Intuitive eating and Health at Every Size in community settings: Dietitian's perceptions of practice barriers

Abstract

Intuitive Eating (IE) and Health at Every Size (HAES) are health promotion paradigms used by dietitians in private practice more commonly than in community-based practice where more diverse and vulnerable populations are served. The primary objective of this study was to examine the perceived barriers and facilitators that dietitians encounter when using IE and HAES in community nutrition practice settings. This phenomenological, qualitative study applied a grounded theory analysis to identify emergent themes from transcripts of semi-structured interviews with 27 dietitians working in community settings in the United States. Dietitians reported the following perceived barriers to the use of IE/HAES: diet culture which was often expressed as inconsistent messages patients receive from the media and other professionals that conflict with nutrition providers’ messages; legislative restrictions and weight-centric administrative policies; and personal beliefs of clients and colleagues concerning weight and health. Dietitians reported occupational autonomy as a salient factor facilitating the use of IE/HAES in community practice and identified the need for shifts in attitudes about weight and its relation to health achieved through research and dissemination of information on weight-inclusive practices. Collectively, respondents experienced more systemic barriers than individual barriers and identified several macro-level facilitators that remain elusive. The unique experiences of RDNs in community practice provide a roadmap for ongoing research to establish the evidence base for best practices, inform education and training, and achieve cultural shifts that move towards weight-inclusive practice in this setting. More research is needed to explore the generalizability of these experiences.