t the uh basically, when we focus on our well being and our overall wellness that, that’s really the key to improving our physical and mental health. So yeah, so it’s been a long journey, but I’m so glad that I, you know, stumbled into this career path, and that I was able to shift from a more traditional, weight centric approach, and find this philosophy, this approach to nutrition, that really feels, feels good, it feels right. 

[00:03:47] Shireen: Yeah, that’s super helpful. You know, you mentioned something there, which is in the approach that you talked about. It really incorporates what we hear about, which is known as the Health at Every Size, and also intuitive eating, like these approaches we hear about them, but what initially drew you to these frameworks, and how do they influence in the way that you practice as a dietitian?

[00:04:07] Rachael: Yeah, it’s funny, when I was working in clinical dietetics, was when I first learned about intuitive eating, and I think I stumbled across, like, a brief article and a handout that was on the 10 Principles, and it was something that really stuck with me, something that just kind of connected, pardon the pun, intuitively, kind of connected with me. But no, it’s funny. I really I practice still, it wasn’t a it wasn’t something that I learned about and immediately changed the way that I approached nutrition. It was this kind of little thing that was like hanging out there in the background. It wasn’t until I started work as a outpatient dietitian in a large medical center and started doing that ongoing counseling, working with people for long periods of time, that I began to see the very clear you know faults in that weight normative, weight centric approach. I was seeing how the focus on the scale was causing people to stress so much about around food and pay attention to the like minutia around nutrition instead of like the big picture patterns of their eating. I was seeing people, you know, lose weight, regain weight. I was seeing like the weight cycling that we talk about in real time. And so that was when I started to just kind of question things a bit more and dive into intuitive eating, learn more about it. And eventually, when I left to start my own private practice, that’s when I was able, because, unfortunately, when you were working in some of these larger medical settings, you you know that weight centric approach is just kind of part of the bag. And so, yeah, starting my own practice was when I was really able to integrate what I was learning about Health at Every Size, intuitive eating into what I was doing with clients.

[00:06:04] Shireen: Super helpful, I do want to go to a point of clarification, though you mentioned the weight centric approach, right? How do you explain this difference between a weight inclusive model and this weight centric approach to new patients or providers who are really unfamiliar with Health at Every Size,

[00:06:22] Rachael: Absolutely! Yeah, there’s this myth that anti diet or Health at Every Size, or intuitive eating is also anti health or anti nutrition, but that, you know, couldn’t be further from the truth. Really, you know the difference between this weight normative, weight centric approach and a more weight inclusive, anti-diet approach, is that the focus, like the things that we’re working on with clients, it’s not about changing the scale. It’s not looking at weight loss or weight maintenance or anything like that as the outcome or the goal of our work together. It’s really focused on, you know, behaviors with food. Overall lifestyle is supporting clients in figuring out what’s a way of feeding themselves that feels good for them. It’s about, you know, creating an environment where we’re not pathologizing body sizes and having this automatic assumption that someone in a bigger body is therefore unhealthy, so yeah, again, it’s really about the health promoting behaviors, not the number on this scale as a measurement of quote, unquote, success.

[00:07:36] Shireen:How do you challenge this usual weight focused approach in this context of nutrition therapy, especially when you start looking at some of the chronic conditions, like diabetes, heart disease, IBS, even PCOS, for instance. How does all of this integrate within the health spectrum?

