Integrating cognitive behavioural therapy into dietetic practice: a challenge for dietitians

Abstract

Historically, State Registered Dietitians have not received in‐depth training in behaviour change skills. Training in this area has been viewed as peripheral rather than fundamental. Whilst a permanent long‐term cure for obesity remains elusive, cognitive behavioural therapy is state of the art in the treatment of obesity. It reliably achieves 10% pretreatment body weight loss in the short‐term. Interesting new developments are occurring in this field which may affect long‐term outcome favourably. This paper examines what can be achieved with traditional dietary therapy in the treatment of obesity, what can be achieved with cognitive behavioural therapy and considers whether dietitians should receive further training in key behaviour change theory and skills. It is recommended that the integration of the fields of nutrition and behavioural psychology is placed centrally on the agenda of State Registered Dietitians.

A review of one-to-one dietetic obesity management in adults

“…This was echoed in a UK dietetic survey where cognitive behavioural therapy skills were highlighted as requiring further attention (Rapoport, 1998). There have been calls for interpersonal skills to become a central aspect of dietetic practice, (Rapoport, 1998; Isselmann et al. , 1993; Long et al.…”

Cognitive‐behavioural and other psychological techniques in the dietetic consultation: Suggestions for practice

“…It is well established that the provision of advice and information about any health behaviour does not necessarily mean that a person will change that behaviour, and this includes eating and physical activity behaviours . In fact, direct persuasion from an expert in order to improve health or reduce risks to health often results in quite low adherence to advice . As obesity is now a major public health concern, the role of the dietician is paramount .…”

“…Hickman stated that dieticians must embrace BT and lifestyle interventions, and that training should reflect this, including ongoing reflection and up‐skilling in such competencies for existing dieticians. Earlier, Rapoport noted that training in behaviour change skills for dieticians has traditionally been viewed as peripheral, but recommended that behavioural psychology and counselling skills become core components of training. She found that most dieticians think that training in CBT would be useful or very useful and were keen to learn new skills that may benefit their clinical practice.…”

“…Grace also argues that the practitioner's interpersonal skills are central to treatment outcomes, and thus communication training, including learning reflection, the use of open‐ended questioning and paraphrasing, are essential skills for dieticians. The ability to express empathy is also deemed a core skill, given that obesity is often viewed negatively in the general community and also among healthcare professionals, including dieticians . Empathy, which in essence, is the ability to understand a situation from another's point of view and ‘place yourself in the other person's shoes’, and which can be relayed both verbally and non‐verbally, has been shown to be fundamental to desirable clinical practice in dietetics …”

“…Ideally, the dietician will be one specialist in a team of healthcare professionals working with obese patients. Thus, it is not expected, reasonable or appropriate to suggest that dieticians should become pseudopsychologists or CBT therapists . However, the training of dieticians to employ basic psychological intervention skills is one way in which to draw upon the evidence‐based efficacy of such interventions for the treatment of obesity.…”