Addressing Weight Control: Are You Asking Your Patients the Right Questions?

Why Do People Eat What they Eat?

When working with patients, dietitians are trained to evaluate the nutrition status of clients, reviewing everything from medical history, to biochemical and anthropometric data, to lifestyle habits and dietary intake. We determine the best diet for individual clients based on this big picture. When it comes to the dietary evaluation, we don’t just ask clients what they eat, we also ask about the timing of meals and snacks, their environment, and even the feelings associated with eating (hunger, mood).

A crucial question that’s often missing in diet evaluation is, “why”. Why do people eat what they eat? Asking this question, with curiosity and without judgement, will provide both you and your patient a lot of valuable information and insight. Of course people should be eating when they are hungry and need fuel, but there are many other reasons people eat, and these behaviors need to be thoughtfully considered.

Sugar’s Role

While mainstream and social media often demonize certain ingredients and focuses on what not to eat, I find it best to focus on what to add to the diet (not what to take away). When healthy foods are added, they generally will displace the less healthy foods.  In addition, it’s also the behaviors surrounding meals that really impact whether a healthy diet and lifestyle can be sustained.

For example, sugar continues to receive headlines, suggesting that health will improve just by focusing on reducing sugar intake. Certainly, this is often not the case. If an individual is using food to treat emotional challenges, a broad approach is required to get them on a healthier path. Emotional eating, binge eating and eating in response to cravings, have all been linked to weight gain, or regain in individuals who have lost weight.

Defining Terms

  • Emotional Eating: Consumption of food in response to emotional arousal
  • Binge Eating: Consumption of large amounts of food at one time, with limited to no control
  • External Eating: Eating in response to external food-related cues (for instance, the sight or smell of food)
  • Food Cravings: Often involves excessive thoughts about craved foods

When these types of eating behaviors are present, it’s important to address them with your patient, helping them find healthier ways to cope with anxiety, stress or the emotional responses to food. If your patient is suffering with some anxiety or depression, he may be self-medicating with sweet foods, as a method to increase serotonin levels. While chronic stress may lead to increased consumption of palatable food, fructose itself does not bring on the craving, nor promote the weight gain. Advising this individual to remove sugar from the diet does not necessarily improve his/her eating behavior. Addressing the root of this problem is your best strategy, before embarking on dietary advice.

Striving for Balance

Tackling emotional eating can be daunting, but helping your patients understand that they will feel better when eating a balanced diet is step one. Offering a simple meal plan, like the one below, can help illustrate intended diet modifications. The goal is to balance carbohydrate, protein, and fat at each meal or snack. While it can be helpful to provide suggestions for modifying meals, listening to a patient describe why they eat can help tailor the meal plans based on the patient’s needs. Assessing cooking ability/interest, need for convenience, cost constraints, and sensorial preferences can be helpful in providing tailored guidance for patients that want to improve their habits.

Breakfast 2 slices of toast with butter and jelly


1 slice of whole grain toast and 1/2 cup low fat cottage cheese with sliced peaches or other mixed fruit 1-2 eggs

1 whole grain English Muffin

Snack candy bar A banana with peanut butter 6 ounce Greek yogurt
Lunch Ham sandwich on white bread with chips and a jumbo cookie Half a sandwich, a cup of vegetable soup, and a side spinach salad Ham sandwich in a whole grain wrap (or bread), an apple, 1 small cookie
Snack potato chips 1-2 ounces hard cheese with 3 crackers 15 almonds
Dinner 8 oz Pork chop, large baked potato, roll with butter, a slice of pie 6 oz Pork chop, 1/2 cup potato, 1 cup broccoli, fresh berries topped with 2 TB whipped cream. 1 cup pasta mixed with chopped chicken and vegetables, plus a tossed salad.

1/2 cup pudding for dessert

Boosting nutrition, in the form of foods such as nuts, vegetables, meats, dairy foods, and grains, will provide the body with the vitamins, minerals, protein and fiber that it needs, thereby reducing cravings. The idea that simply eliminating fructose or other sugars from the diet will cure or prevent obesity is just not supported. You shouldn’t recommend that patients take a “sugar challenge”, or “detox” or eliminate all sugar from the diet. Recommend they balance meals out, and reduce portions of sweets. Reconciling behaviors and planning healthy meals will go a lot farther toward weight management success.


Rosanne RustRosanne Rust MS, RDN, LDN is a registered, licensed dietitian-nutritionist with over 25 years experience. As a Nutrition Communications Consultant  she delivers clear messages helping you understand the science of nutrition so you can enjoy eating for better health. Rosanne is the co-author of several books, including DASH Diet For Dummies® and the The Glycemic Index Cookbook For Dummies®. A wife, and mother of 3 boys, she practices what she preaches, enjoying regular exercise, good food and festive entertaining. Follow her on Twitter @RustNutrition.