[00:07:56] Rachael: The way that these health conditions are often approached, there’s almost this underlying assumption that weight is the main factor, that the main contributing factor. There’s just this, like, yeah, kind of this automatic assumption that for somebody with diabetes, if you just, like, you know, wave a magic wand and could, you know, remove a certain amount of adipose tissue, and this like magic weight loss wand, that all of a sudden they would be in perfect health. So when we use this example of the magic weight loss wand, you know, it is certainly within the realm of possibility that there could be a change to someone’s health or their blood sugars. But it’s not always the case. Some body diversity is a very real thing. There are many people who are at their healthiest weight, at a higher weight, at a weight that may be the BMI scale, which I could go on my own little separate rant about. Would mark is unhealthy, but yeah, so. So with these conditions, the ways that I challenge it, you know, number one is looking at, you know, the whole person, and not making this automatic assumption that losing weight is going to be the key to managing or improving their health condition. We talk a lot about just general health promoting behaviors, ways that we can use food and lifestyle and stress management to help them manage their symptoms and just feel better day to day. A big part of it, too, is just working with a client to figure out what is their definition of health, what are the most important aspects, or what are the places where their health condition is causing the most distress in their life? And how can we add in supports there? I know I mentioned this earlier, but again, it brings in this idea that anti diet, it’s not anti health, it’s just. Looking at a different measurement of health, and it’s also letting the client play a role in defining what health means for them.

[00:10:08] Shireen: I absolutely love what you’re what you’re mentioning there, which is like when the client decides what help means for them, they’re really empowered in their journey, rather than okay, what do I do and what do I do now? And what do I do now? It’s not it’s less hand holding and more empowerment, and like helping them lead the way, which, to me, is is a much more powerful place. You know, when you’re talking about diet culture, right? It is almost the opposite where we’re talking about weight and how it would be associated with all of these chronic conditions. But the flip side of that is that diet culture often presents itself as this pathway to a healthy body, a healthy living, but it can end up making people feel more chaotic around food as well at the same time. So how do you help clients recognize and really break free from that cycle?

[00:10:59] Rachael: Yeah, I think that’s such an important point, how diet culture really does kind of present itself as the as the cure, as the fix, and if it’s not working for somebody. It’s not the diet that’s in the wrong. It’s like, the person just doesn’t have enough willpower. They’re just, like, not doing it right. And so it really does. It sort of presents itself as a almost like a medicine with no side effects. It’s like, okay, this diet is the answer and there are no negative consequences. Of course, people are going to, you know, turn to rigid or restrictive eating patterns when they’re struggling with something health wise, but yeah, oftentimes it does the exact opposite of what it’s selling. You know, oftentimes the diet is the cause of the chaotic eating and not the chaotic eating being. The chaotic eating patterns don’t just like come up in a vacuum there is, there are different factors and different just experiences with food that that lead to that feeling. So, yeah, so a lot of my clients, when they,  when I first see them, they’re often in these patterns, these kind of restrict binge patterns. And, you know, it’s not always a binge, necessarily. On the other end, it could be emotional eating or just really impulsive eating, or just kind of like grazing eating patterns, but it’s almost always this restriction that is the factor or the trigger for the behavior that feels really chaotic and out of control. So what I do with clients, how I tend to address that? You know, number one, we almost always start off by just kind of normalizing their eating pattern, teaching them, like, what does it look like for you to eat enough and fuel your body adequately throughout the day. Most people I work with like their conceptualization of what their body needs is very much dictated by what they’ve read in different diet books or what they were, you know, told when they were a teenager. You know, they have this idea of what they should be eating that’s actually, like, quite restrictive and inadequate. So yeah. So in order to kind of address the chaotic feelings around food, we first want to just like stabilize and make sure somebody is again fueling adequately. And once we address that, when somebody is eating enough food and we’re taking those hunger extremes out of the equation, then we have a lot more room to identify what are the factors that are leading somebody to feel chaotic around food. Maybe it is a lot of emotional distress. Maybe there is a really difficult workplace situation where someone is constantly on high alert all day, and then they come home and they’re using food as a way to numb or to cope with those anxious, on alert feelings that they’re having all day long. You know, maybe it’s something with the food environment. Maybe it’s something with like, just food skills, like food preparation skills like maybe, as somebody comes home and they have no idea how to meal plan or how to be prepared to feed themselves, and so they’re always making decisions about what to eat, just, you know, spur of the moment, without having any sort of loose plan in mind. And that’s the thing feeding into the chaotic eating patterns. It’s 1,000,001 different things, because our relationship and behaviors with food are complicated. But I think unless we kind of take hunger out of the equation, or I should say extreme hunger out of the equation, it’s really hard to identify what, what someone’s like specific triggers are.

