Greater Boston Urology Blog

What Happens When You See a Registered Dietitian?

The fear of the unknown can be a contributing factor when people avoid doing things that they know they should do, whether it's (finally) seeing the dentist after going years between visits or making an appointment with a registered dietitian.

Knowledge is power, as the saying goes. So let's slay those fears once and for all, at least when it comes to what you can expect during a visit with a registered dietitian.

To that end, we've invited our registered dietitian, Elle Wittneben, to describe what people can expect when they visit her.

A couple caveats: Not all registered dietitians have the same mindset and counseling style. Below, we share Elle's perspective. Your mileage may vary if you work with another dietitian. (And that's OK!)

Like all articles on the blog, the information below is meant for educational purposes only; it should not be construed as medical advice. Always discuss your specific health needs with your healthcare providers.

What is an initial visit with a registered dietitian like?

Elle believes in treating the whole person, so she does a thorough intake, getting to know the person's history and current lifestyle, such as what's going on in their day-to-day lives. From there, she will ask for a detailed diet recall.

"We'll get into more of the nitty gritty of what do you eat? What do you drink? How much of it do you eat? When do you eat it?" Elle says.

What happens next will very much depend on what brought the person to see Elle in the first place. Not everyone sees a registered dietitian for weight management, for example. (We'll be tackling dietitian myths in a future blog post.) People can see RDs for a wide variety of reasons—from kidney stones to bladder dysfunction, constipation to oncology support . . . to everything in between.

Some patients need specific education—for example, a kidney stone prevention diet. Others might want help losing or gaining weight.

Elle is quick to point out that she doesn't assign random meal plans. She works within the confines of the foods people are already eating—she uses that as the starting point. So, for example, if someone says they have an English muffin with peanut butter for breakfast, she'd work with that, but maybe suggest adding a glass of milk (again, depending on what the person's goals are).

Elle says, "I make little changes to what they're already eating so that it's not quite so overwhelming. This usually leads to successful and sustainable changes, versus trying a whole new cookie-cutter meal plan."

Initial appointments with Elle can last up to an hour. At the end of the first visit, Elle and the patient will create goals for the patient to work on. The goals are in support of the big goal—which is usually related to the main reason the patient sought out Elle in the first place.

In-person vs. telehealth visits—what's the same, how might they differ?

At GBU, Elle offers both in-person visits in our Dedham Care Center or telehealth visits for folks who'd prefer this method. Elle says the visits are essentially the same, whether in-person or online, so it's truly a personal choice.

Do registered dietitians take vitals, like weight and blood pressure? Do they order labs?

Generally, it's not within a dietitian's scope of practice to order labs (with a few exceptions). But RDs welcome having copies of your most recent lab work, like lipid panels. It helps inform that holistic picture of the patient—and also provides important benchmarks, depending on a patient's goals. For example, if the patient is addressing their diet in an effort to lower their cholesterol, it's necessary for the dietitian to know the numbers.

As for weight—which can be a challenging topic, depending on the patient's social history—Elle is incredibly sensitive to patients with past or current eating disorders. On her intake form, she specifically asks about eating disorders so that she can be cautious about how and if to proceed with weight-related questions.

There's also a section on the intake form about weight history, which patients can choose to fill out—or not. She says if a patient skips over that section, it signals to her to be extra mindful in her approach to any discussions around weight. And, again, whether any weight discussion takes place will all depend on what the patient is seeing Elle for.

Knowing a person's weight might not be relevant per se if the patient is seeing her due to kidney stones. However, if the patient is seeing her due to weight loss, a benchmark weight will likely be necessary—but it doesn't have to happen during the first visit, since Elle and the patient are getting to know each other and developing trust.

Elle brings keen understanding and incredible compassion to these topics. She is a board-certified Specialist in Obesity and Weight Management. This is significant since fewer than 25 providers in Massachusetts hold this credential.

What happens during subsequent visits? And how many visits, on average, do patients normally have with RDs?

At subsequent visits, which tend to run 30 minutes or so, Elle and her patient will review the goals that were set at the previous appointment.

"I take very, very detailed notes," Elle says, "more than the average clinician. So during follow-up visits, I have lots of questions to ask them, like 'How are your walks going? Are you getting in 15 minutes daily?' Or 'Are you still able to get that granola bar in any way before work?' And if they're struggling, I learn where they're struggling and then we'll work on adjusting the goal."

As for the average number of visits, that's dictated by what the patient is being seen for. Someone needing purely educational information (for kidney stone prevention, for example) might only need one visit.

For other issues, like lowering cholesterol, she might meet with the patient several times and then do a follow-up after they get their next lipid panel. If things have improved—great! Stay the course. If not, a couple more visits might be in order to understand what's not working and to adjust.

For weight management, Elle says the research will tell you that the more follow-up visits you have with your dietician, the more successful you'll be. Elle explains, "When it comes to weight management, I would recommend at least monthly visit for probably a year." She adds, "The more follow-up, the better, but people don't need to feel like it's a huge commitment. You can get a lot out of one appointment."

Make an appointment with Elle, GBU's registered dietitian.

Both telehealth and in-person appointments are available with our registered dietitian, Elle Wittneben. And you don't need to be a GBU patient to see her. Click here to learn more and to request an appointment.

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