[00:15:01] Shireen: You know, what are some of the less talked about costs of chronic dieting? You mentioned a couple. So physically, there’s also the emotional aspect, and then there’s this whole another space, which is like the social aspect and how food becomes a part of our day to day, and interactions with people that you see most often in as you’re working with individuals and help us understand, how does one even navigate through some of these challenges.

[00:15:28] Rachael: Totally because, yeah, as I said earlier, diets, they are not a side effect, free medication. It is not something that is free from any potential consequences. And yeah, oftentimes mainstream healthcare throws out this recommendation to either lose weight or to go on a specific diet to someone without having any concept number one of just what the person’s current eating patterns are like, but number two, without actually talking through what the risks involved are. You know, it’s we understand with medication. You know, if a doctor is going to prescribe a medication, we want to talk about like, what are the potential side effects, like going through the informed consent, the, you know, the potential pros and the potential cons. But that almost never happens with dieting, and yet, there are these very serious potential side effects that that that can come up. You know, of course, from like a physical standpoint, we look at weight cycling. So weight cycling, it’s what we commonly call, like yo-yoing, when somebody loses weight regains, loses weight regains. That is actually the most common outcome of someone going on a diet. There’s research that shows about 60% of people will actually gain back more weight than what they lost initially with the diet. So some people will sort of jokingly say that, like, you know, diets are really the, you know, the when you’re prescribing a diet, it’s really just prescribing weight gain in the long run. But yeah, that yo-yoing, it has an effect on our body, on our metabolism, on our metabolic health. And I don’t say metabolic health, meaning weight necessarily. I mean all those like, internal processes in our body. So impacts like blood sugar regulation, blood pressure, you know your body is adjusting to managing blood pressure for a smaller body than a bigger body, than a smaller body, than a bigger body, we see impacts on kidney health with this so, so lots of health effects of that, that chronic yo yoing, that chronic weight cycling, we also see, just like the side effects of undernourishment, somebody doesn’t have to look physically emaciated. They don’t have to look like what most people would conceptualize as someone who’s underweight to be suffering from the side effects of undernutrition. So really common to see people who have vitamin and mineral deficiencies, who are struggling with fatigue, digestive issues galore. That’s probably the biggest one. One of the reasons that I started sort of specializing in IBS was because working with, like so many chronic dieters, so many people with disordered eating, it was almost like impossible to not also specialize in IBS and digestive health. Yeah , so lots of physical consequences. Of course, there’s like the emotional consequences from restriction most people are familiar with, with anger. You know, that is a pretty an experience pretty much everyone has had at some point in their life. But then you extend that like, what do you think happens to your mood when you’re chronically under nourished? We see much higher rates of depression and anxiety. Of course, you know, the chronic sort of yo-yoing, the chronic weight cycling. It has a huge impact on one’s feelings of self esteem, of self efficacy. So there’s a lot of emotional acts as well. Yeah, and you mentioned socially, of course, when somebody is following a really rigid diet pattern that has a big effect on your social life and what you’re able to do, we socialize with food. That is part of how humans evolved, was to connect over food. So when somebody has a very rigid diet that they’re trying to adhere to, oftentimes that means missing out on social engagements, or going to the social engagement, but not actually being able to be present in an emotional sense because they’re so stressed about food.

[00:19:54] Shireen: For someone who’s listening and has been, you know, yo-yoing in their diet, or has been part of their diet. Culture, where does one begin? Because conceptually, it sounds great. Intuitive Eating, I should listen to my body sounds great, right? But where do you begin? What are some small, meaningful steps that can be taken by an individual listening to this podcast today?

[00:20:16] Rachael: Yeah, absolutely, because I sometimes will see social media messages around intuitive eating that kind of frame it as like, yeah, just listen to your body start eating when you’re hungry and stop eating when you’re full. And that’s lovely, and that may be helpful advice for someone who’s already in touch with their body, but most people are not, and that’s especially true for anyone who has a history of chronic dieting. You know, the idea of like, just listen to my body is kind  like,”uhhh hello. Is anyone there? What’s, what’s going on here?” So, yeah, I use the analogy of getting back in touch with your body. I talk about it almost like getting back in touch or reestablishing your relationship with a friend who maybe you’ve lost touch with, a friend that that perhaps you’ve ghosted for a while. I mean, you’d imagine if you had a friend and they were calling you and texting you and you never responded, eventually they’re going to be like, well, I’m going to stop spending my energy reaching out. And it’s, it’s the same way with our body and hunger, fullness cues, you know, if you’ve been suppressing your appetite for a long period of time, it’s almost like your body kind of stops sending out those cues, except for in those very extreme situations. So, so really, you know, before trying to tune in and respond, or, quote, unquote, eat, intuitively, meaning eating according to hunger and fullness cues. We want to establish a pattern of eating consistently and adequately throughout the day that looks different for different people. Generally speaking, it means not going much longer than three, four hours without eating. It means, like, you know, trying to get a balance at your meals, so getting some fat, some protein, some carbs. Beyond that, I think that gets into much more individualized kind of territory. But yeah, it’s that that re establishing your relationship with your body by feeding it adequately. It’s really equivalent to just reaching out to the friend that you used to talk to that you want to re-establish that relationship with, and you doing the work to show like, “Hey, I’m going to be there for you.” Yeah. So sort of a silly analogy, but I feel like it helps kind of highlight the importance of not just jumping into listening to your body and assuming that, that it’s gonna that’s gonna be the answer. That’ll be a simple little thing.

[00:22:46] Shireen: Super helpful. Rachael, with that, we are, unfortunately, toward the end of this episode, I would love for our listeners, before we wrap up, I would love for our listeners to know how they can connect with you and just sort of stay in touch and learn more about your work.

[00:23:00] Rachael: Absolutely. So I have a ton of intuitive eating resources on my website. rachaelhartleynutrition.com so that’s a great place to explore the archives and get some more information about Intuitive Eating Health at Every Size. And I have a bunch of articles about things like diabetes and intuitive eating on there that can be helpful. I’m also in terms of social media, I tend to be most active on Instagram, so you can connect with me @RachaelHartleyrd and again, that’s another place that I’d love to share. Share resources.

[00:23:35] Shireen: Super helpful, Rachael. Thank you so very much for your time. I truly, truly appreciate it. Hopefully this was helpful to our listeners today. To our listeners, thank you for tuning in to another episode of the yumlish podcast. Head over to our social media and tell us what you thought about this episode again. Find this podcast post on our social media. We are @yumlish on both Facebook on Instagram, and find this podcast post and comment below to tell us what you thought about this episode, and if there’s something that you will be doing differently going forward in your health with that, Rachael, thank you so very much for your presence on this episode today.

[00:24:08] Rachael: Yes thank you so much again for having me love to have the chance to chat.

[00:24:13] Thank you for listening to the yamlish podcast. Make sure to follow us on social media at yamlish underscore on Instagram and Twitter and at yemlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective. You can also visit our website, yumlish.com for more recipes advice and to get involved with all of the exciting opportunities yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember your health always comes first. Stay well.

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• Website URL: www.rachaelhartleynutrition.com

• Instagram URL: @ RachaelHartleyRD 

• Facebook URL: https://www.facebook.com/rachaelhartleyrd/

• Other promos (books, publications, speeches, etc.) : https://bookshop.org/p/books/gentle-nutrition-a-non-diet-approach-to-healthy-eating-rachael-hartley/14860280